Adaptive Seating for Children

Intro

Children with physical challenges can have difficulty maintaining their body position in a seated position during the school day. This effort to maintain their body position shifts their attention away from learning. Children with mild motor issues may display excessive movement in and around their seat. Children with significant motor involvement may have struggle managing their components of their body including head and trunk control and positioning their extremities.

Adaptive seating devices help to maintain head and trunk stability.

Adaptive seating is commonly used as an intervention method to enhance postural controlPhysical therapists are involved in the rehabilitation of individuals with multiple handicaps frequently recommend a suitable chair to facilitate functional position, to increase sitting comfort and to improve performance of manipulative skills [5].These adaptive seating devices have the ability to improve the physical function. This improvement is maintained even after the end of the intervention

Postural management is a programme of suitable handling, treatment and positioning of children that promotes motor development and reduces the risk of postural deformity [6]. However, postural management programmes such as balance training, and strengthening exercises, are often unable to optimize functional performance in children when sitting [7]. Therefore, a common approach adopted by assistive technology practitioners is seating interventions. searchers have studied the advantages of adaptive seating devices that aim to enhance postural alignment; provide postural support for the head, trunk, pelvis, and extremities during sitting; develop motor skills; reduce the need for assistance from caregiver; and facilitate daily activities such as playing, eating, and arm and hand functio

therapy balls

Therapy ball chairs are increasingly used with children’s sensory and motor impairments. It has the benefits of improving balance, addressing postural control, attention, and improving vestibular and proprioceptive sense

. Single subject studies have also examined the use of therapy balls as a form of alternative seating. These studies determined that attention to task, in-seat behavior, and writing legibility increased when the therapy balls were used (Schiling & Schwartz, 2004). Another study indicated that fourth and fifth-grade students had increased on-task and in-seat behavior when therapy balls were utilized (Fedewa & Erwin, 2011). The aforementioned studies all indicated an increase in attention within the learning environment when therapy balls were used as an alternative seating in the

sensory cushions

Another form of alternative seating are disc ‘o’ sit cushions (See Figure 1). These round discs are flat on one side and have a bumpy texture on the other side. When placed in traditional chairs, the cushions offer learners a natural range of movement and an opportunity for increased sensory input. Even

addle Seats (Bolster Chairs)

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These narrow seats allow your child to sit in “saddle position.” Recommended for children with spastic or athetoid CP who experience stiffness in their legs, saddle seats help maintain hip flexion. Bolster chairs are considered a safer seating alternative for kids who sit on the floor with their legs beneath them (“W-sitting”), which can cause muscle contractures and skeletal deformities.

In bolster chairs, pelvic and foot supports maintain bodily alignment, freeing the hands for activities – and preventing loss of posture when the child moves. The adjustable foot supports keep the hips and knees at right angles, so the child is always centered over the base of support.

Seat Inserts

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Seat inserts range from elaborate biofeedback devices to simple contoured foam pieces. Contoured foam seating (CFS) is a popular option because it is affordable, easy to transport, and simple to modify.

Built with an eye for skeletal alignment, CFS inserts hold the pelvis in a neutral position. These inserts are thought to increase postural stability and sharpen somatosensory feedback – meaning the child’s perception of bodily sensations (like pressure and warmth) becomes clearer.

External Supports

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There are a variety of external support features on special needs chairs for children, but the most common is the corner chair. Corner chairs assist with visual scanning, breathing, eating, and development of arm mobility; they are ideal for children who lack postural control of the head, neck, or trunk.

The back of the chair is V-shaped rather than straight, and the seat can be lifted or lowered. A raised seat promotes thigh alignment, reducing both tightness in the hamstrings and spasticity in spinal and pelvic alignment. A lowered seat allows the child to relax with legs extended.

Corner chairs often come with abductors, or rectangular cushions that are placed between the distal femurs to ensure hip alignment. The abductor, in conjunction with the seatbelt, helps prevent the child from sliding or pushing out of their chair.

Some adaptive chairs are similar to corner chairs, but with one key difference: they have a straight back, rather than a V-shaped back. These seats are ideal for children who struggle less with head and neck control, but more with hip adduction. Straight-backed adaptive chairs are often recommended for kids who experience undue rotation stress on their femoral heads.

Some adaptive chairs offer a pelvic femoral stabilizer – a vertical, padded board that extends across the front of the knees, keeping the child positioned firmly on the seat.

