Thinking outside the square

I am currently on placement in Shanghai, China working at a children’s rehabilitation centre. I have been working with a 16yo child with quadriplegic cerebral palsy. As she is quite dependent, she tends to be left in her wheelchair off of to the side, poorly positioned. Rarely are her footplates ever down for her feet to go on which leaves her in a slouched and abnormal posture. She is not the only child in the centre that I have observed with poor wheelchair positioning and footplates not in use. With the language barrier it is hard to communicate the purpose behind our treatment. I felt very frustrated and helpless in this situation. Some of the staff are unaware of the consequences poor positioning can have on a weak and hypertonic body. With the help of an OT student who spoke fluent Mandarin to translate, we demonstrated and explained correct wheelchair positioning for this child with additional methods for support. Using what we could find we adjusted the foot plates, applied a hip and chest strap, rolled towels either side of the trunk for support and finally a sandbag in between to assist with the adduction/IR contracture. The rationale was clearly translated and the therapist was appreciative. Every day since, effective positioning has been applied for this child. This child is now more alert in this position and will participate in more activities. This experience really made me aware of the mental/emotional effects good positioning can have on someone's confidence. It just shows what you can achieve with limited resources. It is also now our aim to develop a staff handout informing them of the importance and reason behind correct positioning.