SEPTEMBER 1975 F I S I O T E R A P I E 15 THE PRONE BOARD AND IT’S USE IN T H E T R E A T M E N T OF CEREBRAL PALSY M. V A N D E R V E L D E . B.Sc. W I T S F O R E S T T O W N S C H O O L F O R C . P . C H I L D R E N In th e t r e a t m e n t o f t he c e r e b r a l pals ied child it is d e s i r a b l e for ihe ch il d to be t r e a t e d t h e r a p e u t i c a l l y t h r o u g h o u t the day. T h i s is a c h i e v e d by p e r i o d s o f specific t h e r a p y a n d by correct p o s i t i o n i n g a n d h a n d l i n g a t all o t h e r ti m es , fo r example d u r i n g d r es s in g, e a t i n g , in th e c l a s s r o o m a n d at play. (iv) T h e incl in ed p l a n e s t i m u l a t e s m o r e a c t i v e e x t e n s i o n p a r t i c u l a r l y in hip s, u p p e r t r u n k a n d n e c k a n d hen ce i m p r o v e s he ad a n d t r u n k c o n t r o l a n d h i p e x t e n s i o n for i n d e p e n d e n t s t a n d i n g . (v) It a ls o s t i m u l a t e s m o b i l i ty a n d i m p r o v e s f u n c t i o n of th e s h o u l d e r gi rd le p a r t i c u l a r l y by i n c r e a s i n g t h e incli ne o f th e w o r k i n g su rf ace s. (vi) It e n c o u r a g e s c o - c o n t r a c t i o n p a r t i c u l a r l y r o u n d the h i p a n d t h e r e f o r e i m p r o v e s his sta bil it y. (vii) It s t i m u l a t e s s y m m e t r y wi th e q u a l we ig ht b e a r i n g a n d s o m e we ig h t t r a n s f e r e n c e c a n be b r o u g h t in wi th ac ti vi ti es o f th e u p p e r e x t r e m i ty . (viii) It e n a b l e s t h e seve re ly h a n d i c a p p e d ch i l d t o e x p e r i e n c e (he u p r i g h t p o s i t i o n w h e n he w o u l d o t h e r w i s e n o t be ab l e t o d o so. (ix) W e i g h t b e a r i n g s t i m u l a t e s t he d e v e l o p m e n t o f a well f o r m e d hip j o i n t , p a r t i c u l a r l y th e s h a p e o f t h e a c e t a ­ b u l u m a n d h en ce r e d u c e s th e d a n g e r o f s u b l u x a t i o n . (x) T h e seve re ly h a n d i c a p p e d ch il d w h o sits in a very flexed p o s i t i o n o r is in a lyin g p o s i t i o n f o r t h e g r e a t e r p a r t o f t he d a y , e x p e r i e n c e s a n e n l a r g e m e n t o f his visual hel d. T h e ch il d is s t i m u l a t e d t o be m o r e a w a r e o f it's s u r r o u n d i n g s a n d is e n c o u r a g e d t o i n t e r a c t m o r e re ad il y wit h it as well. T h i s a l s o p la ys a p a r t in a m o r e n o r m a l p e r c e p t u a l d e v e l o p m e n t . (xi) If t h e w o r k i n g s u r f a c e is pl a c e d l ow er t h a n t h e s u p p o r t a l i v e s u r f a c e o n e c a n e n c o u r a g e w ei g h t b e a r i n g o n th e a r m s . (xii) Being s t r a p p e d in gives t h e ch il d a se n se o f s e c u r i t y in th e n e a r u p r i g h t p o s i t i o n in w hi ch he m i g h t o t h e r w i s e feel ver y in secure. Fig. 1 P rone Board, Front View. T he P r o n e B o a rd c a n b e used wit h th e f o l lo w in g a d va nt ag es . (i) W e i g h t is t a k e n t h r o u g h th e legs in a m od ifi ed s t a n d i n g po si t i o n , whil e th e legs a r e well p o s i t i o n e d fo r s t a n d i