The benefits of assistive technology for those with cerebral palsy

It is imperative in any clinical negligence claim concerning a child or adult who has suffered a brain injury to instruct experts in assistive technology and occupational therapy. Such independent experts advise on what equipment will be suitable for the individual in order to seek to overcome some of the restrictions caused by their injuries and to enable greater independence, interaction and enjoyment of life.

Assistive technology (AT) can range from communication aids to powered wheelchairs to aids to assist around the house, and with new technologies being developed all of the time this is a growing area.

A study from 2007 [1] noted: “People with profound cognitive disabilities have profound limitations in the development of self-identity and in the ability to react, act and interact with their environment. To find a stimulating and age appropriate activity that can unveil their potential capacity represents a great challenge to persons living close to these people.”

How is the need for assistive technology assessed?

The degree and nature of brain injury which affects children diagnosed with cerebral palsy can vary greatly; for those with severe injuries affecting them both cognitively and physically the ability to interact and communicate with the world around them is extremely curtailed. Some children and young adults with cerebral palsy are unable to move independently or speak; the ability to interact and express wishes can be so limited that even the smallest opportunities which enable autonomy and fun should be grasped and encouraged. This is where AT can really assist, particularly as it is always developing.

When pursuing a clinical negligence claim, where it is alleged that the brain injury was caused as a result of failings in medical care usually around the time of birth, the first step is to establish whether the hospital or clinician is liable for the injuries suffered. If this is admitted then the next step will be to quantify the case. This will involve a large number of experts. Assistive technology needs and recommendations will be dealt with by an Assistive Technology expert and for items such as powered wheelchairs we will seek the guidance and recommendation of an Occupational Therapy expert.

The AT expert will look at various technology aids, such examples are:

• Eye gaze technology – where the individual uses their eyes to perform certain actions, including to achieve independent communication;
• Environmental controls in the home – to enable the individual to independent perform tasks such as turning lights on and off and opening curtains and doors, instead of having to rely on others to do this;
• Ipad technology and specialist apps;
• A “Soundbeam” system, which helps when there is visual impairment; it provides fun by giving audio feedback to physical movement;
• Multi sensory equipment involving sound, light and vibration;
• A Big Mack to enable communication by hitting a button that produces a spoken pre recorded phrase, this helps with learning ’cause and effect’.

The use and benefits of powered wheelchairs

The OT expert will always seek to promote as much independence as possible for the Claimant who is reliant on a wheelchair for mobility, particularly if they are unable to mobilise at all and are wholly reliant on wheelchair use. The use of a powered wheelchair which the Claimant can control themselves (even if it is only in a limited way to move the direction of the chair) can be a powerful tool in enabling the individual to facilitate their wishes (for example the direction they wish to face), again instead of having to always rely on others.

We work with very specialist OT experts in cases for our clients, and they advise that it is important that children are exposed to opportunities to trial and use such equipment as early as possible to achieve the greatest benefits, and this was also support in a recent study.

A 2016 study [2] concluded that: “The majority of children with CP, aged 0-11 years did not self propel manual wheelchairs regardless of age, gross motor function, range of motion or manual abilities. Power mobility should be considered at earlier ages to promote independent mobility for all children with CP who require a wheelchair especially outdoors.”

Our experience

The costs of this specialist equipment is sought as part of the claim as it is rarely provided for by NHS or educational services or if they are they may not be tailored to the specific requirements of the individual. The costs claimed will include the capital costs of purchasing equipment and regular replacements for as long as these are needed, together with annual costs of maintenance, insurance etc.

A huge difference can be made to the lives of those who have cerebral palsy if they are provided with bespoke assistive technology to enable them to express their views and wishes, something the able bodied will take for granted, and I have seen these benefits with my clients. For a young child with severe CP it can be empowering to be able to burst a visual balloon by the use of eye gaze technology, for they cannot control anything else in their lives.

I hope that with continued research the technology available can only improve and in the meantime we will seek to obtain the best products available for our clients so that they can engaged with the world around them, however small that level of engagement may be seen to be.

[1] Driving to learn: the Process of growing Conscious of Tool use – a grounded theory of de-plateauing; Lisbeth Nilsoon: Lund University Sweden: 2007

[2] Physical risk factors influencing wheeled mobility in children with cerebral palsy: a cross-sectional study. BMC Pediatr. 2016 Oct 10;16(1):165 Rodby-Bousquet E et al