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Guide stroller

Mobility for rehab children & parents

Families are like small businesses: Time management is a challenge in hectic everyday life - joint activities often fall by the wayside. As a father of two children, I know only too well how important and precious family time is.

As a pioneer in Germany, we began providing disabled children with special rehab strollers more than 50 years ago to make it easier for the children and their families to participate in everyday life. A lot has changed since then - the clunky tubular frames have become chic strollers that accompany special children and their parents in their often strenuous everyday lives.

There is a lot to choose from, but in this guide we will provide you with the essential information to help you find "your" rehab stroller.

When & why does my child need a rehab stroller?

Not every child with a handicap needs a special rehab stroller at first glance. The decisive factor is whether this rehab stroller can promote participation in life and togetherness.

Very often, children with a handicap cannot be transported in standard strollers without problems. These strollers offer too little support, so that the child "hangs" in the stroller and cannot sit or lie in it stably and safely. The positioning aids of a rehab stroller, such as pads, headrest, high back or upper body belts, provide the child with support and hold when sitting upright. Postural defects are thus prevented at an early stage and a therapeutically correct sitting position can be adjusted.

First contact with aids

Very often, the rehab trolley or rehab buggy is one of the first aids ever, even if the actual diagnosis has not yet been made or is unclear. For this reason, many parents are still not very familiar with the subject of medical aids. The pediatrician and the local medical supply store can help with the selection and supply of the appropriate aid.

Children with special needs

Some children have to be transported mainly or temporarily lying down due to their disability, e.g. spinal muscular atrophy (SMA). For larger children, commercially available strollers no longer offer this option. In this case, a rehab baby carriage is used in which the seat can be converted into a lying surface. Medical equipment such as an oxygen bottle or suction device can also be carried on a special shelf under the seat.

Bigger children

A rehab baby carriage is also used for older children if the child cannot drive a wheelchair independently or is already too big for a standard buggy. Even children who can walk shorter distances independently despite their disability - e.g. cerebral palsy with mental handicap - still need a rehab buggy for resting or as a place to retreat. This offers, for example, a slight reclining position for resting or a canopy as a shield from environmental stimuli.

So all win

Last but not least, the "right" rehab stroller or buggy promotes interaction with family and friends and thus participation in everyday life - a piece of quality of life for child and parents.

Daniel Feick - Medical Devices Consultant and Rehabilitation Trainer DOSB (German Olympic Sports Confederation)

The right to participation

"Again and again there is talk of the right to "participation," that is, "being included in a life situation."

For people with disabilities, there is even a legal entitlement to participation in SGB IX and thus also to aids such as gait trainers. This is because they promote self-determination and equal participation in social life. This active participation is an important building block in child development."

You can also find more important and exciting information on the topic of "participation" in our children's rehab podcast.


Special strollers for special children

What actually distinguishes a rehab stroller from a standard stroller?

Rehab cars are specially designed for children with handicaps. They are designed to meet the needs of children with a wide range of disabilities (physical and sometimes mental). The rehab stroller therefore differs from a standard stroller in terms of its functions, load-bearing capacity and, to some extent, its appearance.

As a rule, a rehab trolley has these features:

Size adjustable, ergonomic & grows with you

Children with disabilities need an individually adjustable stroller to support a good sitting position. In a rehab stroller, for example, the lower leg length, seat depth, seat width and back height can be adjusted precisely to the child's size. This helps the children to be able to sit stably. The rehab stroller is adjusted in parallel with the child's body growth and development.

higher load capacity, very stable & robust

Standard strollers can usually only support loads of up to 25 kg and are only as stable as necessary. This is not enough for children who have to be transported in a stroller or buggy for longer periods of time due to their disability. That's why rehab strollers and rehab buggies can sometimes carry loads of up to 50 kg and also weigh more. This means that even larger and heavier children - or teenagers - can travel safely. A stable construction is also important for spastic children, because enormous forces are released when spasticity sets in. The rehab trolley must be able to withstand these forces.

Positioning in the seat and back area

For example, children with special needs more often have problems with their hips, little strength in the upper body or spastic movement patterns. A rehab trolley can adapt to this with a wide variety of adjustments, improving the children's seating options.

Support for the head through headrests

On the road, when the ground gets bumpy or the child is tired and sleepy, a secure hold of the head is quite important. Especially children with weak head control need a well adjustable headrest.

removable & rotatable seat

A rehab stroller is usually heavier than a standard stroller due to its many adjustment options. It is therefore important and functional that the seat unit can be removed from the undercarriage. In some models, the seat can also be easily turned around. This means that the child can sit facing the direction of travel at one time and facing the mother or father at another. If you want to be flexible, look for a model where the viewing direction can be changed easily without tools.

