Clever Postural Control Training Aid for the Home or School

Author: Billi (Beverly) Cusick, PT, MS, COF, NDT

Mary Weck, PT extroardinaire of Chicago — a mighty senior staff member and originator of weight-line training as a key component of serial casting to reduce and control equinus deformity at the Ann & Robert H. Lurie Children’s Hospital, and a valuable part-time staff member and program developer at La Rabida Children’s Hospital — shared this idea with Diane Gabanyic, OTR/L and Director of the Carolina Pediatric Therapy Cooperative of Rock Hill, SC.

Diane’s daughter, Elizabeth, is actively engaged in raising her GMFCS level from III (at age seven) to Level II by participating in a variety of orthotic and therapy management strategies, including wearing a Swash hip orthosis, serial casting followed by tuned AFOs and shoes, strengthening on a gliding board apparatus, climbing on playground apparatus, cruising about the house, daily proning, and with Susan Blum’s, PT, guidance using total motion release techniques for large muscle contracture reduction.

The great idea I want to pass on to you is the adapted plastic barrel you see in the photos. Elizabeth spends ~20-30 minutes/day standing in this barrel and playing ball while wearing her tuned AFOs and shoes — and at the time of this photo — her SWASH orthosis (no longer needed).

The advantages of this barrel as a postural control and strengthening aid include:

• A safe and controlled environment in which to practice self-initiated and self-controlled body weight shifting and recovery skills while engaged in a game that requires overhead throwing.
• The interior diameter of the upper barrel can be adjusted down by lining it with foam rubber.
• Daily strengthening of antigravity musculature needed for trunk and hip control.

Materials

• Rubbermaid 32 Gal Non-Wheeled Trash Can: (Brute #1867531) or a comparable heavy-duty outdoor can with a smooth wall to the base – available at Home Depot. The Brute trash can interior base diameter is 16¼”.
• 2 pieces of strong wood:
• 1 for the interior base – 16” square x 1” thick (2.5cm).
• 1 for the exterior base – 36” square x 1” thick (2.5 cm) or consider purchasing a premade, round wood table top from Home Depot – these tabletops are 1.5” to 2” thick, so you would need to get longer bolts and T-Nuts if you use this option. The advantage of the round base is that you can turn the device on its side and roll it to move it. The square base would need to be dragged or carried.
• 4 strong flat head bolts, 4.7 cm (1 7/8”) x 1 cm (1/2”) diameter (longer if using the premade table top described above)
• 4 T-nuts: shaft = 1 cm diameter x 1.5” (3.8 cm) to accommodate the bolts. (A longer shaft is needed if using the premade table top described above)

Preparation

1. Cut the smaller piece of wood as needed to fit into the interior base of the barrel. If not made circular, sand the corners to round them a bit.
2. Drill 4 countersunk bolt holes, 1 cm in diameter, sunk ~1/8” (3mm) for the bolt head, ~6” apart in the center of this inner piece.
3. Leave the larger piece of wood square or cut it into a circle (shown).
4. Drill 4 bolt holes in the center of the large wood piece, 1 cm in diameter, ~6” apart.

Assembly

1. Set the small wood piece on the interior floor of the barrel with the depressions for the nuts uppermost.
2. Mark through the holes in the wood insert to the floor of the barrel and drill them.
3. Pound the T-nuts into the holes in the large base piece.
4. Lay the large base piece down with the T-nuts underneath
5. Set the barrel on the base with the holes overlaying the T-nut shafts.
6. Set the small wood base into the barrel floor with the holes overlaying the T-Nut shafts.
7. Insert and screw the bolts into the T-nut shafts securely, with the bolt heads sunk into the depressions around the holes.

Voila!