n g . (ii) T h e p o s i t i o n o f t h e child o n t h e b o a r d is a Reflex I n h i b i t i n g p o s t u r e , i.e. i n h i b i t in g a d d u c t i o n , flexion a n d i n te r na l r o t a t i o n a n d s t i m u l a t i n g e x t e n s i o n with a b d u c t i o n a n d s o m e e x t e r n a l r o t a t i o n o f th e legs. (iii) T h e child w h o n o r m a l l y relies o n his h a n d s f o r s u p p o r t in the s t a n d i n g p o s i t i o n is t h e n a b l e t o free t h e m fo r o t h e r activities. Fig. 2 S pastic Child on P ro n e B o a rd : can only stand in a flexed, supported standing position; sits in wheelchair all day. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) 16 P H Y S I O T H E R A P Y SEPTEMBER, 1975 F ig. 3 S p a s t i c A th e t o i d Chil d on P r o n e B o a r d : c a n n o t s t a n d a l o n e d u e to v a r y in g m u sc le t o n e ; si ts in w h ee l c h a ir all da y. S P E C I F I C E F F E C T S O F T H E P R O N E B O A R D (1) F l e x i o n is i n h i b i t e d a n d e x t e n s i o n is s t i m u l a t e d in t h e p r e d o m i n a n t l y flex or chil d. (2) I n c r e a s e d t o n e is s t i m u l a t e d in t h e h y p o t o n i c ch il d. (3) S t a b i l i ty is i m p r o v e d in t h e d y s k y n e t i c ch il d . (4) P r e - o p e r a t i v e l y t h e ch i l d c a n e x p e r i e n c e t h e u p r i g h t p o s t u r e . (5) C o m m o n p r o b l e m s p o s t o p e r a t i v e l y a r e a s t r o n g w i t h ­ d r a w a l reflex w h i c h in itially t h e c h il d d o e s n o t k n o w h o w t o c o n t r o l a n d f e a r o f i n v o l u n t a r y flex or s p a s m . O n th e p r o n e b o a r d , s t i m u l a t i o n o f e x t e n s i o n a n d w ei gh t b e a r i n g h e l p h i m t o o v e r c o m e th e s e p r o b l e m s . T h e s u p p o r t o f t h e p r o n e b o a r d p r e v e n t s h i m f r o m c o l l a p s in g i n t o flexio n a n d he feels s e c u r e a n d c o n f i d e n t . P O S I T I O N I N G T H E C H I L D (a) T h e ch i l d is laid o n th e p r o n e b o a r d w h i c h is p l a c e d o n t h e floor. T h e p a r t s a r e t h e n a d j u s t e d s o t h a t t h e t r u n k is s u p p o r t e d f r o m j u s t b e l o w th e axill a o n t h e t r u n k s u p p o r t . T h e t r u n k s u p p o r t s h o u l d be a t t h e h i gh es t level. ( b ) T h e k n e e s m u s t lie in t h e m i d d l e o f th e k n e e s u p p o r t . T h e ch i l d m u s t n o t sit o n t h e p o m m e l . (c) T h e heel s m u s t be well a g a i n s t t h e heel g u a r d w i t h t h e l e a t h e r s t r a p h o l d i n g t h t f o o t in p o s i t i o n . (d) T h e s t r a p s a r e f a s t e n e d r o u n d t h e ch il d , o n e a c r o s s the t h o r a x , o n e a c r o s s t h e b u t t o c k s a n d o n e a c r o s s t h e bac k o f th e knee s. T h e m o s t i m p o r t a n t o n e be i n g t h e on e a c r o s s t h e b u t t o c k s . As a p r o g r e s s i o n t h e t h o r a x a n d k n e e s t r a p c a n be left of f a n d as st a b il i t y i m p r o v e s still f u r t h e r t h e b u t t o c k s t r a p c a n be left off. (e) O n c e t h e ch i l d is c o r r e