Adaptive Strollers
Delia “Dee Dee” Freney, OTR/L, ATP
NRRTS Webinar June 13, 2017
Learning Objectives
1. The participant will be able to define the adaptive
stroller and how it differs from a wheelchair
2. The participant will be able to identify one feature
that an adaptive stroller has and why a commercial
stroller won’t meet the client’s seating needs
3. The participant will be able to describe how
adaptive strollers will fit infants, children and adults.
Greetings from
Riley and Dee Dee
DME Clinical Specialist with Kaiser
 Began as a pediatric OT specializing in adaptive
equipment from birth to 21 years in the California
Children Services Medical Therapy Units
 Became a provider for 6 years in complex rehab
 Consultant and educational speaker working with
 High Mobility DME clinic evaluations including
regional spina bifida clinics
Developing countries; benefit from
donated adaptive strollers
In Peru with
What is a commercial stroller and
how does it differ from
adaptive stroller?
Commercial Strollers
 Most parents have commercial strollers for their
babies and infants
 Commercially available: strollers, prams, umbrella
strollers at retail and online stores
 New parents often receive commercial strollers as
 Many attractive strollers with cute animal or design
 A variety of extra convenient features like parent cup
Adaptive Strollers
 Special needs children and clients need adaptive
strollers that have seating support systems than a
commercial stroller cannot provide
 Necessary medical equipment such as suction
machines may need to have its own platform on the
adaptive stroller
 Adaptive strollers are available online but a quality
evaluation by an RTS/ATP and a therapist is
recommended and required for most funding sources
More Commercial vs Adaptive
Stroller Comparisons
 Commercial strollers have
size and weight capacity; up
to 50 – 70 lbs.
 Commercial strollers have
basic shoulder and seat belt
 Some lightweight umbrella
strollers can be opened with
one hand
 Adaptive strollers have
growth capabilities and can
support up to 200 lbs.
 Adaptive strollers have
positional supports
including an independent
 Adaptive strollers are
funded as medically
necessary and may carry
medical equipment
Cerebral Palsy
Developmental Delay
Down Syndrome
Spinal Muscular Atrophy
Spinal Cord Injury
Traumatic Brain Injury
Muscular Dystrophy
Neurological and Orthopedic diagnoses
Adaptive strollers come in all sizes
to fit infants to adults
 Adaptive strollers are dependent mobility devices
 An end user will not be able to self propel sitting in
the stroller
 Base adaptive stroller is lighter than most
 Many adaptive strollers “grow” in seat depth
 Ability to adjust shoulder straps to accommodate
back height of the end user
 Sizes can accommodate infants to young adults
Adaptive Strollers
 Historically, strollers have not been funded
 Funding agencies did not know the difference
between commercial vs adaptive strollers
 Creative justification was to call it a dependent
mobility device (which it is!)
 Tray and canopy are accessories unless ~
 Medically justified as an anterior horizontal support
 Canopy for sun sensitivity due to medication
Poll Question
How many of you are getting adaptive strollers
Who funded? Justification?
History of Adaptive Strollers
and Pediatric Wheelchairs; they didn’t exist!
 Infants and children with special needs cannot be well
supported in the commercial stroller
 No pediatric wheelchairs available and narrow adult
14” wide strollers too big for most children
“She’ll grow into it”
First Versions of Adaptive Strollers
 Mulholland, Safety Travel Chair
 Tumbleform Carrie Seat has a stroller base/car seat
 Snug seat with the shell for seating
Kid Kart
 Designed and developed by Wayne Hanson, Montana
 Tilt, recline, complex seating supported system, could
accommodate the Whitmeyer head supports
 Cut out trays
 Base folds like a stroller
 Can face forward or rear facing to be able to see parent
 “Cute upholstery” keeps it looking more like a stroller
Aesthetics: why is it important?
 Parents want and will use strollers that are cute and
adaptive strollers should be no different
 Parents of special needs children have many new
issues to face; including special seating and mobility
 Parents with their new little end users will more easily
embrace attractive strollers than equipment that
looks to “medical” like a wheelchair
Kid Kart
(early version)
Kid Kart
Sunrise Medical
Front facing
Rear Facing or Pram Style
Ease of Use
 One of the biggest benefit of stroller bases is that it is
lightweight, folded in a configuration that is typically
easier for a parent to use
 Umbrella Strollers; no support but can fold with one
Options: 3 and 4 wheel bases
 Adaptive strollers have both 3 and 4 wheel base
 3 wheel bases are also known as jogging strollers
Kimba Neo
Special Tomato
Wheelchair vs Adaptive Strollers
 Independent or
dependent mobility
 Wheelchair heavier
 Offers complex seating
 Tilt and recline
 Folds side to side or rigid
Dependent mobility only
Adaptive stroller lighter
Offers complex seating
Tilt and recline
Base is foldable
3 wheel option
Wheelchairs fold side to side or rigid
Base folds differently from
Strollers are not just for children
 Many widths up to 18” wide
 Seat depth; telescoping increase of seat depth
 Weight capacity; up to 200 lbs.
Advance Mobility
Freedom Stroller
Adaptive Stroller as a back up to a
Power wheelchair
Power wheelchairs are great for end users
unable to self propel any manual wheelchair.
However, parent and caregivers often prefer to
have adaptive strollers as a convenient way to
transport in cars
Poll Question
Who recommends adaptive strollers as a back
up to a power wheelchair?
End users who drive power wheelchairs are not able to
self propel. A manual wheelchair as a back up mobility
device is an option but many parents and caregivers
choose an adaptive stroller.
Case Studies
 17 months old
2’5” 20 lbs.
 Diagnoses: Encephalopathy, severe developmental
delay, seizures, A commercial stroller did not offer
enough support and with no head and trunk control it
was difficult to hold him in midline
 Kolbe has limited head and trunk control
 Requires full support in sitting to be able to
engage in activities
 Visually impaired
 G tube fed
 Moves his arms only with a startle reflex
 Lower extremities show minimal movement
 Adaptive stroller with full seating support system that
also allows parent to fully recline to horizontal to
change his diapers while in the stroller.
 Rear facing so mom can keep an eye on him as it gives
her comfort to be able to watch him
 Adaptive stroller need to hold suction machine and
portable oxygen holder
 Easy to fold mother has a compact car and often
Grandmother is a passenger
21 months old 2’8” 27 lbs.
Diagnosis: cerebral palsy
Spastic quad with no head or trunk control
Full time nurse due to her medical needs
Portable oxygen tank
suction machine
Tube fed; nasal but soon to get a G tube
 Has a commercial stroller from Target but she has
outgrown it
 Multiple medical support equipment that a
commercial stroller cannot accommodate
 Poor head and trunk control but spasticity is present
requires moderate to maximum support in sitting
 Needs specific head support
 Secondary funding MediCal/MediCaid
 Adaptive stroller with full seating support system that
also allows parent to fully recline to horizontal to
change his diapers while in the stroller.
 Cervical head/neck support to keep Angel’s head
supported especially important for suctioning
 Adaptive stroller with growth features
 Stroller needs to have vent tray, oxygen holder,
suction machine
One more challenge…
 Evaluation was on 3/8/17
 Quote was approved on 3/28/17 for 80%
 Secondary funding of 20% has not been approved to
date 6/10/17
 Angel has grown 1 inch and gained 2 pounds while
waiting for funding to be approved
 Pediatric challenge of timely funding due to growth
 4 years old 3’3” no present weight
 Diagnosis: encephalopathy, respiratory failure,
developmental delay, congenital defect of bilateral
 She does not ambulate due to her feet
 Poor head control
 Spasticity in all extremities with a hypotonic trunk
 She required both supported seating and various
angles to manage her severe spasticity and achieve
the most optimum head control
 Only a custom manual wheelchair was recommended
 Non folding tilt in space custom manual wheelchair
could not be transported in the family vehicle
 Adaptive stroller with a variety of supports including a
headrest with multi axle adjustments
 Family can get the adaptive stroller in their vehicle.
 Compared to the custom manual wheelchair, they
prefers the ease of use with the stroller base and its
ability to fold
 All the features on the custom manual wheelchair
were duplicated on the adapted stroller
 32 years old
5’2” 124 lbs.
 Diagnosis: had a stroke at 6 weeks old, grand mal
seizures and presents with spastic hemiplegia,
developmentally delayed
 Unable to self propel wc but can crawl around the home
 Non verbal; has receptive language
 Self stimulates by rocking and shake things to make
 Becomes agitated when unable to rock therefore
prefers as little support restraints as possible
 Attends a community day program and his manual tilt
in space wheelchair is not WC-19 compliant
 He is independently mobile crawling around the
 If school transportation is not available, mother
cannot transport wc in her vehicle
 Young adult size adaptive stroller
 Minimal supports; he has good head and trunk
 Adaptive stroller is WC-19 compliant to safely
transport to Day Program in paratransit vehicle
 After medical appointments, mom is able to take
Evan to his Program using the foldable stroller
 His stroller has some dynamic components to allow
him to self stimulate without damage to the frame
How about this Solution?
Will share a story from Nicaragua
When commercial strollers can’t provide seating support and
growth for the end user, consider Adaptive Strollers.
An Adaptive Stroller is a good alternate device to non-folding
manual wheelchairs for transportation
Adaptive strollers can be considered as back up to a power
Not only infants and children use adaptive strollers but young
adults who are not able to self-propel can benefit from them
as well.
Dee Dee
Rusty Hallett, NSM
Portia Lemmons, End user
Charlotte Mann, OTR/L
Steven Ortiz, NSM
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