Aids for Positioning, Mobility, and Communication
Neuromotor or musculoskeletal impairments - such as muscle contractures, skeletal deformities, and inadequate balance and control of muscle groups - prevent many children with disabilities from taking part in the same activities as their peers. As part of the intervention team, you may recommend AT in such areas as positioning, mobility, and communication to help overcome the limitations these impairments can cause. With appropriate selection, acquisition, customization, and implementation of AT devices, you help ensure that children receive - and can effectively use - the technology they need in all environments.

Positioning Systems: Critical for Many Children with Disabilities
Positioning systems are among the most important ways you can help children with disabilities function, move, and participate within their environments. These systems help improve:

• head position and control
• the ability to breathe, eat,and digest food
• postural alignment
• listening and communication skills.

Two basic categories of positioning systems are available:

1. Recumbent systems provide support in supine, prone, or sidelying positions. Children with severe physical disabilities frequently use devices such as wedges, bolsters, mats, and sidelyers as a means of alternative positioning throughout the day.  When recommending positioning alternatives, you should consider the movement demands of the tasks the child needs to perform from that position and also the effect that such positions have on adult and peer interaction.
2. Upright systems support the child in either seated or standing positions. They include:
• Seating systems for children who use wheelchairs for mobility
• Seating supports to improve posture in class for children with developmental coordination disorders
• Standing systems for children who can't stand independently, allowing them access to work surfaces such as sinks and cabinets.

Zeroing in on Your Role
Your key objective in positioning intervention is to determine the position in which the child has the most control with the least amount of support or restriction. To establish the level of support a child needs in a seating system, for example, first perform a physical examination to determine whether the child's postural changes are flexible or fixed. Flexible deformities can be corrected with proper supports; fixed deformities can't be eliminated. The goal of providing supports that accommodate existing deformities is to prevent further progression while providing a comfortable and functional position for the child.

Implementing 10 Types of AT for Children with Disabilities
Along with AT for positioning, a vast array of AT devices and services are available to help eliminate functional limitations of the children you treat. The Rehabilitation Engineering and Assistive Technology Society of North America has identified the following 10 categories of AT for children in educational environments:

1. Positioning
2. Mobility
3. Augmentative communication
4. Access
5. Computer-based instruction
6. Environmental control
7. Activities of daily living
8. Recreation/leisure/play
9. Vision technology
10. Assistive listening.

Federal Laws Help
Many laws in the United States help ensure that children have access to the AT they need. For example, the Individuals with Disabilities Education Act, is a federal law that ensures special education and related services for children with disabilities from birth through high school graduation. Amendments to this special education law continue to mandate what school districts must do if a student with disabilities needs AT:

• Evaluate the child's AT needs.
• Obtain the necessary AT.
• Coordinate AT use with other therapies and interventions.
• Provide training in the effective use of the AT for the child, his family, and the school staff.

You'll work closely with the child's family, school staff, and other team members to achieve these goals. Along with evaluating the child's AT needs, you may also be responsible for completing the necessary paperwork for funding, training the child to use AT, and providing follow-up and support to ensure that the AT meets the child's needs as they change.

Challenges and Rewards
Advances in technology have greatly increased the number and quality of AT devices and services available to children with disabilities. And access to AT is improving, thanks in large part to federal legislative support. As a result, helping children get appropriate AT and use it effectively is both challenging and rewarding. With the help of AT, children with disabilities are graduating from high school, completing college, and confidently looking forward to living and working independently.

To Learn More
DavisPTnetwork offers a variety of online continuing-education courses for PTs. This article is based upon content written by Maria Jones, PT, PhD, ATP, originally published in Meeting the Physical Therapy Needs of Children, by Susan Effgen, PT, PhD. It is also based on course materials written by Dr. Effgen. To learn more about AT, access this online continuing-education course on the DavisPTnetwork:

Mobility and Assistive Technology for Pediatric Patients