Seat position is adjustable

Most often, the back of the rehab stroller can be adjusted so that the child can be placed in a lying position. In addition, the seat of a rehab stroller can be tilted. This means that the seat can be tilted completely backwards. Both options are important, for example, if the upright sitting position cannot yet be maintained for a long time, the child is still sleeping in between or, for example, has to be laid flat every now and then in the event of cramps. Children who are ventilated also need a lying position, e.g. in the case of SMA (spinal muscular atrophy).

Positioning & Fitting Accessories

Good sitting and stable support is made possible by various rehab accessories: upper body harnesses such as 5-point harness and seat vest, pads, abduction block, seat pants, therapy table. However, a 5-point harness can offer more than just stable support when sitting - a good 5-point harness also means more safety for children who, due to their mental disability, could simply jump out of the stroller and run into the street, for example.

Daniel Feick - Medical Devices Consultant and Rehabilitation Trainer DOSB (German Olympic Sports Confederation)

"Children benefit from wearing shoes when sitting in the rehab cart - even if they can't walk yet. Sturdy shoes over the ankles, or even orthotic fittings, provide stability and make it easier for children to place their feet more firmly. That's a basic foundation for being able to sit well."


Child & Rehab Trolley
- How does this fit together properly?

Putting the child in the rehab cart and off it goes is not sufficient in most cases. The rehab cart has to fit the child - it has to be "adapted" to the child. Your child's therapist will take care of this. He pays particular attention to the following:

Pelvis position as a starting point

First, pay attention to the posture of the pelvis, as it is the key point for the entire posture and other functions. It is therefore important to stabilize the pelvis in an upright position. To do this, the child is placed against the backrest with the back straight and stretched all the way back. This can only be done if the seat depth corresponds to the child's measurements. If the seat depth is too long, the child will automatically sink into a rounded back. As a result, the pelvis tilts back and the bottom slides forward. This is exactly what is not desired with a good fit. Once the child is seated on the seat with the pelvis upright backwards, it should be observed whether the child can hold this position on its own. If not, then accessories such as seat pants, pelvic belt, etc. are possibilities. can be used to passively support the child in this position.

lateral support & guide

Lateral guidance should also not be ignored. To the right and left, the pelvis should receive contact for further stabilization and informal perception. Now that the pelvis has the optimal position and guidance, the torso is partially capable of physiological responses all on its own. These include torso alignment, balance behavior, improved head con trol or coordinated muscle responses.
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Special children need special support. A rehab stroller or buggy is therefore a must for many parents.

But the wide range quickly causes headaches. Find out which model is perfect for your child and your family.

Daniel Feick - Medical Devices Consultant and Rehabilitation Trainer DOSB (German Olympic Sports Confederation)

Correct fitting as a therapeutic measure

"In extensor spasticity, the child shoots into a hollow back, with only the shoulder blades and feet resting. The risk of extensor spasticity can be reduced with proper adjustment: Hip, knee and foot angles are adjusted to a 90° angle or more acute using the back, knee and footrest adjustment. Positioning is achieved with the appropriate harness, for example. The seat tilt also allows for an easy resting position."

stable support of the upper body

Now the attention should be consciously focused on the existing or non-existing stability in the child's upper body. There are various options that we can offer the child for improved posture for training the functions. On the one hand, the adjustment options of the seat unit (in seat tilt and hip angle) and on the other hand the accessories such as thorax pelotte pads, chest strap, etc. serve this purpose.

When choosing supply accessories, the motto should always be: As little as possible and as much as necessary. The services that the child can already perform do not need to be taken over by an aid. Example: If the child has good trunk posture, a harness is not necessary. Rather, the child should find support in the weak or non-existent functions. Example: If the child does not have sufficient trunk stability, thorax pelotte pads are a support for the child.

Back height

An adjusted back height is important to provide the child with support and hold in the back and head area.

Lower leg length

(for footrest height)
The child's feet should be at a 90° angle on the footrest of the rehab cart.

Seat depth

To ensure that the child sits as stably as possible, it is important to aim for an optimally adjusted seat depth.

Seat width

The more precisely the seat width fits, the straighter the child sits in the rehab cart.

What dimensions are important
- and why?

For an accurately fitting rehab stroller, the child's body measurements should also be known. As a therapist or parent, it is therefore important to spend time with the child, i.e. to "measure" him or her. Here you can see what these measurements are and how to select them.

Back height

An adjusted back height is important to provide the child with support and hold in the back and head area. The upper edge of the backrest should be at least at the child's crown height so that the head is supported. With some rehab carts, a separate headrest can be selected. In this case, the backrest extends at least to the lower edge of the shoulder blade, and an individual headrest shape is selected for the head.

Lower leg length

The child's feet should be at a 90° angle on the footrest of the rehab trolley. The lower leg length is measured from the hollow of the knee to the sole of the foot or shoe.

Seat depth

To ensure that the child sits as stably as possible, it is important to aim for an optimally adjusted seat depth. The seat depth is the extended back line up to approx. two finger widths in front of the back of the knees.

