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CHAPTER 8
Paper-Based Aids:
Seating and Standing Aids for Cruz and Kim, and a Helmet for Edgar
APPROPRIATE PAPER-BASED TECHNOLOGY
Most of the special seats described in this book have been made, at a
fairly low cost, with wood or plywood. But for many families, even local
wood is too expensive or difficult to obtain. For this reason, in
Zimbabwe, Africa many years ago, an elderly man named Bevill Packer
began to make special seating and other assistive devices out of waste
paper and cardboard. In this Appropriate Paper-Based Technology (APT),
layers of paper and/or cardboard are glued together with a paste made
from flour and water. Paste can be made from maize flour or even with
left-over "sadza," a wheat-flour baby food widely used in Africa.
Well-made paper-based seating aids and other devices can be unbelievably
strong.
Apart from being low-cost (in terms of materials),
paper-based technology has other advantages. It is:
 | Easy and fun to make. Children love to help make
this equipment. (However, care with technique is needed for the
results to be strong and durable.) |
| Adaptable to personal needs. Seat-backs and
supports can be molded to meet individual needs. Adjustments can
easily be made, hollows scooped out, or lumps or wedges added where
needed, for greater comfort, protection, or support. |
| Gentle to the touch. The finished seat or device
has a surface that is somewhat flexible, especially when made of
corrugated cardboard (from "thick wall" cardboard boxes). This
provides a softer, giving, personal touch and is gentler where it
comes in contact with knees, butt bones, and other bony areas. It
tends to be more comfortable and protective (against pressure sores)
than wood, plastic, or metal. |
|
This stool, made only of paper and cardboard, can support 3
people. The photo is from the APT manual mentioned on
page 73. |
During the last few years, the art of Paper-Based Technology has spread
over much of Africa, and is now being discovered in other continents,
including the Americas and Europe.
For years, PROJIMO and Project Piaxtla in Mexico have made limited use of
paper-based technology for things such as paper-maché puppets, learning
aids, and wheelchair cushions. (A cardboard cushion to prevent pressure
sores is shown on page 157.) PROJIMO has only
recently begun to experiment with using APT for special seating, standing
boards, and other assistive devices. The aids in this chapter are among
PROJIMO's first experiments.
|
This donkey, with a head of paper maché, was made by Piaxtla health
workers and used in a farm worker theater skit to awaken villagers to
their constitutional land rights. |
To make a paper-maché frog, strips of newspaper several layers thick
are pasted over a balloon. |
A child with developmental delay plays at feeding a frog by putting
small stones into its mouth. |
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| CRUZ is a 2 year old boy with
cerebral palsy that is in part floppy (low muscle tone) and in part
spastic (uncontrolled tightening of muscles). His mother devotes a lot
of time to helping him develop his body, mind, and spirit to their
best potential. Cruz's brothers and sisters play with him, talk to
him, and help him with activities.
=================================
Cruz learns to sit, with the help of sandbags on his legs and behind
his hips (see page 46).
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Thanks to this loving family effort, Cruz has gained
fairly good head control and, with effort, he manages to open his
hands to wave hello and goodbye. He also tries very hard to speak. His
words are difficult to understand, but his family has learned to
interpret them, and they encourage him to speak as much as possible.
The boy thrives on all the hugging, handling, and encouragement he
receives. |
| A wooden Seat the child hated.
Cruz's mother brought him to PROJIMO from a nearby village. She
understood his condition so well that the rehabilitation workers
learned as many practical developmental activities from her as they
were able to teach her. It was agreed that Cruz might benefit from a
special seat. Juan designed and built a handsome plywood seat for him
with a removable backrest. But for some reason, Cruz hated his
wooden seat. Usually a cheerful child, no sooner was he placed in the
seat than he began to scream and wail. His mother was sure he would
get used to it, but after two months he still refused to accept it. |
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A cardboard seat that he liked.