c t ly p o s i t i o n e d , t h e b o a r d is lifted u p t o t h e r e q u i r e d s u p p o r t i n g su r f ac e. T h e ideal hei g ht be in g t h a t h eig ht w h i c h a l l o w s t h e c h il d t o rea ct in the d es i re d w ay , f o r e x a m p l e , t h e ch i l d w h o n ee ds m o r e h e a d c o n t r o l is p l a c e d o n a fl at te r b o a r d , w h e r e a s in the ch i l d w h e r e m o r e e x t e n s i o n a n d w e i g h t b e a r i n g is r e q u i r e d a n d a fe eling o f t h e u p r i g h t p o s i t i o n , th e b o a r d m u s t be p l a c e d at a g r e a t e r a n g l e t o t h e flo or, i.e. m o r e vert ica l. T h e w o r k i n g s u r f a c e s h o u l d be flat a n d wide e n o u g h t o a l l o w t h e ch i l d sufficient s p a c e t o s u p p o r t itself a n d p e r f o r m a n ac ti v it y. O n e c a n p l a c e a tilting w o r k i n g s u r f a c e o v e r t h e t a b l e rest. (f) In t h e c l a s s r o o m t h e t e a c h e r o f t e n pr ef e rs t h e ch i l d to be m o r e p a r t o f t he g r o u p w h il e s t a n d i n g o n t h e p r o n e b o a r d . H e n c e t h e use o f a spe cial tab le , e n a b l i n g t h e . ch i l d t o face i n t o t h e c l a s s r o o m . M A T E R I A L S U S E D I N M A K I N G T H E P R O N E B O A R D (a) T h e t r u n k , k n e e a n d f o o t s u p p o r t s a r e m a d e f r o m a c o m p r e s s e d b o a r d o r R e s o c o r e , t h e t r u n k a n d knee s u p p o r t s be i n g c o v e r e d by 4 c m f o a m a n d d u r o h i d e or d u r o k i t . (b) T h e b as e is c o n s t r u c t e d f r o m s o l i d c o r e c o a t e d w i t h a veneer. (c) T h e p o m m e l a n d h e e l g u a r d s a r e m a d e f r o m piece s of s o l i d c o r e g l u e d t o g e t h e r t o give th e r e q u i r e d thi ckn es s a n d t h e n s h a p e d a c c o r d i n g l y . (d) T h e t w o ce n t r a l pi p es a r e c u t f r o m elec tr ic c o n d u i t s 2 cm in o u t e r d i a m e t e r . (e) T h e c o v e r i n g pip es, w hi ch a r e fixed t o t h e b a c k o f the t r u n k a n d k n e e s u p p o r t s a r e c u t f r o m w a t e r p ip es 3 cm in o u t e r d i a m e t e r . T h e c o v e r i n g p i p e b e l o w t h e fo o tre st is c u t h a l f w a y d o w n i n t o 4 e q u a l p a r t s w h i c h a r e t h e n s p l a y e d o u t w a r d s f o r a t t a c h m e n t t o lo w er s u r f a c e o f the fo o t re s t . (f) T h e o u t e r p ip es a r e fixed t o t h e b a c k o f t h e t r u n k a n d k n e e s u p p o r t by m e a n s o f a s a d d l e a t t a c h m e n t which c a n be e i t h e r b o u g h t o r m a d e . (g) T h e s u p p o r t i n g b a r is m a d e f r o m a 3/4 cm i r o n r o d . T h e a n g l e b e t w e e n this b a r a n d th e c e n t r a l p ip es being d e t e r m i n e d by t h e h e ig h t o f t h e s u p p o r t i n g su r f ac e. (h) 10 m m t hi ck g u a g e wire, a t t a c h e d by n y l o n s t r i n g t o the m o v e a b l e p a r t s a r e u se d as s t o p p e r s t o m a i n t a i n p o s i t i o n o f e a c h m o v e a b l e p a r t . H o l e s a r e dr ill ed t h r o u g h the c e n t r a l pipes. (i) A n o n s l i p r u b b e