Some disabled children have a really hard time controlling their bodies. When working with physical disability, the most common problem we come across is cerebral palsy (CP). CP is the name given to disability caused by injury to a child’s brain during the mother’s pregnancy, during birth, or soon afterwards. It's a problem all over the world, although rates are higher where pre-natal and birth care is not very good, and where doctors prescribe high levels of drugs to expectant mothers (amongst other problems).
Like with a stroke or a brain injury in an adult, the amount and area of damage to the brain determines what type and degree of problems the child experiences. CP can range from children with normal behaviour and learning and just very mild movement problems, to children with significant problems with movement, sensation and thinking.
For some children with CP, the injury damages the part of the brain which helps them to hold themselves upright (the bit that sends signals to the postural muscles). For some of these children, the signals for 'activity' don't get produced, so they're floppy. For other children the signals aren't regulated properly, and so their muscles are overactive. They might arch back, straighten and/or cross their legs, and/or their arms might take unusual positions.
From David Werner's 'Disabled Village Children'
To get an idea what this lack of postural balance might feel like for a child (and I often get the staff and parents to try this….) imagine sitting on a gym ball - one of those big bouncy exercise balls - and lifting your feet off the floor. Then while you’re trying to balance, try to colour in a picture. Or write your name. Or put on your clothes. Or eat a meal. It’d be pretty difficult, right?
Well that’s how things are for a child who has a problem with their postural muscles. When you sit them on an ordinary stool or chair, it takes everything they’ve got to try and stay upright, never mind to concentrate on swallowing their food, or gripping a pencil, or stacking bricks. They can’t concentrate on developing their functional skills (eating and drinking for example), their 'fine motor' skills (small movements with the hands), or their speaking or swallowing skills, because they don’t have a stable base to start from. They’re simply trying to balance. They feel vulnerable, and they are. This feeling of insecurity makes their muscles misbehave even more (again – think about what you’re arms and legs would do if you try to sit and balance on a wobbly gym ball).
So…. in order to give children like this some stability, some balance.... we have to give them good seating. They need suitably sized, suitably supportive chairs. Some children need straps. Some need the seat to be sloped downwards towards the back (to stop them arching their body back). Some need head-rests. Some need arm rests.
When these kids are properly supported in a sitting position, without having to work too hard, they suddenly have the opportunity to use their hands. To work at holding their head up. To concentrate their efforts on swallowing their food or practicing speech.
Surely they have chairs in Vietnam? Why bother making them?
In the UK, children with CP can get an astonishing array of fantastic specialist seats, for free, courtesy of our quite incredible NHS. But here in Vietnam, ‘seating’ for kids generally means the floor, or whatever plastic seating is available at the market. So you often see adults squatting on tiny stools, and children perched high up on bar stools. The standard sized seats and tables are far too big for children. For kids who can balance well, the solution is simply to cut the legs of the plastic chairs and tables. But for the children who can't balance the options are;
1) Sit them on the floor or whatever seat you've got around.
2) Save up and order specialist seating from Hanoi or HCMC - around $100 for a very basic chair, off the shelf, which may or may not fit well. Then it's a few weeks wait and an expensive delivery (1000+ km). In a years time, when the child has grown too big for it, save up another $100..... and order another one (bear in mind some families are living on around $2-3 per day).
3) Try to find a kind charity or organisation to order one for you. And another one in a year's time. Then another one....
or 4) Make your own seats to measure.....
So, one of my main focuses here has been to teach the therapist and volunteers how to make strong, durable, made-to-measure chairs from cheap (or free) locally available materials.
I attribute all the techniques we’re using here to the late Bevill Packer and the very much alive and inspiring Jean Westmacott, who refined these methods in Zimbabwe and other countries. Jean runs training programmes in the UK and abroad, and has generously made their advice and instructions freely available on the web. Please see ‘www.cerebralpalsyafrica.org/APT_Programmes’ or search for 'appropriate paper based technology' for more information on their projects.
Cardboard is everywhere in Vietnam. Thanks to the prolific smoking of the adult male population, there are huge ‘Bastos’ and ‘White Horse’ boxes discarded outside every small shop. And the only glue we need is made from flour – here we’re using cassava flour, but you could use rice or wheat flour.
The only cost is around 6,000 VND (£0.20p) for the bag of flour, and then coloured paper, stickers, varnish or whatever you want to cover the chair with.
It’s basically just papier-mache, on a large scale, with some structural engineering thrown in. And it’s a lot of fun.
The first stage is to make strong, thick boards. This is done by layering large pieces of corrugated cardboard in alternate directions. We’re using 3 or 4 layers, depending on the thickness.
These are pasted together with cassava glue, which is made by adding boiling water to a paste of flour and cold water. The kids love helping with the pasting.
Then we dry the boards under tables and weights outside in the Vietnamese sun. They need turning over regularly, and dry in around 3 days.
Once the boards are dry, we measure the child and cut the pieces to the appropriate size. The sides are tensioned together with rods with splayed ends.
All the joints are then glued and re-enforced with ‘angle irons’ made from thinner cardboard.
Edges are covered with strips of magazine or newspaper, and once dry, the chair is ready for a layer of tougher paper, paint, varnish......
......in any colour or design the child chooses!
Straps can be made very cheaply by tailors at the market, and it's easy to cut holes through the back or sides to attach them.
The therapist is currently making her first chair completely independently, and I really hope that she will carry on making seating for the children in the area. It makes such a difference to their lives and to their development. Maybe some of the families can learn from her, so that when their child grows, they can make new chairs themselves…..