How Columbia OT Students Are Helping Local Kids with Disabilities
For 2-year-old Bella, a play table created by Columbia occupational therapy students is not just a platform where she can play with her favorite toys.
It’s an integral part of her therapy that allows her to be a kid at the same time.
Bella has extensive hypotonia (muscle weakness) and has difficulty sitting upright for long periods of time. “It's really helpful for her to have a custom table so she doesn't have to work so much on stabilizing herself and she's able to use both hands to play with her toys,” says Bella’s dad, Arun Viswanath. “She loves to explore, and this table should help her develop fundamental skills.”
The play table is one of several devices and pieces of furniture built in recent months for young clients with severe disabilities by students in the occupational therapy program at Columbia’s Vagelos College of Physicians and Surgeons. As part of a new course, the students learn how to design and build assistive and adaptive devices—using little more than heavy-duty cardboard, glue, and some decorative decals.
There is a great need for customized devices for young people with disabilities. “Often, kids with disabilities will get an adaptive or assistive device at school, but they can’t take it outside of school to do their homework or sit or position themselves correctly at home. Their families may not be able to afford to purchase one for home use. Or there is simply nothing available on the market that addresses the child’s specific needs,” says Rochelle Mendonca, PhD, assistant professor of rehabilitation & regenerative medicine, who teaches the course. “We wanted to fill this gap and give kids the resources they need to be successful, whether it’s at home or at school.”
Design and construction 101
Through the course, the students learn how to create custom devices out of low-cost materials that address specific therapeutic goals for children with disabilities.
The course is part of a national movement founded by Alex Truesdell, a teacher for children with multiple disabilities, who began creating adaptive devices over 20 years ago and won a MacArthur fellowship for her work. Mendonca first learned about the movement a few years ago when she took part in a training workshop led by Truesdell for local occupational therapists.
“Learning to build adaptive devices with cardboard can be such a great way for occupational therapists to address the needs of a population that might not have access to devices and tools they need for greater independence and participation,” Mendonca says. “Cardboard can be used to create devices that facilitate play, leisure activities, and family engagement—goals that are not typically met through insurance or commercially available devices.”
Mendonca started the course to give Columbia OT students real-life experience in building assistive and adaptive devices for people in the community with disabilities.
Working with SKIP of NY, a nonprofit organization that connects children with disabilities to medical services and equipment, Mendonca selected seven children and young adults, ranging in age from 18 months to 26 years, in need of assistive devices. Over the first few weeks, the students met with families, caregivers, and Columbia occupational therapists to learn about the clients’ needs.
Then the students—55 in all—rolled up their sleeves and got to work building the devices.
Helping each child meet therapy goals
To meet Bella’s occupational therapy goals, occupational therapy students Ginger Pojednic and Amy Lopez knew they needed to start with a sturdy bench. “Bella’s therapy is currently focused on her upper body and postural control while she reaches for small objects,” says Lopez. That means the bench must hold Bella’s weight when she leans on it.
Off-the-shelf tables and benches weren’t a good fit because of other considerations—such as Bella’s frequent rocking back and forth and her limited ability to reach for objects while feeling safe.
Heavy-duty, triple-ply cardboard is the perfect material for designing custom adaptive devices: It’s inexpensive, strong, and easy for students to work with. “One of our goals is to keep the devices low-cost,” Mendonca says. “Assistive and adaptive devices can cost from $500 to $10,000 on the market. Everything we built cost less than $100 in materials.”
Lopez and Pojednic designed and built a small bench and a removable lap tray for doing activities and playing with toys. The tray has a small cutout with soft padding that fits snugly against Bella while she reaches for toys but prevents injury when she rocks. Paint and colored plastic tape decorates and protects the furniture, and the two students personalized the bench for Bella by painting her name in flowy script.
But when Bella came in for a mid-semester fitting, the students noticed a problem.
“The way she sat on the bench, we saw that it was about six inches too tall for her, so we had to redo almost every measurement and redesign the seat in order to make it fit,” says Pojednic.
These are not one-size-fits-all products, Mendonca says, “so having the clients trial the device is an essential part of the design process. Before we get to a final product, we need to see the patients work with first iteration, so we can perfect the device.”
On Dec. 12, Bella and the other clients came to Columbia to pick up the finished devices and put them to the test.
“It was really great, seeing it all come together, watching Bella do exactly what we had envisioned,” Pojednic says. “It was a lot of work, but the result shows how making simple adjustments in a person’s environment can really make a difference,” adds Lopez.
Devices delivered to other clients included custom phone holders, supportive activity desks, and a comfortable wedge to lie on while watching television.
Children grow and change, and so do their needs. “We invite all of the families to check in with us in a few months so we can make any adjustments that may be needed,” Mendonca says.
Mendonca plans to double the number of families they serve next year.
Rochelle Mendonca, PhD, is assistant professor of rehabilitation & regenerative medicine in occupational therapy at Columbia University Vagelos College of Physicians and Surgeons.
Dr. Mendonca is working with SKIP of NY, a nonprofit organization that connects children with disabilities to medical services and equipment, and Manhattan Childrens Center for Autism Spectrum Disorders to identify local families in need of assistive and adaptive devices.