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

<b>Purpose:</b> 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. <b>Materials and methods:</b> 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. <b>Results:</b> 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. <b>Conclusions:</b> 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 rehabilitationAssistive 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. 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.

【研究目的】低收入国家中，脑性瘫痪（cerebral palsy, CP）儿童往往难以获得合适的辅助器具。目前已有多个国家在使用采用APT（APT）制作的辅助器具，但相关应用效果尚未得到评估。
【材料与方法】本研究开设了为期2周的培训课程，内容涵盖APT原理、儿童评估测量以及姿势支撑辅具的制作。共有23名肯尼亚参训人员参与本次培训。主办方招募了4名当地脑性瘫痪儿童前来接受评估与测量。参训人员自行完成辅具制作，随后儿童返回进行辅具适配与必要调整。本次研究的评估环节包括填写课后问卷、制定行动计划、14个月后的回访以及3年后的联络随访。
【研究结果】所有参训人员均认为本次培训获益良多，且十分认可主办方提供的交流合作机会。他们对本地制造的高性价比辅具的实用性与应用价值给予了高度评价。参训人员计划进一步推广相关工作，为所在地区的脑性瘫痪儿童提供辅助器具。回访结果显示，本地持续生产辅具面临多项挑战。
【研究结论】为低收入社区人员开展培训，使其可为脑性瘫痪儿童定制辅助器具，该方式操作简便，且本次培训课程获得了积极评价。但如果缺乏本地团体支持与稳定的领导团队，辅具生产的可持续性将受到限制，理想情况下应将该项工作纳入现有项目体系中。
【康复领域应用启示】低收入国家的脑性瘫痪儿童往往难以获取适配的辅助器具。APT是满足这一需求的高性价比方案，且培训照护或参与脑性瘫痪相关工作的人员使用APT制作辅具的操作难度较低。APT培训的反馈显示，参训人员认为该技术可切实为所在社区的脑性瘫痪个体制作辅助器具。维持辅具生产需要获得本地支持、配备稳定的管理团队，并提升当地公众对APT应用的认知水平。