Seat width

The more accurately the seat width fits, the straighter the child sits in the rehab trolley. The seat width is measured in the seated position at pelvic level from the outside of the thighs. With an exact pelvic alignment, the child has ideal conditions for upper body activity.
The new children's rehab podcast

A special child

The new children's rehab podcast EIN BESONDERES KIND (A SPECIAL CHILD) wants to take parents of children with disabilities by the hand and support them.

Listen now - every Saturday a new episode!


High safety standard
- for the protection of children

Before a rehab trolley or rehab buggy can be used by children, it must pass many tests by testing institutes. "Fire test", "Tilt test", "Crash test" and many more - this is how rehab strollers are put to the test nationally and internationally.

We carry out various product safety tests for our rehab trolleys and rehab buggies. Depending on the country in which the product is to be marketed, the required scope of testing differs. Some countries, such as France, require testing according to their own country-specific standard. In other countries, testing according to a European standard is sufficient.

Stability, fatigue strength, brake hold, tilt resistance ...

In total, we test our rehab trolleys in four "areas". First, the stability and fatigue strength of the rehab trolley is put through its paces. Also checked are, for example, the hold of the parking brake on an inclined plane, the tilt resistance of the rehab trolley / buggy on a slope, as well as the information for the user and the labeling of the product. These and many other safety-relevant aspects are tested according to the following standards:
  • EN 12182 Technical aids for disabled persons - General requirements and test methods

  • EN 12183 Muscle-powered wheelchairs - Requirements and test methods

  • ISO 7176-1 Determination of static stability

  • ISO 7176-3 Determination of the effectiveness of the brakes

  • ISO 7176-5 Determination of basic dimensions, mass and turning space

  • ISO 7176-7 Measurement methods for seat and wheel dimensions

  • ISO 7176-8 Requirements and tests for static strength, impact resistance and fatigue strength

  • ISO 7176-15 Requirements for information, documentation and labeling

Crash test

As a rule, we also offer our rehab trolleys and / buggies in the "crash" version. They are then equipped with special fastening eyes as well as additional safety snaps and are approved for use as a seat in a motor vehicle. In Germany, children are usually transferred to a child car seat for travel in a car or minibus. The rehab stroller/buggy is then folded and stowed in the trunk. In other countries, however, it is quite common to push the child in its rehab cart / buggy into an appropriately equipped minibus and to secure the rehab cart and child with an approved (personal) restraint system for the journey. We have developed the "crash" variant for these requirements. We verify that the child is also well protected in the rehab trolley / buggy in the event of an accident by means of crash tests in accordance with the following standards:
  • ISO 7176-19 Wheelchairs for use as a seat in a motor vehicle

  • ANSI/RESNA WC 19 Wheelchairs Used as Seats in Motor Vehicles

ISO 7176-19 is required as verification in most European countries. ANSI/RESNA WC 19 is a standard specifically for the USA.

Preparation for the crash test:
EASyS Advantage rehab trolley is attached to the test sled with the dummy strapped in.

Risk analysis

Since rehab trolleys and rehab buggies are medical devices, a risk analysis must also be prepared. As part of risk management, the product is analyzed with regard to possible risks. If risks are identified, they are subsequently evaluated and measures are defined to eliminate or minimize these risks. The risk analysis is carried out in accordance with the DIN EN ISO 14971 standard.

Cushion

Children with disabilities sometimes spend many hours a day in their rehab stroller. To ensure that parts such as the upholstery of the rehab trolley/buggy in particular do not contain any hazardous substances, they are tested for biocompatibility in accordance with DIN EN ISO 10993-5.

In addition, we test our pads for flame resistance according to EN 1021-1 and EN 1021-2. In the test according to DIN EN 1021-1, the pads are brought into contact with a smoldering cigarette; in the test according to DIN EN 1021-2, a gas flame comparable to a match serves as the ignition source.

international tests

In order to be able to market aids worldwide, additional tests must be verified depending on the country-specific legal requirements. In some cases, these country-specific requirements also necessitate the design of additional product variants.
In the USA, children are transported in the rehab car in an appropriately equipped handicapped van (BTW). Similar to children's car seats, a different test standard (ANSI/ RESNA WC 19) must be demonstrated here than in Europe, for example. Such differences are often found directly in the design of the products.
For rehab trolleys to be marketed in France, we must also have product safety tested by the French C.E.R.A.H. Institute. Similar criteria to the previously mentioned standards are tested.

Once the product has been successfully tested in all areas, we CE mark it and certify its compliance with Regulation (EU) 2017/745 of the European Parliament and of the Council of 5 April 2017 on medical devices (MDR - Medical Device Regulation).

Only when all the required tests have been successfully passed and the corresponding test certificates are available can the aid number for the rehab trolley be applied for in Germany from the GKV-Spitzenverband (statutory health insurance). Many certificates must also be available for the international marketing of assistive devices before sales can begin.

CE marking

By affixing the CE marking, the manufacturer confirms that the product complies with the product-specific applicable European directives. Unlike other industrial products, medical devices must not only be safe, but also perform medically and technically within the scope of the intended purpose specified by the manufacturer.

Where will the rehab trolley
used in everyday life?

In order for the rehab trolley to really make everyday life easier for child and parents, it must be well adapted to the area of use.

Location

If the rehab stroller is to be used on long journeys, for example, it must be ideally adjustable to the child and comfortably padded. When shopping in the city, on the other hand, simple handling and easy car transport are more important.

Here we are mostly on the road

Outdoor, longer distances
Indoor (home environment / institution)
in the city, e.g. while shopping
For example, a stroller designed mainly for city driving (light, maneuverable, small wheels) is difficult to push on uneven paths or in nature. For outdoor use, you need large wheels, a stable chassis and a safe braking system. That's why there are different models on the market for different requirements: There are rehab buggies that are especially suitable for medium and long distances or those that are specially designed for uneven paths. Then there are rehab buggies for shopping, traveling or indoor use.

Upholstery

This should be comfortable for longer distances and as thick as possible, so that the child feels comfortable for several hours. Screws or adjustment devices should not be noticeable. If you only want to go into town or go shopping, the upholstery is a less decisive factor in the selection of the rehab stroller.

Wheels

As a general rule, the larger the wheels, the off-road is the car!

However, the following also applies: The larger the wheels, the Less maneuverable he is!

In addition, large wheels are often rigid and do not swivel. This means that at every turn, the cart must be lifted slightly at the front. This is still okay for very small, light children because you don't have to use quite as much force. However, rehab carts are more often used for several years and you should always keep in mind that children usually still gain quite a bit of weight.

Strollers with swivel wheels are much more maneuverable and easier to steer in curves. But of course they have the disadvantage that even slightly uneven dirt roads are really uncomfortable to walk on. A good compromise and thus a real alternative are lockable swivel wheels. They can be put on swivel mechanism in the city and stores and fixed "off-road". Another advantage is that these wheels take up little space when folded.

Frame

The construction of the frame should definitely look confidence-inspiring. Of course, the areas of use from robust for long, uneven paths to particularly light for short distances with little stress can be found here as well. This means that the weight of a rehab cart or buggy increases with the number of functions. The functions offered are reflected in the frame design. So, as a rule of thumb, you can remember: More function equals more weight, and vice versa.

Michael Krause - rehaKIND consultant

Suspension

"Many children do not tolerate vibrations well and therefore get spasms more often. As a preventive measure, the rehab trolley should then have good suspension that ensures a pleasant ride and dampens vibrations. A suspension that is not too soft but slightly firm helps. If the suspension is too soft, the result is a "spongy" pushing feeling and driving over curbs, for example, becomes more difficult. Too long a suspension travel makes the ride unsteady for the child."

What makes a
good rehab car from?

Do you already have a particular rehab trolley model in mind? A good rehab trolley should meet these criteria. This way, it becomes a real support in everyday life.

Customization options

For individual adjustment and setting of a therapeutic sitting posture, the rehab trolley should offer a range of options. E.g. adjustment of seat depth, seat width, back height, lower leg length, hip angle ...

multiple accessories

Make sure that the rehab trolley is expandable with accessories. It offers additional adjustment and positioning options, more seating comfort for the child and better handling for parents. With some rehab trolleys, the basic model is already equipped with a wide range of accessories.

Upholstery & Cover

Cozy soft padding, especially in the seat area, provides children with plenty of comfort even on longer rides. Breathable cover fabrics prevent sweating and thus ensure more relaxed children. Make sure that the covers are removable and washable, it goes quickly times something "off".

High stability

The rehab trolley must be able to withstand the heavy loads, including those caused by heavy or seizing children. That is why a rehab trolley with many functions cannot be a lightweight. But stability and safety come first here.

Tilt safety

If a child is lying in the rehab trolley, the weight load on the chassis changes. There is a risk of tipping over if the rehab trolley does not provide suitable compensation.

simple handling

Not so easy with all the levers and screws. Take a close look at how the individual adjustment options work - from the headrest and seat tilt to the footrest and brake. Only when you have a comfortable and quick grip on the functions will you be able to use the potential of the rehab buggy for you and your child.

successful testing & HMV number

Choose a rehab trolley that has really been put through its paces. International test specifications are often even stricter than the national German specifications. A medical aid number (HMV number) indicates that the product is recognized as a medical aid by the health insurance fund and is included in the list of medical aids.

Design

In contrast to the "tube monsters" of the early days, rehab trolleys today fortunately look chic and modern. This makes shopping trips or excursions twice as much fun. Choose the fabric and color scheme that suits your child and you best.
Anette Detjen - Rehab Trolley Consulting

Important for parents!

"Very important, especially for parents: An abduction block is not a "brake wedge"! It is placed at knee level, not at thigh level. For one thing, it's painful - especially for little guys - and for another, the wrong position of the abduction block leads to more spasticity."


Setting options
& Functions of rehab trolleys

After the most important measurements for the child are noted, the next step follows. It must be determined which special adjustment options and functions are required to fully accommodate the child. These adjustment options are offered by rehab trolleys:

Lying position

For children who want to sleep or need to be transported lying down due to their diagnosis.

Rotatable seat (face-to-face)

Child can look forward in the direction of travel or look directly at parents, good for seizure children or anxious children.

Back angle adjustment

Resting position adjustable and sitting with open hip angle when therapeutically necessary.

Seat tilt

Tilt adjustment to relieve the spine and circulation, easy rest position.

growing with you

The back height, seat width, seat depth and lower leg length are adjustable for long supply times and growth spurts.

height adjustable footrest

Adjustment of the correct lower leg length for a stable sitting position.

Knee angle adjustment

For elevating the legs and setting a lying position.

Different model sizes

Optimal supply and familiar handling through easy change to the next size.
Michael Krause - rehaKIND consultant

Pay attention to stability!

"Make sure that the rehab trolley is still stable and cannot tip over, even in the lying position. Otherwise, there is a risk that your child will tip backwards while lying with the rehab trolley! There are rehab strollers that have a special safety mechanism on the seat that shifts the center of gravity when lying down. This eliminates the risk of tipping over."

Status survey to determine the need for aids

Use the survey form from rehaKIND e.V. to document the provision of aids.


Accessories for individual
Customization & Comfort

Once a rehab trolley has been selected, the question of accessories then arises. True to the motto "as little as possible but as much as necessary", it is important that the accessories support the child's movement potential and do not restrict existing abilities.

Lap belt - easy positioning of the pelvic area

It runs horizontally down over the child's groin to the rear. Children who can maintain a fairly good sitting position are thus adequately secured. A lap belt is part of the basic equipment in many rehab carts. While the 2-point pelvic belt provides a simple, secure hold, the 4-point pelvic belt is attached on each side in addition to the side down. This provides extra support when sitting.

Seat pants - padded positioning aid for the pelvic area

In addition to a padded guidance of the pelvis, a slight spreading of the thighs in the hip joint becomes possible. For a better sitting posture and against crossing the legs. The two belt loops are guided from the center over the groin or thigh to the right and left with the pull to the back, down.

Abduction block - for guiding the thighs

Abduction here means spreading the thighs in the hip joint. If a child requires this kind of abduction, this can be achieved by using a sitting aid - the abduction block - between the knees. At the same time, unwanted overturning of the legs is prevented. By the way, an abduction block is not a "seat brake" to prevent the child from sliding forward. It is placed at knee level, not at thigh level. The stable sitting position is maintained with seat pants or a lap belt.

Vest - padded guide for torso or upper body

A vest is used for additional support. It provides secure support in the lateral thorax area, the anterior torso area and the shoulder area. The vest can be easily opened at the front and conveniently put on and taken off.

Thoracic pads - lateral support in the upper part of the body (thorax)

The pads are attached to the right and left of the child's torso. In this way, it is held stable and can still move its arms freely and actively. Thoracic pads can be individually adjusted in height and width to the respective child.

Headrests - additional support for the head

Depending on the clinical picture, the child may not be able to hold its head on its own. Headrests are used to prevent the head from falling or slipping sideways and causing injuries. The selection ranges from simple head cushions to three-dimensionally adjustable headrests that securely hold and protect the child's head.

Weather / visual protection - protects from weather influences and stimulus overload

Sun, wind, rain, cold - anyone out and about in the fresh air needs protection to prevent colds or sunburn, for example. For children who have difficulty processing external influences such as large crowds or noises due to a perceptual disorder, a place to retreat is important. Under a privacy screen, they feel safe and can come to rest.


The first rehab cars in Germany - This is how it started

Until the 1970s, there were only a few transport trolleys for children with a physical disability in Germany. These carts were heavy and unwieldy, some simply had a wooden board as a back. No attention was paid to comfortable seating for the children or easy handling for the parents.

The first real rehab trolleys came to Germany in the mid-1970s through an initiative by Thomashilfen. Jürgen Schlichting, retired Thomashilfen veteran and rehab trolley consultant from the very beginning, talks about the early days.

How did you become aware of rehab cars for children back then?

When I started at Thomashilfen in the early 1970s, I was immediately on the road with aids all over Germany. Many doctors were urgently looking for consultants for physiotherapists and parents of disabled children. So I quickly established direct contact with the families. I then visited them personally at home all over Germany. At that time, the specialized trade did not actually offer on-site consultations. And then the parents approached me more and more frequently to ask if I could get them some sensible rehab carts ...

Where did the first rehab cars come from?

For children, there were only some heavy, unwieldy transport carts. These were quite complicated things that really didn't look nice. But I always had the parents' questions about alternatives in mind. In 1974, at a small rehab fair in Nuremberg, I suddenly saw a man walking by with two strollers. That was exactly what I had imagined. I followed the man down the aisle and we got to talking. He was from Sweden, where health care at that time was much more advanced than here in Germany. So, together with the Swedes, I developed these rehab strollers further and brought them to Germany.

What happened next?

I continued to drive directly to the parents and now finally had rehab trolleys with me according to their ideas. The parents were thrilled. At some point, of course, the specialist dealers got the message. "There's someone driving around and doing direct consultations." So it didn't take long before I was not only doing direct consultations and further developing rehab trolleys. Now I also visited specialist dealers who were trained by me. I couldn't cope with all the requests on my own.

What was important to the parents during this time?

Simple operation, easy folding and the most important settings, without a lot of frippery, that's what the parents wanted. Disability or not - the rehab trolley should look chic and shapely, and definitely not have a "disabled look". Of course, a lot has happened over the years, but we have always developed the rehab trolleys further and listened to the parents about what they need.


Kinderleicht mobil - A normal Friday with rehab trolley

How does a rehab trolley actually work in everyday life? For other affected parents, social pedagogue Christina L. recorded her experiences with her son Paul.

Paul is ...

... a curious child. Even if you don't always see it at first glance. While the development of our older daughters was quite inconspicuous, he found many things difficult: lifting his head, crawling, sitting independently. From the very beginning, he seemed somehow flabbier and tired more quickly than other children in our group of mothers. I therefore suspected relatively early that something was wrong.

The diagnosis ...

... Muscular hypotonia we finally got at nine months. Since then, we as a family have been doing everything we can to support Paul as best we can. He should discover the world, like every child. We want to make him strong for a future that he can shape himself according to his possibilities. Because Paul, at almost four years old, still lacks the strength to walk longer distances on his own, his rehab cart is one of his most important companions.

A normal Friday ...

... begins with breakfast and preparations for the daycare center. When the driver rings at 7:45 a.m., the rehab buggy is already ready so that Paul can go everywhere. The stroller was recommended to us by our pediatrician and has worked very well for the last three quarters of a year. At his integrative daycare center, our youngest is one child among many: Paul enjoys looking at picture books in the cuddle corner with his friend Lea and loves trips to the outdoors. With the support of the caregivers, he often walks short distances by hand. Paul is highly motivated, especially when there are lots of new things to discover in the surroundings. The rehab buggy still has to come along so that he can rest in between. We are very happy that a therapist also comes to the daycare center twice a week to train him to walk. Paul's body control has already improved and we notice that he is slowly but surely becoming more active.

A small stopover ...

... in the supermarket is already a ritual. However, for some time now I have always turned the seat backwards and towards me. At least Paul can no longer sweep the shelves so quickly with his arm, which has happened to me otherwise. Especially because of the storage space under the seat, the rehab cart is wonderful for shopping in general. I never need a basket, but can pack cookies, fruit and pasta directly into the stroller.

Back home ...

... Paul is in the best of moods again. While our oldest takes him to the playground, I finally have time for a cup of coffee. Thanks to the sturdy construction and soft suspension of the rehab buggy, I don't have to worry about the sometimes bumpy paths in our neighborhood. What's more, our big girl has long since understood how to use the stroller to easily negotiate even smaller barriers such as curbs. When I go to pick her up an hour later, Paul is already asleep in his rehab cart. No wonder, after all the impressions of the past week! My daughter has already folded the high backrest into the reclining position so that he can snuggle up really comfortably in the soft cushions. - The end of a very normal Friday in the life of our little boy.

"Our everyday life is very varied. Paul is on the road a lot - and his rehab car is always with him."
Christina L.

Status survey - What assistive devices does my child need?

A needs assessment form makes it easier for parents, caregivers, and providers to clearly describe and document a supply of assistive technology.

Many stakeholders are involved in the provision and use of assistive devices. In order to find the best possible aid for the child's development and participation in the respective environment, it is advisable to clearly document and describe the need.

For example, the following information is gathered:

  • general information about the child
  • accompanying therapeutic measures
  • Classification of the degree of disability (e.g. according to GMFCS)
  • Body functions (physical and mental)
  • Activities and participation

The classification of motor impairments in children with cerebral palsy is based on the Gross Motor Function Classification System (GMFCS for short) of the ICF. The GMFCS system includes five levels. The classification is based on the ability for independent mobility and the need for assistive technology support. Parents can help with the classification, as they can usually assess their child well. GMFCS is easy and quick to use, experienced professionals only need about 15 minutes.

Stage I

Free walking without limitation; limitation of higher motor skills.

Stage II

Free walking without walking aids; limitation in walking outside the home and on the street.

Level III

Walking with walkers; limitation in walking outside the home and on the street.

Stage IV

Independent locomotion limited; children are pushed or use e-wheelchair for outdoors.

Stage V

Independent locomotion severely limited even with electrical aids.

Status survey to determine the need for aids

Use the survey form from rehaKIND e.V. to document the provision of aids.


What is the ICF
and why is it so important?

The basis for the provision of assistive devices is not only legal requirements such as the entitlement to benefits for assistive devices, self-determination and participation in SGB XI. The ICF must be taken into account when assessing and justifying the provision of aids.

ICF means "International Classification of Functioning, Disability and Health".. (The ICF is a classification of the World Health Organization (WHO), which was first created and published in 2001 and is considered a globally recognized standard. It describes the current functioning, activity and participation of a person in order to derive participation goals, support measures and process recommendations.

Significance of the ICF for the provision of assistive devices

Aids are intended to ensure the success of medical treatment, prevent an impending disability or compensate for a disability. For the successful provision of an aid, an individual care concept must be created for the child.

For this purpose, the classification according to the bio-psycho-social model of the ICF is included. This model describes a current state of health and the interaction between the components. With the help of the ICF it is described what the child can do and what help and support he needs.

Objective: Auxiliary means supply rehab trolley

The ICF classification is used, for example, to request a supply of a rehabilitation trolley for children. The goal-oriented justification of the supply is always better than having to formulate an objection later. Example:

Health issue: Epilepsy, hypotension

Body functions and structures:

  • Compensate for severe hypotonia in the trunk
  • reduce and prevent epileptic seizures triggered by overstimulation and emotions

Activity: Be actively involved in the school trip in 4 weeks, preferably without seizures

Participation: Participation in school as well as private activities, e.g. excursions, hiking days and museum visits

Environmental factor: barrier-free room and place changes in school and private everyday life possible, suitable aid (rehab trolley) with accessories for protection against environmental influences is available

Person-related factor: Strengthen self-awareness, fulfill desire for inclusion and socialization in groups.

Daniel Feick - Medical Devices Consultant and Rehabilitation Trainer DOSB (German Olympic Sports Confederation)

The right to participation

"Time and again there is talk of the right to "participation", i.e. "being included in a life situation". For people with disabilities, there is even a legal right to participation in SGB IX and thus also to assistive devices such as gait trainers. This is because they promote self-determination and equal participation in social life. This active participation is an important building block in child development."

Difference between
Rehab Trolley & Rehab Buggy

Sometimes it is not so easy with the exact designation of a thing: It is spoken in the regions of Germany of rehab carts (Reha-Karren) and rehab buggies, but are there really differences? And if so, which ones? Here is a classification:

A rehab buggy ...

... is a relatively simple stroller for children with special needs. It offers a little seat correction, adjustment and support, but is otherwise intended mainly for transportation.

This is often used for children who can actually sit quite well on their own, but who, for example, are not yet able to walk on their own for longer distances or tire quickly. Rehab buggies can also be useful for children with mental disabilities. (E.g. because these children need a means of transport due to their behavior or their weak condition when shopping in the city).

Important!

If your child only needs a light bug gy, he or she is often able to learn to get in and out independently. From a certain weight class, this is enormously relieving for the parental backs. You should then in any case make sure that the buggy has the prerequisites to practice getting in and out independently. This can be a particularly firm or also a folding footrest. For the safety of your child, always allow him or her to get in and out of the stroller only under supervision and hold the stroller firmly to prevent it from tipping over.

A rehab car ...

... is more elaborately designed and offers more positioning options than a rehab buggy when the children need a little more support when sitting.

For this purpose, it offers a variety of adjustment options that support the child while sitting and ensure a good sitting position. In addition, there are numerous accessories to give the child stability. These can be pads (supporting aids), belts or similar. This means that even longer distances and sitting phases are easy for the child to endure.

Rehab trolleys sometimes also offer the option of placing the child in a reclining position. In some, the entire seat can be tilted or even removed. This makes it easier to transport the rehab trolley in two parts. Turning the seat unit in the direction of travel or facing the parents is also possible with some rehab trolleys.

In contrast to the rehab buggy, the rehab trolley is heavier and more sturdily built due to its extensive equipment.

Another difference

Another difference between rehab trolleys and rehab buggies is the classification in the list of medical aids (HMV) of the GKV-Spitzenverband (statutory health insurance). This is how the product group is structured as a number: 18.99.01.1 or 2

Outline: 18. ... (ambulance / disabled vehicles)
Definition with indication range: 99. ... (Without special application site/additives)
Product subgroups (according to § 139 SGB V): 01. ... (Rehab carts/buggies)
Product type descriptions: 1000-1999 Buggies / 2000-2999 Rehab cart