PROJIMO had been experimenting with paper-based technology. So they
tried sitting Cruz in a still-unfinished seat made of laminated
cardboard (layers of cardboard from old cartons, glued together). To
everyone's surprise, Cruz was all laughs and smiles. His mother was
amazed at the difference. We are not sure why Cruz, who had such a
strong dislike for the plywood seat, took such an instant liking to
the cardboard one. The positioning and support provided by each was
much the same. We suspect that the cardboard seat - with its thick,
rounded, relatively soft, yielding structures - was somehow friendlier
and more similar to human touch. By contrast, the plywood seat, even
with its cushioned lining, was more rigid and unyielding. Despite the
smiling rabbits painted on its sides, the wooden seat was not as
child-friendly. |
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A Cardboard Seat Built for Cruz
The seat was designed with many special features. A removable post, or
pommel, was placed between the boy's thighs to keep him from slipping
forward. A table-top fits around his waist to help stabilize his lower
body. A removable, U-shaped hip support fit into the seat to stabilize his
hips. It held him slightly forward from the seat-back so that when he
wanted to, he could sit up without leaning against the seat-back. (This
idea came from watching Cruz's mother place sand bags around his hips to
help him sit upright.)
| All of the seat parts, including the table top, the
pommel, and the U-shaped hip support, were made by pasting
together (laminating) layers of corrugated cardboard cut from
old cartons. |
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On his first try, Cruz sat fairly well in the seat.
But there were problems that required some modifications:
 |
- When Cruz was excited, his legs stiffened and his tense body
pushed backward.
So a removable ankle bar was added to keep his feet
on the foot-rest. The bar was made of cardboard, reinforced by a
flat metal rod, bent to help position his feet. A removable
foot separator of layered cardboard was added to help him
position his feet well.
- Although the U-shaped hip-support at times seemed to help Cruz
sit upright, often he would slump or push back against the seat
back.
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So a 2-piece low-back support was made of layered
cardboard. It could be easily removed as he gained better hip and back
control.
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| Addition of an adjustable tilt to the seat.
On experimenting with the angle of the seat, it was found that sometimes
Cruz sat more upright when the seat tilted forward. (See discussion of
positive seating in Chapter 4, page 48.)
So a mechanism to change the seat angle was added.
The forward tip of the seat seemed to help Cruz sit in a more upright
position. The tilt caused him to push downward with his legs to keep
from slipping forward. This increased the muscle tone in his back. But
since the foot-bar kept his knees bent, he avoided spastic arching
backwards.
All of these adaptations and additions were simple and fun to make
because the cardboard frame and attachments were so easy to cut, drill,
and modify. Almost the only tool needed was a knife. Removable pieces
molded from cardboard could be firmly attached by pressing them (or the
pegs attached to them) through grooves or holes cut into the frame. The
thickness and texture of the cardboard frame provided a firm grip for
the inserted posts and attachments.
The different pieces and attachments to Cruz's seat are almost all
removable and many are easily adjustable. The final version of the seat
with its removable parts is shown here.
An instruction sheet for making cardboard seats is on
page 72. |
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A Cardboard Standing-Frame for Cruz
Cruz's mother, brothers, and sister often held him upright, and Cruz
did his best to stand. At first his legs stiffened in a tip-toe
position. But, if he was held quietly for a while, the spastic muscles
would gradually relax and his feet would flatten on the ground. Cruz's
mother had bought him new, high-top shoes, which seemed to help him
position his feet better.
The PROJIMO team felt Cruz might be ready for a standing-frame.
Again, they decided to use mainly corrugated cardboard. The cardboard
was reinforced with wooden struts, and had a wooden base-board.
In a preliminary trial of the standing frame, Cruz
stood fairly well on it. His feet rested flat on the base-board and were
held apart by the foot-holes in the vertical frame. The boy seemed
delighted with being able to stand by himself.
However, his knees angled inwardly as he stood. |
He needed something that would hold his legs straight and apart.
So a leg-separator was made by re-shaping and
gluing together 2 cardboard boxes to form a long, thin triangle. |
A big advantage of a standing-frame made of cardboard is its smooth,
soft surface, and its capacity to bend or sink in slightly, under
pressure. The cardboard, therefore, provides more gentle support for
bony areas such as Cruz's knees.
In conclusion: PROJIMO's early trials with
cardboard assistive devices show great promise. The PROJIMO team still
needs to improve its technique, to create smoother and cleaner products.
But the results are working remarkably well. Cardboard provides a number
of advantages over other materials: especially its low cost, and the
ease with which the structures can be modified and adapted to meet
individual changing needs.
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