r m a t is a t t a c h e d t o t h e u n d e r s u r f a c e o f t h e base. (j) T h e c e n t r a l p ip es a r e a t t a c h e d t o t h e b a s e b y m e a n s of a h i n g e w h i c h c o n s i st s o f 2 piece s o f a n g l e i r on 10 cm lo ng , w i t h a 6 c m s p a c e r , fixed w it h a 3/ 4 c m bol t. (k) T h e s t r a p s us ed t o h o l d th e c h il d on th e p r o n e b o a r d ca n b e m a d e f r o m l e a t h e r o r w e b b i n g , th e l a t t e r be i n g m o r e flexible. T h e l e a t h e r s t r a p s a r e fixed w i t h a b u c k l e , the w e b b i n g w it h velc ro . T h e b u t t o c k s t r a p is 10 c m wide whil e t h e t h o r a c i c a n d k n e e s t r a p s a r e 5 c m wide. L e a t h e r s t r a p s a r e us ed t o h o l d t h e feet in place. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. ) SEPTEMBER 1975 F I S I O T E R A P I E 17 Trunk Support (,See Table f o r m easurem ents) Fig. 4 P ro n e B oard, F ro n t View. TABLE O F M E A S U R E M E N T S Pari B by M edium T runk S u p p o rt a 21 22 b 30 40 c 29 34 Knee S u p p o rt d 20 20 e 35 35 Pommel f 13 13 g 10 10 h 10 10 Voot R est i 23 23 j 36 36 Ankle G u a rd k 8 8 1 10 10 m 12 12 Base n 23 23 o 31 35 Total L ength P 100 130 Supporting B a r q 31 31 Covering P ipes (i) T ru n k r 14 38 (ii) K n e e s 19 19 Width B etw een B ars t 6 6 Distance B etw een H oles u 3 4 W idth o f S addle A tta c h m e n t V 2 M y th a n k s a n d a p p re c ia tio n go to m y colleagues in a ssistin g m e in w ritin g th is a rtic le a n d to M r. de M eyer w ho m a d e a n d a d a p te d th e p ro n e b o a rd s to o u r specifications a n d specific re q u ire m e n ts. S U M M A R Y T h e P ro n e B o a rd is a piece o f a p p a ra tu s o n w hich a ch ild c a n b e se c u re d in a c o rre c te d sta n d in g p o sitio n w hen this w o u ld o th erw ise n o t be possible o r o nly w ith g re a t difficulty f o r th a t p a rtic u la r child. I t c a n be u se d in c o n ju n c tio n w ith th e ra p y in C e reb ra l P alsy, fo r e x am p le in th e c la ssro o m . I t c a n play a p a rt in th e th e ra p y o f o th e r N e u ro lo g ic a l c o n d itio n s w here s ta n d in g is d esirable. T h e P ro n e B o a rd is easily c o n stru c te d , th e p a rts being re ad ily o b ta in a b le a n d c o stin g a p p ro x im a te ly R 25.00 a n d re q u irin g 10-12 h o u rs to c o n stru c t. O P S O M M I N G D ie “ P ro n e B o a rd ” is ’n s tu k a p p a r a a t w a a ro p ’n k in d v a sg e m a ak k a n w o rd in ’n g e k o rre g e u rd e s ta a n posissie w a a r to e hy n o rm a l weg nie in s ta a t so u wees nie. D i t k a n g e b ru ik w o rd as ’n b y k o m stig e tera p eu tiese b e h an d e lin g , by v o o rb e eld in d ie k la sk a m e r. D it k a n o o k g e b ru ik w o rd in die b e h a n d e lin g v a n a n d e re N e urologiese to e s ta n d e w a a r die p a sien t nie d a a r to e in sta a t is om s o n d e r h u lp te s ta a n nie. D ie dele v ir so ’n “ P ro n e B o a r d ” is m ak lik b e k o m b a a r tee n ’n k o ste v a n o m tre n t R 25 e n n eem 10-12 u re o m a a n m e k a a r te sit. R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )