Adaptive Seating for Children: Difference between revisions

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== Intro ==
<div class="editorbox"> '''Original Editor '''- [[User:Robin Tacchetti|Robin Tacchetti]] based on the course by [https://members.physio-pedia.com/course_tutor/dana-mather/ Dana Mather]<br>
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.<ref name=":2" />
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>


''Adaptive seating devices help to maintain head and trunk stability.''<ref name=":0">Elsayed AM, Salem EE, Eldin SM, Abbass ME. [https://bfpt.springeropen.com/articles/10.1186/s43161-021-00046-8 Effect of using adaptive seating equipment on grasping and visual motor integration in children with hemiparetic cerebral palsy: a randomized controlled trial.] Bulletin of Faculty of Physical Therapy. 2021 Dec;26(1):1-8.</ref>  
== Introduction ==
Children with physical disabilities can have difficulty maintaining their body position in a seated position during the school day. The effort to maintain their body position shifts their attention away from learning. Children with mild motor impairment may display excessive movement in and around their seat. Children with significant motor involvement may struggle to manage components of their body, which can affect head and trunk control and the positioning of their extremities.<ref name=":2">Gierach J. [https://www.wati.org/free-publications/assessing-students-needs-for-assistive-technology/ Assessing students’ needs for assistive technology (ASNAT)]. Madison, WI: Wisconsin Assistive Technology Initiative (WATI) and the Wisconsin Department of Public Instruction (DPI). 2009 Jun.</ref>


''Adaptive seating is commonly used as an intervention method to enhance postural control<ref name=":0" />Physical 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''<ref name=":0" />
A commonly used intervention to enhance head and trunk stability in children with physical disabilities is adaptive seating.<ref name=":0">Elsayed AM, Salem EE, Eldin SM, Abbass ME. [https://bfpt.springeropen.com/articles/10.1186/s43161-021-00046-8 Effect of using adaptive seating equipment on grasping and visual motor integration in children with hemiparetic cerebral palsy: a randomized controlled trial.] Bulletin of Faculty of Physical Therapy. 2021 Dec;26(1):1-8.</ref><ref name=":1">Inthachom R, Prasertsukdee S, Ryan SE, Kaewkungwal J, Limpaninlachat S. E[https://www.tandfonline.com/doi/full/10.1080/17483107.2020.1731613 valuation of the multidimensional effects of adaptive seating interventions for young children with non-ambulatory cerebral palsy]. Disability and Rehabilitation: Assistive Technology. 2021 Oct 3;16(7):780-8.</ref> The use of adaptive seating can help develop motor skills, facilitate arm and hand mobility, self-feeding, visual scanning and tracking and reduce the need for assistance from caregivers.<ref name=":1" /> Studies have shown that individuals using adaptive seating often have positive experiences, including increased performance of activities of daily living and social interaction.<ref>CPFamilyNetwork.org 2009.  Available at https://cpfamilynetwork.org/resources/blog/adaptive-seating-devices-for-children-with-cp/</ref>  


''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<ref name=":1">Inthachom R, Prasertsukdee S, Ryan SE, Kaewkungwal J, Limpaninlachat S. E[https://www.tandfonline.com/doi/full/10.1080/17483107.2020.1731613 valuation of the multidimensional effects of adaptive seating interventions for young children with non-ambulatory cerebral palsy]. Disability and Rehabilitation: Assistive Technology. 2021 Oct 3;16(7):780-8.</ref>
== Behaviours ==
Children with mild disability may have issues with core strength, vision, fatigue or muscle tone. Some observable behaviours that may indicate that adaptive seating is necessary include:<ref name=":2" />  


* Falling out of a chair
* Getting in and out of their seat beyond what is allowed / acceptable
* Frequent position changes
* Wrapping legs around chair legs
* Slumping over their desk
* Propping themselves on their desk
* Holding their head on their hand
<br>
<nowiki>**</nowiki> Children with significant disabilities will often have more than one seating or positioning device such as a stander, wheelchair and/or walker.<ref name=":2" />


''therapy balls''
== Positioning ==
Physiotherapists and Occupational Therapsits can be involved in recommending adaptive seating to facilitate functional positioning, improve performance of manipulative skills and increase sitting comfort.<ref name=":0" /> A thorough posture evaluation looking at the pelvis, trunk, head and extremities is necessary to determine optimal seating. Traditional seating guidelines encourage the following:


''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''<ref name=":0" />
* Feet resting on the floor
* Ankles dorsiflexed to 90 degrees
* Knees flexed 90 degrees
* Hips flexed 90 degrees
* Hips well back in chair<ref name=":2" />
* Both arms resting comfortably on the desk without causing the shoulders to elevate / shrug
<br>
<nowiki>**</nowiki> The fit is considered appropriate if the child sits in the chair within these parameters.<ref name=":2" />


