S U G G E S T I O N S
F R O M
T H E
F I E L D
Reinventing the Adjustable Bench for Community-Based Research and Practice Barbara Stoskopf, RN, MHSc; Daniel Fedrock; Doreen Bartlett, PT, PhD CanChild Centre for Childhood Disability Research (Ms Stoskopf), McMaster University, Hamilton, Ontario, Canada; Prosthetics and Orthotics Department (Mr Fedrock), Hamilton Health Sciences, Hamilton, Ontario, Canada; School of Physical Therapy (Dr Bartlett), Western University, London, Ontario, Canada.
INTRODUCTION For reasons of economy in effort and cost, the 60 equipment kits for the multisite, North American study about Movement and Participation in Life Activities of Young Children with Cerebral Palsy (Move & PLAY Study)1 were bought and assembled in Canada at CanChild Centre for Childhood Disability Research at McMaster University and then shipped to all the participating centers. This allowed us to produce completely standard kits and save on time and expense. The most expensive item in the kit was an adjustable bench to use when administering some items of the Gross Motor Function Measure,2 the Pediatric Balance Scale,3 and the Spinal Alignment and Range of Motion Measure4 that required the preschool-aged children in the study to sit with hips and knees flexed to 90◦ and feet flat on the floor. THE PROBLEM Adjustable benches available on the market tend to be heavy, bulky, expensive, and difficult to transport. 0898-5669/110/2602-0274 Pediatric Physical Therapy C 2014 Wolters Kluwer Health | Lippincott Williams & Copyright Wilkins and Section on Pediatrics of the American Physical Therapy Association
Correspondence: Doreen Bartlett, PT, PhD, School of Physical Therapy, 1588 Elborn College, Western University, London, Ontario Canada N6G 1H1 ([email protected]). The institutions of Ms Stoskopf and Mr Fedrock received financial support through the grants described below for their roles in coordinating the study and in designing and constructing the adjustable stools, respectively. No conflicts are declared for Doreen Bartlett. Grant Support: The study for which the adjustable stools were required was funded by the Canadian Institutes of Health Research (MOP 81107) and the US Department of Education, National Institute for Disability and Rehabilitation Research (H133G060254). DOI: 10.1097/PEP.0000000000000024
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Stoskopf et al
Several sizes are usually needed to accommodate a range of children’s heights. For this study, we needed one that would adjust to the multiple leg lengths of children aged 18 months to 5 years and also accommodate the weight range of this age group. Our study therapists needed a kit bag that would contain all the required assessment equipment and be easily transported to clinics and homes. We found a sturdy and inexpensive rolling duffle bag, which would accommodate all of the testing materials; however, the available adjustable benches were too heavy and bulky for this bag. OUR SOLUTION With the assistance of staff in the Prosthetics and Orthotics Department at the local children’s rehabilitation center, we designed and assembled an inexpensive, compact, strong stool that adjusts (in 1- to 2-in increments) from a height of 61/2 to 123/4 in. It weighs only 2 lb, has a wide, nonskid base, supports up to 800 lb, and requires only 14 × 10 × 7 in of storage space. Three Ethafoam blocks provide the incremental layers needed to add extra height and are stored inside the stool itself, in addition to a 1-in “cap.” MATERIALS NEEDED
r Nuby “step up” stool (Nuby Inc., Monroe, Louisiana)
This child-sized plastic stool is available at many retailers (eg, Babys R Us and Amazon). This stool is highly recommended, as it is very strong and stable due to its construction. Approximate cost at the time of writing is Can$25.
r Ethafoam (Engineered Foam Products Canada, Toronto, Ontario, Canada) Ethafoam is a strong, resilient, medium-density, closedcell, polyethylene foam, easy to cut and commonly used Pediatric Physical Therapy
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
by orthotists for seating products. Four pieces of foam are needed; three 1-in deep pieces and one 2-in deep piece. We used the color black to resist staining.
r Vinyl, black, to cover the stool seat r Velcro, black, 1- and 2-in wide r Contact cement BARGE brand is recommended for the strongest bond. This is used for attaching Velcro. SPECIAL EQUIPMENT NEEDED
r Sewing machine for vinyl covers (usually available in orthotic departments)
ASSEMBLY One of the skilled and experienced seating clinicians from the Prosthetics and Orthotics Department of Hamilton Health Sciences (second author) provided the expertise to construct these stools. He took the basic idea presented to him and translated it into a workable design. He advised us that any orthotic department should be able to produce the stool. Therapists with appropriate skills and access to necessary equipment will also be able to assemble the stool. The total cost for materials and labor was approximately Can$100 per stool. Time required for 1 stool is about 1 hour, and it is more efficient to produce several at a time.
