The efficacy of appropriate paper-based technology for Kenyan children with cerebral palsy.

PURPOSE: Appropriate paper-based technology (APT) is used to provide postural support for children with cerebral palsy (CP) in low-resourced settings. This pilot study aimed to evaluate the impact of APT on the children's and families' lives. MATERIALS AND METHODS: A convenience sample of children with CP and their families participated. Inclusion was based on the Gross Motor Function Classification System levels IV and V. APT seating or standing frames were provided for six months. A mixed methods impact of APT devices on the children and families included the Family Impact Assistive Technology Scale for Adaptive Seating (FIATS-AS); the Child Engagement in Daily Life (CEDL) questionnaire; and a qualitative assessment from diary/log and semi-structured interviews. RESULTS: Ten children (median 3 years, range 9 months to 7 years). Baseline to follow-up median (IQR) FIATS-AS were: 22.7 (9.3) and 30.3 (10.2), respectively (p=.002). Similarly mean (SD) CEDL scores for "frequency" changed from 30.5 (13.2) to 42.08 (5.96) (p=.021) and children's enjoyment scores from 2.23 (0.93) to 2.91 (0.79) (p=.019). CEDL questionnaire for self-care was not discriminatory; seven families scored zero at both baseline and 6 months. Qualitative interviews revealed three key findings; that APT improved functional ability, involvement/interaction in daily-life situations, and a reduced family burden of care. CONCLUSIONS: APT devices used in Kenyan children with non-ambulant CP had a meaningful positive effect on both the children's and their families' lives.Implications for rehabilitationAssistive devices are often unobtainable for children with cerebral palsy (CP) in low-income countries.APT is a low cost and sustainable solution to make seating and standing devices for disabled children in Kenya.The regular use of a postural support device enhanced the children's motor skills, ability to function and participate in everyday activities, reduced the burden of care for the families and promoted the children's social interaction.The postural support devices were highly valued and utilised by the children and families in this study.

Thinking outside the cardboard box: insights from a course to train rural Kenyans to make postural support devices from appropriate paper-based technology (APT) for children with cerebral palsy.

Purpose: Suitable assistive devices for children with cerebral palsy (CP) in low-income countries are often unavailable. Devices made from APT are in use in several countries but are unevaluated.Materials and methods: A 2-week training course focused on APT principles, measuring children and constructing postural support devices. Twenty-three Kenyans attended the course. The host organization identified four local children with CP who attended for assessment and measurement. Participants made the devices and children returned for fitting and necessary adjustment. Completion of post-course forms, action plans, visits after 14 months and contact 3 years later comprised the evaluation.Results: All participants found the course beneficial and valued the networking opportunity provided. They appreciated the practicality and utility of locally manufactured cost effective devices. The trainees planned further implementation to provide assistive devices for children with CP in their localities. Follow-up visits revealed several challenges to local ongoing production.Conclusions: Training people in low-income communities to make bespoke assistive devices for children with CP is straightforward, and the course was positively evaluated. However, maintaining device production is limited without local group support and stable leadership, ideally as part of an existing programme.Implications for rehabilitationAssistive devices are often unobtainable for children with cerebral palsy (CP) in low-income countries.APT is a cost effective way of fulfilling this need and it is relatively straightforward to train people who care for or work with those with CP to make devices using APT.Feedback from APT training suggests participants find the technique a practical way of producing assistive equipment for individuals with CP in their community.Maintaining device production requires support, leadership and increased public awareness of the use of APT at a local level.