Cerebral Palsy and Assistive Technology in the NDIS

Cerebral Palsy - What is involved?

A diagnosis of Cerebral Palsy may result in minor muscle stiffness or spasticity. With these symptoms, you may be able to perform day to day activities with little to no difficulty.

On the other hand, cerebral palsy may result in a more severe level of impairment. This is referred to in the NDIS as high support needs.

Cerebral Palsy and High Physical Support Needs

High physical support needs involve a high level of person-to-person support and the use of assistive technology. 

Person-to-person support may involve one person or two people helping you with the various routines that make up your day, including showering, eating, drinking, toileting, etc.

These tasks typically involve manual handling, where you may require assistance to transfer or reposition. 

Manual handling involves the practice of safe movements and lifting to reduce the risk of injury to the participant and support workers involved. In this case, using assistive technology may be necessary. This is to keep you and your support workers or carers safe.

Due to cognitive impairment that may be associated with your cerebral palsy diagnosis, it may not be safe to operate assistive technology independently. In most cases, assistance is needed to operate devices to ensure your safety and the safety of others.

What Assistive Technology Will Help Participants with Cerebral Palsy?

There is a wide range of assistive technology that can support NDIS Participants with cerebral palsy.

A common question our NDIS Navigators get is "What assistive technology can I use my NDIS funds for to help with cerebral palsy?"

We asked our resident OT to tell us what type of equipment she regularly prescribes to assist NDIS Participants with cerebral palsy.

Here are the main assistive technology solutions she mentioned:

• ​Mobility Devices such as a wheelchair
• Transfer Assistive Technology such as hoists and slings
• Bedroom Assistive Technology such as adjustable beds and pressure mattresses
• Bathroom Assistive Technology such as shower commodes and toilet equipment
• Living and Dining Assistive Technology such as seating and special trays
• Kitchen Assistive Technology such as tools to help you cut and prepare food
• Communication Assistive Technology such as the use of ipads or tablets with communication applications
• Hearing Devices such as hearing aids
• Assistive Technology for Children during Early Intervention including therapy aids.

Mobility Devices to Support NDIS Participants with Cerebral Palsy

Manual and Powered Wheelchairs

A manual wheelchair involves a seat and backrest attached to a frame with two large wheels with push-rims. Either the user self-propels the wheelchair, or it is attendant propelled via handlebars positioned at the rear of the backrest.

It can be difficult to accommodate seating and positioning needs for someone with a cerebral palsy in a manual wheelchair.

A powered wheelchair involves a base with motorised wheels that are controlled by a joystick. Attached to the base include a cushion, backrest, armrests and any other postural supports required.

A powered wheelchair offers a high level of customisation for seating and postural supports. This is often necessary for individuals with an cerebral palsy with significant impact to their functional capacity.

To operate a powered wheelchair, the joystick can be placed at the front of the armrests for the user to operate, or at the top of the backrest for carers to operate (or both). Carer operation may be necessary if you also have an intellectual disability.

Specialised seating and positioning aids may be necessary when cerebral palsy has resulted in postural changes and contractures that require additional support.

Ankle Foot Orthosis

An Ankle Foot Orthosis (AFO) is a brace worn to support one or both ankles which may be weak due to cerebral palsy.

AFO’s are to help with ankle and lower leg alignment and positioning.

Depending on your needs, an AFO may be hinged (made to bend at the ankle) or solid (no movement at the ankle). AFO’s can be worn underneath and inside your shoe to assist with walking.

Walking Aid - Walking Stick or four-wheeled Walker

Walking aids and devices are helpful for people with cerebral palsy who have the capacity to stand and walk with varying difficulty, and therefore may need a bit of extra support for some or all of the time.

There are various types of walking sticks, walking frames and walkers available, depending on your mobility needs.

Transfer Assistive Technology

Mobile Hoist

A mobile hoist is a device that is designed to lift and carry (transfer) you from one surface to another. This may be from your bed to your wheelchair, or from your wheelchair to shower commode.

It has a mobile base that can be wheeled from room to room, so long as there are no steps inside the home or other obstacles. Typically, two support workers or carers are required to operate a mobile hoist.

Ceiling Hoist

A ceiling hoist is a device attached to a frame that is built into your ceiling. It can transfer you between surfaces, and can sometimes travel between rooms.

It is usually easier to handle compared to a mobile hoist and usually requires one or two support workers or carers to operate.

Sling

Both a mobile hoist and a ceiling hoist require the use of a sling that attaches to the hoist via straps. A large fabric sling supports your whole body when you are lifted between surfaces.

Slings can come in all different shapes and sizes, and be made of different materials and straps designed for a variety of hoists.

Standing Hoist

If you can weight-bear, but require a bit of additional support to stand up, a standing hoist can help you with completing transfers i.e. standing from sitting at the edge of your bed, wheelchair, or recliner chair.

Various slings and straps are available to assist you in using your standing hoist. Typically, a standing hoist is operated by one support worker or carer.

Bedroom Assistive Technology

Hi-lo Adjustable Bed

Bedroom assistive technology involves a hi-lo adjustable bed.

An electronically powered hand remote is available to adjust the power features of the bed. 

The power features have various benefits, including:

• Raised back section - elevates the head and body for comfort, positioning, breathing, and eating.
• Lower limb elevation and knee break - supports the lower limb in an elevated position for comfort, pressure care management, management of swelling etc.
• Height adjustability - the bed can be lowered to assist you with standing transfers (if completed), or raise the bed to a height best suited for support workers or carers providing care to you in bed.

An adjustable bed is beneficial for someone with cerebral palsy who has difficulty adjusting and repositioning in bed.