This foam piece is attached to the vinyl top of the stool. This creates a comfortable seat about 71/2-in high (Figure 2). 3. When the stool is upside down, there is a cavity, which is used to store the 3 remaining foam layers (Figure 3). This maintains the compact size of the original stool. When the top of the stool is removed, small strips of 1-in Velcro are looped through the spaces of the crisscrossed framework from the inside to provide an attachment place for the foam layers. 4. The 3 pieces of foam are cut and shaped to fit inside the stool. Velcro strips (loop side on the top and hook side on the bottom hold them in place. 5. These additional pieces can be added, 1 at a time, or in combinations, on top of the stool. Each piece adheres to the next one, using the Velcro strips. This adjusts the stool for the height required by individual children (Figure 4).
1. The top of the stool is removed by undoing the small screws underneath. It is then slipped into a vinyl pocket with 2 strips of 2-in wide Velcro loop sewn to the top of the vinyl. The pocket is then stitched shut. The top is screwed back in place (Figure 1). This gives a strong base for attaching the additional pieces of Ethafoam, as needed. 2. One 1-in deep piece of Ethafoam is also upholstered in vinyl with strips of the 2-in wide hook Velcro sewn to the bottom of the vinyl (ie, opposite side of Velcro from that used for the stool top).
Fig. 2. Bench with 1-in upholstered padded foam layer applied to the top as a seat.
Fig. 1. Bench top enclosed in vinyl envelope with Velcro attachments in place.
Fig. 3. Storage area under the bench for additional 1-in foam layers.
Pediatric Physical Therapy
An Adjustable Bench for Research and Practice
275
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
the child with safe and comfortable seating adjusted to his or her size, during routine physical therapy examinations. It is easy to adjust, very light and portable, safe, easy to clean with mild soap and water, and well accepted by children and parents. Therapists also found it useful to sit on, while holding small children during physical assessments. In addition, some parents were pleased to see their children sit independently without back support for the first time! CONCLUSION
Fig. 4. Bench with additional foam layers inserted to raise seat height.
SAFETY CONCERNS Caution should be used when assembling the stool for use, to be sure that all foam pieces are firmly attached to each other and to the top of the stool. Once the pieces are assembled to achieve the height required, test the stool to be sure that the pieces remain firmly attached. Also, integrity of the Velcro strip bond to the Ethafoam should be tested over time; it can dry out and might need to be redone. Over the course of 2 physical examination sessions of 430 children (with 90% retention at the second session) no safety concerns were expressed. CLINICAL UTILITY This lightweight adjustable stool is useful for both researchers and clinicians when using standardized measures that require a seated position with hips and knees flexed at 90◦ and feet flat on the floor. The stool provides
276
Stoskopf et al
In our experience, this adjustable stool is convenient, affordable, and easy to produce. We had much positive feedback from the study therapists who continue to use the stools in their clinical settings. Subsequently, we have had additional stools made for a next study to monitor early development of children with cerebral palsy. We hope these instructions are clear and adequate, but please feel free to contact us for further information. The Move & PLAY Study Team contact information is located on our Webpage at http://www.canchild.ca/en/ourresearch/moveplay. asp. Please contact Dan Fedrock at [email protected] with specific questions about stool construction. REFERENCES 1. Bartlett DJ, Chiarello LA, McCoy SW, et al. The Move & PLAY study: an example of comprehensive rehabilitation outcomes research. Phys Ther. 2010;90:1660-1672. 2. Russell DJ, Rosenbaum PL, Avery LM, Lane M. Gross Motor Function Measure (GMFM-66 & GMFM-88) User’s Manual. London, England: Mac Keith Press; 2002. 3. Franjoine MR, Gunther JS, Taylor MJ. The pediatric balance scale: a modified version of the Berg Scale for children with mild to moderate motor impairment. Pediatr Phys Ther. 1999;11:216. 4. Bartlett DJ, Purdie B. Testing of the spinal alignment and range of motion measure: a discriminative measure of posture and flexibility for children with cerebral palsy. Dev Med Child Neurol. 2005;47:739743.
Pediatric Physical Therapy
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
F R O M
T H E
F I E L D
Reinventing the Adjustable Bench for Community-Based Research and Practice Barbara Stoskopf, RN, MHSc; Daniel Fedrock; Doreen Bartlett, PT, PhD CanChild Centre for Childhood Disability Research (Ms Stoskopf), McMaster University, Hamilton, Ontario, Canada; Prosthetics and Orthotics Department (Mr Fedrock), Hamilton Health Sciences, Hamilton, Ontario, Canada; School of Physical Therapy (Dr Bartlett), Western University, London, Ontario, Canada.
INTRODUCTION For reasons of economy in effort and cost, the 60 equipment kits for the multisite, North American study about Movement and Participation in Life Activities of Young Children with Cerebral Palsy (Move & PLAY Study)1 were bought and assembled in Canada at CanChild Centre for Childhood Disability Research at McMaster University and then shipped to all the participating centers. This allowed us to produce completely standard kits and save on time and expense. The most expensive item in the kit was an adjustable bench to use when administering some items of the Gross Motor Function Measure,2 the Pediatric Balance Scale,3 and the Spinal Alignment and Range of Motion Measure4 that required the preschool-aged children in the study to sit with hips and knees flexed to 90◦ and feet flat on the floor. THE PROBLEM Adjustable benches available on the market tend to be heavy, bulky, expensive, and difficult to transport. 0898-5669/110/2602-0274 Pediatric Physical Therapy C 2014 Wolters Kluwer Health | Lippincott Williams & Copyright Wilkins and Section on Pediatrics of the American Physical Therapy Association
Correspondence: Doreen Bartlett, PT, PhD, School of Physical Therapy, 1588 Elborn College, Western University, London, Ontario Canada N6G 1H1 ([email protected]). The institutions of Ms Stoskopf and Mr Fedrock received financial support through the grants described below for their roles in coordinating the study and in designing and constructing the adjustable stools, respectively. No conflicts are declared for Doreen Bartlett. Grant Support: The study for which the adjustable stools were required was funded by the Canadian Institutes of Health Research (MOP 81107) and the US Department of Education, National Institute for Disability and Rehabilitation Research (H133G060254). DOI: 10.1097/PEP.0000000000000024
274
Stoskopf et al
Several sizes are usually needed to accommodate a range of children’s heights. For this study, we needed one that would adjust to the multiple leg lengths of children aged 18 months to 5 years and also accommodate the weight range of this age group. Our study therapists needed a kit bag that would contain all the required assessment equipment and be easily transported to clinics and homes. We found a sturdy and inexpensive rolling duffle bag, which would accommodate all of the testing materials; however, the available adjustable benches were too heavy and bulky for this bag. OUR SOLUTION With the assistance of staff in the Prosthetics and Orthotics Department at the local children’s rehabilitation center, we designed and assembled an inexpensive, compact, strong stool that adjusts (in 1- to 2-in increments) from a height of 61/2 to 123/4 in. It weighs only 2 lb, has a wide, nonskid base, supports up to 800 lb, and requires only 14 × 10 × 7 in of storage space. Three Ethafoam blocks provide the incremental layers needed to add extra height and are stored inside the stool itself, in addition to a 1-in “cap.” MATERIALS NEEDED
r Nuby “step up” stool (Nuby Inc., Monroe, Louisiana)
This child-sized plastic stool is available at many retailers (eg, Babys R Us and Amazon). This stool is highly recommended, as it is very strong and stable due to its construction. Approximate cost at the time of writing is Can$25.
r Ethafoam (Engineered Foam Products Canada, Toronto, Ontario, Canada) Ethafoam is a strong, resilient, medium-density, closedcell, polyethylene foam, easy to cut and commonly used Pediatric Physical Therapy
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
by orthotists for seating products. Four pieces of foam are needed; three 1-in deep pieces and one 2-in deep piece. We used the color black to resist staining.
r Vinyl, black, to cover the stool seat r Velcro, black, 1- and 2-in wide r Contact cement BARGE brand is recommended for the strongest bond. This is used for attaching Velcro. SPECIAL EQUIPMENT NEEDED
r Sewing machine for vinyl covers (usually available in orthotic departments)
ASSEMBLY One of the skilled and experienced seating clinicians from the Prosthetics and Orthotics Department of Hamilton Health Sciences (second author) provided the expertise to construct these stools. He took the basic idea presented to him and translated it into a workable design. He advised us that any orthotic department should be able to produce the stool. Therapists with appropriate skills and access to necessary equipment will also be able to assemble the stool. The total cost for materials and labor was approximately Can$100 per stool. Time required for 1 stool is about 1 hour, and it is more efficient to produce several at a time.
