Statement of Purpose
The purpose of the Mechanical Design and Services Program is to provide adaptive equipment to meet a child's specific needs when a suitable product is not otherwise available.

To accomplish this, the Mechanical Design and Services clinicians function as members of a multidisciplinary team in the provision of assessment, intervention, and education to clients, families, and caregivers.

The principal function of the Mechanical Design and Services Program is to provide a technical service to assist in meeting the specific and unique needs of children with physical and developmental disabilities. These needs may be in:

• seating
  
• alternate positioning
  
• mobility
  
• mounting or positioning of other assistive technologies
  
• safe containment

The child's needs may be addressed through:

• modification of a mainstream consumer product
  
• customization of commercial adaptive equipment
  
• custom design and fabrication of a unique product
  
• fabrication of "standard RCC design" adaptive equipment

Source of Referrals (requisitions)
Referrals are received from:

• RCC clinics,
  
• Assistive Technology Clinic
  
• Neuromuscular Clinic
  
• Spina Bifida Clinic
  
• Orthopedic Clinic
  
• other RCC programs - AAC, electronics, STS, POTC
  
• community based therapists
  
• RCC therapists
  
• St. Amant Centre
  
• Children's Hospital - therapists or physicians

On occasion, families or caregivers may initiate requests for equipment modification. In these cases, a therapist at the Rehabilitation Centre for Children assesses the child and a requisition for the appropriate equipment is generated.

Requests for equipment modification, ADL equipment, custom-mounting hardware may be requisitioned by a therapist. A physician should requisition requests for wheelchair seating, standers, and walkers, preferably when the child is in attendance.

Eligibility For Service
Children are eligible for service if they have a physical or developmental disability, reside in Manitoba, Northwestern Ontario, or Nunavut and are under 18 years of age or still in school.

Service for children residing outside of Manitoba and for those with federal health benefits is provided on a cost-recovery basis. Eligible Manitoba children may be provided with one each of the pieces of equipment they require, with the exception being two modular seating systems. Duplicate equipment necessary for use in more than one environment may be provided on a cost-recovery basis.

Assessment
The child's needs in relation to adaptive equipment are assessed. This may occur:

• In a clinic setting, wherein the attending therapist, mechanical design and services clinician, treating therapist (if present) and the child and his/her family or caregiver discuss the needs and determine a plan of action.
  
• During an outpatient visit scheduled for that purpose.
  
• In the child's community environment, in which case the child's treating therapist, in conjunction with the family and/or school personnel will determine the child's needs and forward a written referral to the Mechanical Design and Services Program.
  
• At Children's Hospital when it is identified that an inpatient requires adaptive equipment (usually seating) prior to being discharged from hospital. A therapist and MD&S clinician assess the child with input from the child's treating therapist.
  
• At St. Amant Centre; a MD&S clinician works with a St. Amant therapist to assess the client's needs.

When it is determined that a specific piece of equipment should be customized, fabricated or modified to meet the child's needs, the appropriate measurements are taken by the MD&S clinician.

Method of Service Delivery
Following completion of the assessment and measurement, the following steps occur:

• A detailed drawing of the required device is prepared.
  
• The job is assigned a number and entered into the computer job log.
  
• At the end of each week, a work list for the following week for each of the shop technicians is generated, with jobs being drawn from each clinician's waiting list
  
• When all of the jobs for an individual child are completed, a follow-up appointment time is requested. Information regarding amount of time required for the appointment, work to be done and equipment needed for the appointment is conveyed to the administrative assistant.
  
• The administrative assistant to the Mechanical Design and Services Program arranges an appointment,
  
• At the fitting appointment, the equipment is provided, and the fit and function of the equipment is fine tuned to best meet the users needs.

In some cases, the delivery of the prescribed interventions may occur immediately. This occurs when:

• the work can be accomplished in a reasonable amount of time,
  
• the necessary components are available,
  
• time permits.

Priority of Service
Service is generally provided chronologically in order of date of receipt of referral with some priority given to:

• seasonally relevant requests (bicycles, tricycles, toboggans, etc.)
  
• in patients at Children's Hospital
  
• infants who do not have an adequate seating device
  
• broken equipment which is critical to the child's daily function
  
• equipment necessary for the child's safety
  
• coordinating with other appointments for children from rural areas

Consultation/Communication
At the time of delivery of new equipment, written and/or verbal instruction is provided on it's care and maintenance, assembly/disassembly when relevant, and method of ongoing follow-up.

Referral for Additional Services
There are a number of types of adaptive equipment which are not within the scope of the Mechanical Design and Services program. These include but may not be limited to:

• items which have a readily available commercial alternative
  
• modification to items for which there is a reasonable commercial alternative
  
• furniture or furniture modification, i.e. stools, tables, desks
  
• clothing modification
  
• items which are "standard" order and do not require any technical expertise, i.e. easels, E-tran boards, wedges

In situations where a client requires a piece of equipment which is outside the scope of the Mechanical Design and Services program, reference to the source of a reasonable alternative will be provided. This may be:

• a local distributor of a similar product
  
• a source for fabrication of a product or alteration of an existing product
  
• a pattern, drawing or instruction to assist in the fabrication of a similar product

If the referring source so desires, the Mechanical Design and Services Program may fabricate or modify items, which are outside of its scope on a cost-recovery basis.