Pressure Relieving Mattress

Various pressure relieving mattresses are necessary for individuals with cerebral palsy.

Pressure-relieving mattresses may be:

• Foam mattress - consisting of various layers of foam to immerse the body and distribute pressure
• Alternating air mattress - Air cells within a mattress that are inflated and deflated by an automated pump to redistribute pressure throughout the body for pressure care management
• Combination of foam and air mattress - a pump-free mattress that combines air cells and foam padding to achieve comfort and pressure care management

Bed Positioning Aids/Sleep Systems

In some cases, additional cushions and support pads are required to support someone with cerebral palsy sleep and rest in bed.

Their purpose is to provide support that may be necessary for hip alignment and supporting contractures caused by spasticity to improve comfort.

Bathroom Assistive Technology

Mobile Shower Commode

A mobile shower commode is a waterproof wheeled device that has a similar setup to a wheelchair. It may be helpful for you if you cannot stand to shower and/or require support for personal-care routines.

A mobile shower commode typically has an oval gap in the centre of the padded commode seat, similar to the inside of a toilet seat. This is beneficial as the commode can be wheeled over a toilet so that it can also be used for toileting.

A mobile shower commode requires an accessible bathroom. This involves level (flat) access into a shower recess which ideally does not contain glass screens or doors. The toilet seat needs to be low enough for the commode to wheel over.

Mobile shower commodes are more commonly required by people with cerebral palsy who require a hoist to complete transfers. This is because they may not be able to transfer on and off a standard toilet or shower chair. Additional positioning aids and supports can be attached to the commode.

Over Toilet Aid

An over toilet aid is a frame that can be positioned over your toilet to assist with sit to stand transfers. This is beneficial for people with cerebral palsy who can stand and walk, and need a little more support with transfers.

An over-toilet aid can promote your independence and reduce the need to rely on a support worker or carer to get on and off the toilet.

Shower Chair

In some cases, a shower chair may be the support you require in the shower if standing and balancing during your showering activity is difficult.

Shower chairs come in all shapes and sizes, including shower stools with or without backrests and armrests.

Living and Dining Assistive Technology

Living and dining supports can often be overlooked when mobility and transfer assistive technology are prioritised. For someone with cerebral palsy and high physical support needs, a standard couch or armchair is unlikely to meet your needs and sitting upright and maintaining comfort will be a challenge.

In this case, a disability-specific recliner chair with additional positioning features is required, to provide an opportunity to sit somewhere else that isn’t your wheelchair or bed for relaxation, leisure and social engagement.

A tray table on wheels that is compatible with the recliner chair is beneficial for eating meals and performing activities.

Kitchen Assistive Technology

Meal preparation aids can be beneficial for individuals with cerebral palsy that may have difficulties engaging in the kitchen for meal preparation. Due to reduced finger strength, hand strength and range of motion, difficulties can be experienced completing some tasks.

Some examples of kitchen and meal preparation aids include:

• Modified chopping board
• Spreader boards
• Modified knives and utensils (thicker or different handle designs)
• Easy open devices - one-touch bottle, jar and can openers
• Kettle tipper device
• Thermomix (in some cases if deemed appropriate following trial with an OT)

Communication Assistive Technology

Communication difficulties may be experienced by someone with cerebral palsy due to muscle spasms in the throat, mouth and tongue. This can impact word formation.

With limitations in the ability to communicate, it can be challenging and frustrating to express wants, needs and emotions.

There are a wide variety of communication aids available, ranging from low technology solutions to high technology solutions.

Low Technology Communication Aids:

• Picture exchange
• Symbol boards
• Printed word board with common phrases
• Communication books
• Sign language

High Technology Communication Aids:

• Electronic communication boards
• Software vocabularies with voices
• Eye-tracking devices
• Difficulties with typing and writing may also be necessary if impaired hand function is experienced.

Typing and Writing Aids

Typing Aids

Typing aids may involve a modified keyboard and mouse. This is to accommodate people with limitations in upper limb skills.

There is also talk to type software available which may be beneficial for you if your speech is not impacted but your physical capacity to access computer controls and accessories is limited.

Writing Aids

Adaptive writing aids and tools are beneficial, particularly for children, who may have difficulties with grasping a pencil or pen, or manage writing tasks on a level desk.

Writing aids may include:

• Specialist pencil grips and writing claws
• Handcuffs or cuffs
• Wrist supports
• Slanted writing board

Hearing Devices

Hearing loss is prevalent in the cerebral palsy population. There are several hearing devices available, including hearing aids and the cochlear implant.

The Hearing Services Program, funded by the Australian Government, provides partially and fully subsidised hearing device options.

The NDIS funds hearing support for NDIS participants aged 26 and over who are not eligible for the HSP. The NDIS also funds additional reasonable and necessary hearing support for participants if they are not available through the HSP. This includes people under 26.

See resources below:

Hearing Services available through the Health Department

Understanding NDIS and other Government Services Hearing Supports

Assistive Technology for Therapy

Assistive technology can play a large role in therapy and capacity building, particularly in the early intervention stages of your NDIS journey.

Assistive technology and adaptive equipment for therapy can include:

• seating systems
• standing frames
• gait trainers
• Electronic gaming devices, such as Mouseware - https://dextrowaredevices.com/mouseware/

Summary

There is a wide range of assistive technology available, with only some of the useful daily living aids discussed above. To learn what is right for you, you may benefit from a Functional Capacity Assessment from an Occupational Therapist.

Find an Occupational Therapist

The MyCareSpace NDIS Navigators can connect you with support workers who have experience with cerebral palsy in your area.

Find a Support Worker