Thinking outside the cardboard box: insights from a course to train rural Kenyans to make postural support devices from appropriate paper-based technology (APT) for children with cerebral palsy

Abstract

Purpose: Suitable assistive devices for children with cerebral palsy (CP) in low-income countries are often unavailable. Devices made from APT are in use in several countries but are unevaluated.

Materials and methods: A 2-week training course focused on APT principles, measuring children and constructing postural support devices. Twenty-three Kenyans attended the course. The host organization identified four local children with CP who attended for assessment and measurement. Participants made the devices and children returned for fitting and necessary adjustment. Completion of post-course forms, action plans, visits after 14 months and contact 3 years later comprised the evaluation.

Results: All participants found the course beneficial and valued the networking opportunity provided. They appreciated the practicality and utility of locally manufactured cost effective devices. The trainees planned further implementation to provide assistive devices for children with CP in their localities. Follow-up visits revealed several challenges to local ongoing production.

Conclusions: Training people in low-income communities to make bespoke assistive devices for children with CP is straightforward, and the course was positively evaluated. However, maintaining device production is limited without local group support and stable leadership, ideally as part of an existing programme.

Implications for rehabilitation

• Assistive devices are often unobtainable for children with cerebral palsy (CP) in low-income countries.

• APT is a cost effective way of fulfilling this need and it is relatively straightforward to train people who care for or work with those with CP to make devices using APT.

• Feedback from APT training suggests participants find the technique a practical way of producing assistive equipment for individuals with CP in their community.

• Maintaining device production requires support, leadership and increased public awareness of the use of APT at a local level.

Keywords:

• Cerebral palsy
• resource limited country
• paper technology
• assistive devices

Acknowledgements

The other course facilitators – Timothy Kiragu (TK), Peter Kinua, Diane Lyle, Michael Belcher and a course participant Julius Orwaru for translation of questionnaires. St Martin Catholic Apostolate disability programme, particularly its director, Daniel Mutahi, for providing logistics, including sourcing materials and transport for course participants, local trainers, children and their parents. Also to Marian Velthuijs, Occupational Therapist for helping coauthor PL in identifying and preparing the communities providing participants. Funding for the course and follow-up visit came from the Gibbs Trust, Wales Africa Community Links Development Grant and support for the first two authors time from Powys teaching Health Board.

Disclosure statement

No potential conflict of interest was reported by the authors.