Benefits of Adaptive Seating Devices

Adaptive seating devices are believed to provide skeletal stability, thus improving postural control. Postural control allows children to develop heightened functional ability – particularly mobility of the arms, grasping, visual scanning and tracking, and especially self-feeding. These devices are particularly useful in the development of self-feeding skills because they hold the pelvis in a neutral position, providing a secure foundation for the rest of the spine. Altogether, this promotes trunk alignment, which both frees the child’s hands and allows for proper digestion.

Adaptive seating is also associated with decreased risk of spinal deformity. In some cases, these devices can promote the correction of existing scoliosis in children with CP.

Researchers commonly observe that individuals who use adaptive seating devices often experience increases in social interaction, occupational satisfaction, and performance of the activities of daily living (ADL). Many of these improvements persist even after the device is removed.

One study suggested that regular use of adaptive seating devices can “prevent deterioration of [an individual’s] measured skill set over a period of five years.” This means that, in addition to increasing function and posture during use, these devices can help “lock in” existing abilities and result in cumulative improvement over time.

Studies About the Benefits of Adaptive Seating Devices

Dozens of studies about the benefits of adaptive seating devices have been conducted since the 1980s, but their findings have varied widely. At the end of 2008, the American Physical Therapy Association (APTA) oversaw a comprehensive review of these studies’ methods and results, which was published in their pediatric journal.

APTA concluded that the devices seem to help manage impairments associated with CP and can improve overall function. They noted that quality research on whether these devices truly improve postural control is limited, and the results of this research have been mixed.

Research into the benefits of saddle seats yielded mixed results – some children experienced improved mobility and posture, while others did not. Seat inserts, external supports, and modular seating systems produced more uniformly positive findings, with the majority of children demonstrating improvements. All devices – especially saddle seats and seat inserts – seemed to bolster social skills and ADL performance to some degree.

Nearly all adaptive seating devices showed positive results moreover, APTA concluded – but the improvements were rarely drastic. Anecdotal evidence for the benefits of these devices, however, is strong; an overwhelming majority of families report substantial improvements in their child’s performance when the child is using an adaptive seating device.

Most students have no problems managing the multiple positions that are required; from standing and walking to get where they need to go to sitting in various places throughout the day (desk, floor, lunch room, library, playground, etc.). However, when a child has physical challenges ran. However, when a child has physical challenges ranging from slight to severe, this automatic task can have a significant impact on their daily functioning. Focusing their attention on trying to maintain their body position takes attention away from academics and learning. Children with mild motor involvement may have problems that manifest in excessive movement in and around their seat and desk. Children with significant motor issues may have difficulty managing all aspects of their body including, head control, trunk control (required for a stable base to work from), and positioning of their extremities.

mild disabilities

Some of the behaviors that indicate this may be an issue are: falling out of their chair; frequent changes of position; getting in and out of their seat beyond what is allowed; slumping over their desk; wrapping their legs around the legs of the chair; or propping themselves on other surfaces such as the desk or holding their head on their hand. These are indicators that there may be issues with core strength, muscle tone, fatigue, vision or other problems.

. Traditionally, seating guidelines have focused on the following: • Feet resting on the floor - ankles dorsiflexed to 90 degrees • Knees flexed 90 degrees • Hips flexed 90 degrees • Hips well back in chair • Both arms resting comfortably on desk without causing shoulders to shrug If the child is able to fit in the chair within these parameters, then the chair is an appropriate fit. This does not mean, however that this is the expected position for the student to be in duri

significant disabilities

Students with significant disabilities often have one or more positioning/seating devices. They may use a walker, wheelchair, stander or other positioning device. There are several factors to consider: position within their seat; seat location; and accessing materi

Feet resting on the floor - ankles dorsiflexed to 90 degrees • Knees flexed 90 degrees • Hips flexed 90 degrees • Hips well back in chair • Both arms resting comfortably on desk without causing shoulders to shrug

he importance of posture evaluation and body measurement is explained with regards to determining optimal seating. There are devices for positioning the pelvis, trunk, head, and extremities. The positioning chart at http://www.atilange.com takes each area and identifies th

Tilt and recline components of a wheelchair seating system may be necessary to address issues of postural alignment, function, physiology, transfers and biomechanical issues, contractures or orthopedic deformities, edema, tone, pressure relief, comfort or dynamic movement. For some students these features may be manual, but for other students providing power tilt, recline and elevating leg rests may give them control over these features.

Resources

http://www.atilange.com/resources.html

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