FAQ - Frequently asked questions

Why do I need to consider the maximum allowable body weight of the child?
Please always observe the maximum permissible body weight (payload) for the use of rehab trolleys. You can find this information in the operating instructions or on the type plate on the frame of the rehab trolley. Overloading could break connecting elements and cause the child to fall. In addition, there is an increased risk that the trolley could tip over. Keep in mind that, in addition to your child, the contents of the basket, storage plate or bags are also part of the load of the undercarriage.
Does a rehab cart increase the child's mobility?
Children for whom a standard stroller does not fit can still actively participate in everyday life and family life in a rehab stroller. Rehab strollers offer your child an optimal position to better perceive the environment or to withdraw and rest if necessary. In addition, short shopping trips as well as long distances can be covered together without any problems.
Is our rehab car safe too?
Safety must be proven by the manufacturer in many tests. Only then does a rehab product receive a CE mark and is listed under an aid number in the list of aids of the statutory health insurance funds. If the aid is offered worldwide, further tests are required in many countries. Only when these have been successfully passed may the rehab trolley be used.
By whom can modifications and customizations be made to the rehab trolley?
Modifications should only be made by trained personnel in appropriate institutions or by e.g. orthopedic technicians at the specialized trade.
How many years are you allowed to use rehab carts?
Rehab trolleys are suitable for reuse, i.e. your health insurance company can also provide you with a used rehab trolley. However, rehab trolleys are subject to exceptional wear and tear. Proper use and regular maintenance will extend the service life of your rehab trolley. Your local rehab specialist dealer will provide you with precise information on the condition of your rehab trolley.
At what age does a rehab car make sense?
This varies from child to child and cannot be generalized. In principle, however, it can be said that a change to a rehab baby carriage should be made at the latest when the range of functions and/or the size of a standard baby carriage are no longer sufficient.
As parents, can we adjust the rehab cart ourselves if our child has had a growth spurt?
If you notice that your child has grown and no longer sits well in the rehab cart, you can change the simple settings yourself. As a rule of thumb, for example: The top edge of the backrest should be flush with the crown of the head, and there should be a little two fingers' width of air between the front of the seat and the back of the knee when sitting. For more complex adjustments, your child's therapist or your local dealer will advise you.
Is a rehab cart suitable as a precursor to a wheelchair for children?
If the child is later able to drive the wheelchair himself and has the necessary overview and awareness of danger to steer the wheelchair, the rehab trolley is suitable as a preliminary stage. In the case of severe hypotonia ("floppy" child) or tetraspasticity, however, the rehab trolley is often preferred. With a canopy or similar protection, it offers a possibility of retreat for children who sometimes find environmental stimuli too much compared to the wheelchair. Children who can walk very short distances on their own are more likely to be motivated to do so with a rehab trolley or buggy instead of "pushing themselves forward".
The harness is getting too tight for my child. Do I need a bigger rehab cart?
Many rehab trolleys grow with the user and can be enlarged in the seat, back and leg areas. Accessories are also available in different sizes without having to buy a new rehab trolley. If all these options have been exhausted, you should consider a larger rehab trolley. Your child's therapist and your dealer will help you make the right assessment.
Why should I use swivel front wheels with steering stop?
The swiveling front wheels make the rehab trolley very maneuverable and easy to maneuver even in the smallest spaces. If the ground is rather rough, the front wheels are locked, which makes steering and pushing easier for the caregiver.
My child needs a new rehab car soon. How do I proceed?
Contact your medical supply store to select the right aid. Your child's needs will be analyzed together with the trained specialist staff. Take advantage of the opportunity to test your desired model before applying to the health insurance company.
Do I have to pay anything towards the rehab car, such as rehab car seats?
Depending on the health insurance company, a co-payment may be due if the child is not yet 3 years old at the time of the aid application. This is because, regardless of whether the child has a disability or not, a stroller is usually purchased for children in the first few years of life. This co-payment is often waived for children who are 3 years old or older.
Can I use the abduction block to prevent the child from sliding forward?

The abduction block is no "seat brake"! It is placed at knee level, not at thigh level. On the one hand, it is painful - especially for little boys - on the other hand, the wrong position leads to more spasticity. If the child often slides forward on the seat, then a lap belt or seat pants are used to keep the child in a good sitting position.

My child should still be able to see something of the surroundings even when lying down and not just stare at the clouds. How can I help the child?

On the rehab trolley, set a combination of seat tilt and backrest adjustment to the rear. This way, the child lies relatively flat and the head is also supported, but the child can still look to the sides.

What do I have to consider if the rehab trolley or buggy is to be used as a seat in the vehicle?

Not every rehab trolley/buggy is suitable as a seat in a motor vehicle and approved by the manufacturer. Please be sure to take this into account when making your selection. Often, rehab trolleys/buggies are also offered in two versions: As a crash version with tethering points for attachment in the vehicle or as a standard variant that is not equipped and approved for vehicle use.

Why can my full shopping bags be dangerous for my child in the rehab cart?

Again and again, full (shopping) bags are hung on the push handles of strollers. Unfortunately, people do not consider that this increases the risk of tipping over immensely: Bags attached to the push handle in particular hang significantly higher than the center of gravity of the cart, and on a long lever to boot. For the safety of your child, you should therefore always stow purchases or similar in the storage bags / baskets provided by the manufacturer and be sure to observe the max. payload.