This foam piece is attached to the vinyl top of the stool. This creates a comfortable seat about 71/2-in high (Figure 2). 3. When the stool is upside down, there is a cavity, which is used to store the 3 remaining foam layers (Figure 3). This maintains the compact size of the original stool. When the top of the stool is removed, small strips of 1-in Velcro are looped through the spaces of the crisscrossed framework from the inside to provide an attachment place for the foam layers. 4. The 3 pieces of foam are cut and shaped to fit inside the stool. Velcro strips (loop side on the top and hook side on the bottom hold them in place. 5. These additional pieces can be added, 1 at a time, or in combinations, on top of the stool. Each piece adheres to the next one, using the Velcro strips. This adjusts the stool for the height required by individual children (Figure 4).
1. The top of the stool is removed by undoing the small screws underneath. It is then slipped into a vinyl pocket with 2 strips of 2-in wide Velcro loop sewn to the top of the vinyl. The pocket is then stitched shut. The top is screwed back in place (Figure 1). This gives a strong base for attaching the additional pieces of Ethafoam, as needed. 2. One 1-in deep piece of Ethafoam is also upholstered in vinyl with strips of the 2-in wide hook Velcro sewn to the bottom of the vinyl (ie, opposite side of Velcro from that used for the stool top).
Fig. 2. Bench with 1-in upholstered padded foam layer applied to the top as a seat.
Fig. 1. Bench top enclosed in vinyl envelope with Velcro attachments in place.
Fig. 3. Storage area under the bench for additional 1-in foam layers.
Pediatric Physical Therapy
An Adjustable Bench for Research and Practice
275
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
the child with safe and comfortable seating adjusted to his or her size, during routine physical therapy examinations. It is easy to adjust, very light and portable, safe, easy to clean with mild soap and water, and well accepted by children and parents. Therapists also found it useful to sit on, while holding small children during physical assessments. In addition, some parents were pleased to see their children sit independently without back support for the first time! CONCLUSION
Fig. 4. Bench with additional foam layers inserted to raise seat height.
SAFETY CONCERNS Caution should be used when assembling the stool for use, to be sure that all foam pieces are firmly attached to each other and to the top of the stool. Once the pieces are assembled to achieve the height required, test the stool to be sure that the pieces remain firmly attached. Also, integrity of the Velcro strip bond to the Ethafoam should be tested over time; it can dry out and might need to be redone. Over the course of 2 physical examination sessions of 430 children (with 90% retention at the second session) no safety concerns were expressed. CLINICAL UTILITY This lightweight adjustable stool is useful for both researchers and clinicians when using standardized measures that require a seated position with hips and knees flexed at 90◦ and feet flat on the floor. The stool provides
276
Stoskopf et al
In our experience, this adjustable stool is convenient, affordable, and easy to produce. We had much positive feedback from the study therapists who continue to use the stools in their clinical settings. Subsequently, we have had additional stools made for a next study to monitor early development of children with cerebral palsy. We hope these instructions are clear and adequate, but please feel free to contact us for further information. The Move & PLAY Study Team contact information is located on our Webpage at http://www.canchild.ca/en/ourresearch/moveplay. asp. Please contact Dan Fedrock at [email protected] with specific questions about stool construction. REFERENCES 1. Bartlett DJ, Chiarello LA, McCoy SW, et al. The Move & PLAY study: an example of comprehensive rehabilitation outcomes research. Phys Ther. 2010;90:1660-1672. 2. Russell DJ, Rosenbaum PL, Avery LM, Lane M. Gross Motor Function Measure (GMFM-66 & GMFM-88) User’s Manual. London, England: Mac Keith Press; 2002. 3. Franjoine MR, Gunther JS, Taylor MJ. The pediatric balance scale: a modified version of the Berg Scale for children with mild to moderate motor impairment. Pediatr Phys Ther. 1999;11:216. 4. Bartlett DJ, Purdie B. Testing of the spinal alignment and range of motion measure: a discriminative measure of posture and flexibility for children with cerebral palsy. Dev Med Child Neurol. 2005;47:739743.
Pediatric Physical Therapy
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins and the Section on Pediatrics of the American Physical Therapy Association. Unauthorized reproduction of this article is prohibited.