Evaluation of Clinical Interventions
Evaluation of clinical interventions are conducted via:

• consumer satisfaction surveys
  
• feedback from clients, caregivers and therapists
  
• outcome measures

Discharge Criteria
Clients are discharged from the program when they reach the upper age criteria.

Program Planning and Continual Quality Improvement
Program planning and continuous quality improvement is ongoing. Input and ideas are achieved through participation in;

• interdisciplinary meetings
  
• professional education
  
  

Prosthetics and Orthotics
The purpose of the Prosthetic/Orthotic (P&O) Department is to apply prosthetic/orthotic devices, which correct or replace various anomalies allowing the patient/client to live a relatively normal life.

To accomplish this, we function as members of interdisciplinary teams in the provision of assessment, treatment, and education to the clients and their families.

Our area of expertise is that of assessing, fabricating, fitting, and finishing the prosthetic or orthotic device. For the prosthetic patient, we address the requirements and expectations of each individual. For the orthotic patient, our concerns deal more with orthotic, corrective management. However, these guidelines do tend to overlap in some instances.

The principle functions of the P&O department are to provide professional, custom fitted prosthetic/orthotic management. To accomplish this, we have sound, interdepartmental communication between certified and technical personnel.

Certified Prosthetist/Orthotist

• Assessment - Follow prescription, determine prosthetic/orthotic device required.
  
• Casting - Measuring
  
• Modification of cast
  
• Fitting, alignment, comfort and dispensing of prosthetic/orthotic device

Prosthetic/Orthotic Technician

• Designing, fabricating prosthetic/orthotic device from mold or measurements
  
• Finishing device after final fit.

Source of Referrals
85% of the referrals are received from the following RCC Clinical settings:

• Amputee Clinic
  
• Orthopedic Clinics
  
• Scoliosis Clinics
  
• Spina Bifida Clinic
  
• Assistive Technology Clinic

The remaining 15% of the referrals come from outside sources (i.e. general practitioners, paramedical personnel, support organizations).

Admission Criteria
Clients of the prosthetic/orthotic department range in age from birth to approximately 21 years of age or, with some exceptions, older.

Conditions for which clients may be referred for prosthetic/orthotic management include, but are not limited to:

• Amputation - congenital, traumatic or acquired
  
• Spina bifida
  
• Cerebral palsy
  
• Muscular dystrophy
  
• Juvenile arthritis
  
• Head injury
  
• Scoliosis
  
• Quadriplegia
  
• Paraplegia
  
• Hemiplegia

Priority of Service
Clients are assigned to a production list, which normally has a three to four week completion time. Exceptions are made based on the following order of priority:

• Category 1 Client has recently had surgery and requires post-operative prosthetic/orthotic intervention.
• Client has been hospitalized due to traumatic injury and requires immediate orthotic management.
• Category 2 Client has outgrown the prosthesis/orthosis and requires it for daily ambulation.

Assessment
The physical status of the client is assessed in order to determine the need for prosthetic/orthotic intervention. Information is acquired by both subjective and objective methods. For example:

Subjective Parent/client interview

• Documentation from community agencies, paramedical personnel, referring physician,
  
• Discussion with client/family regarding requirements and expectations of prosthetic/orthotic device

• Orthopedic status
  
• Neuromusculoskeletal function
  
• Neurological status

Planning
A plan of care based on prescription criteria and assessment results is developed in conjunction with the client and/or family/caregiver in order to establish common goals, and to determine how to achieve them.

Treatment
A client receives treatment in accordance with the plan of care to facilitate his/her ability to ambulate and/or function in day-to-day activities.

Treatment Stages

• Assessment
  
• Casting/measuring
  
• Modifying cast
  
• Designing prosthetic/orthotic device
  
• Fitting prosthetic/orthotic device
  
• Finishing prosthetic/orthotic device
  
• Follow-up

Follow-Up
The prosthetist/orthotist relies on feedback from the client's physician, physio/occupational therapist, parent/caregiver, and community agencies to determine fitting and wearing patterns of the device.

Clients are monitored through regular clinic appointments by the physician, as well as maintenance and repair visits to the department.

Consultation/Communication
Recommendations and information is provided to the client, family/caregiver in a clear and concise fashion using terminology, which can be readily understood.

Referral for Additional Service
Clients and families/caregivers are referred to other services both internal and external to the RCC in order that all clients' needs are addressed. For example:

• Physiotherapy - gait training, postural exercises.
  
• Occupational therapy - training in the use of a myoelectric prosthesis

Discharge Critera
Clients are followed on an outpatient basis once the device has been fit. Most clients are monitored through clinic visits until the age of 18. Some clients request only one intervention of prosthetic/orthotic management, and are therefore not followed through the clinic format.

Program Planning and Continual Quality Improvement
Programs and services within the prosthetic/orthotic department are evaluated to ensure continual improvement. Quality control is maintained, ensuring professional prosthetic/orthotic service.

Methods used in evaluation include:

• Satisfaction surveys
  
• Questionnaires
  
• Departmental review

Methods used for quality control include:

• Attending seminars on up-to-date prosthetic/orthotic management techniques.
  
• Maintaining continuing education credits within professional organizations.