. ''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 <ref name=":1" />''
== Assessment ==
The [https://www.the-movement-centre.co.uk/wp-content/uploads/2016/10/SATCo-Form-and-instructions.pdf SATCO (Segmental Assessment of Trunk Control)] and the [https://primeengineering.com/wp-content/uploads/2017/08/PPAS-Posture-and-Postural-Ability-Scale.pdf?_ga=2.85661917.571331094.1673325027-1818623111.1673325027 PPAS (Posture and Postural Ability Scale)] are two free tests used for adaptive equipment selection and implementation.<ref name=":3">Mather D. Adaptive Seating Course. Plus. 2023.</ref>  


''sensory cushions''
The SATCO is designed to test the degree of trunk control. The examiner progressively alters the level of trunk support, moving from fully supported sitting to free sitting. It assess control proximally from the head to the lumbar spine, and measures static control, active / anticipatory control, and reactive control. This assessment enables the clinician to determine at which level trunk control issues arise and enables a "level-by-level" treatment approach.<ref name=":4">Butler P, Saavedra MS, Sofranac MM, Jarvis MS, Woollacott M. [https://journals.lww.com/pedpt/Fulltext/2010/22030/Refinement,_Reliability,_and_Validity_of_the.2.aspx Refinement, reliability and validity of the segmental assessment of trunk control (SATCo).] Pediatric physical therapy: the official publication of the Section on Pediatrics of the American Physical Therapy Association. 2010;22(3):246.</ref> More information on the SATCO is available in this article: [https://journals.lww.com/pedpt/Fulltext/2010/22030/Refinement,_Reliability,_and_Validity_of_the.2.aspx Refinement, reliability, and validity of the Segmental Assessment of Trunk Control]<ref name=":4" />


''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<ref name=":1" />''
The Posture and Postural Ability Scale (PPAS) assesses quantity and quality of posture in supine, prone, sitting and standing. 'Quantity' is an individual's ability to ''stabilise'' their body segments in relation to each other / the supporting surface while 'quality' is the ''alignment'' of body segments.<ref name=":5">Rodby-Bousquet E, Persson-Bunke M, Czuba T. [https://journals.sagepub.com/doi/full/10.1177/0269215515593612?casa_token=cy0RkEtHNboAAAAA%3AdKdLgO9MK9iAmcw_l2efSMZzwLjYTi0juf4vKRGdKcCrXetpXFHFOyrJQXNRiok_X5CNGfqoo6yYkQ Psychometric evaluation of the Posture and Postural Ability Scale for children with cerebral palsy.] Clinical rehabilitation. 2016 Jul;30(7):697-704.</ref> Thus, this scale allows for posture and postural ability to be assessed separately. More information on the PPAS is available in this article: [https://journals.sagepub.com/doi/full/10.1177/0269215515593612?casa_token=cy0RkEtHNboAAAAA%3AdKdLgO9MK9iAmcw_l2efSMZzwLjYTi0juf4vKRGdKcCrXetpXFHFOyrJQXNRiok_X5CNGfqoo6yYkQ Psychometric evaluation of the Posture and Postural Ability Scale for children with cerebral palsy]<ref name=":5" />


''addle Seats (Bolster Chairs)''
== Modifications to Seating ==
=== Stabilisers ===
# Nonslip surfaces: applied to the seat of the chair to prevent sliding
# Theraband: stretched between the legs of the chair allows students to stabilise their feet rather than wrapping them around the chair
# Seat cushions: can be smooth or bumpy and/or inflated to different levels; can provide sensory input<ref name=":0" />
# Foot support: raises a student's feet to prevent them from dangling; can use wooden box or cardboard
# Desk modifications: change the angle of the writing surface; help with low tone, abnormal reflexes or poor grip patterns-grip strength can be improved when the wrist is in extension (a three-ring binder turned sideways or a slant board can help to achieve this position)
# Chair with arms: helps with lateral support and provides boundaries
# Additional stabilisers include: rolled towel, blocks, cushions, and bolsters - these can all provide positional support<ref name=":2" />


''© www.theradapt.com''
=== Movement Enhancers ===
# Seat cushion: disc cushions with a non-slip surface. The amount of air in the cushion provides different degrees of movement, which can help a child stay alert.<ref name=":2" /> They also provide sensory input.<ref name=":2" /><ref name=":0" />
# Chair leg modifications: tennis balls are placed on opposite legs of the chair to create a safe rocking motion (vs tipping the chair on two legs).<ref name=":2" />


''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.''
=== Alternative Chairs ===
# T-stool: a wooden one-legged stool made in the shape of "T". It can help with engagement, focus, balance and perceptual motor skills.<ref name=":2" /><ref name=":3" />
# Beanbag chair: good for listening and silent reading tasks. It is useful for students with fatigue issues,<ref name=":2" /> and can help to decrease hyperactivity in children with autism.<ref name=":3" />
# Ball chairs: help to increase attention of students who have difficulty attending. They can improve vestibular and proprioceptive sense.<ref name=":2" /><ref name=":0" />


''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.''
=== Other Seating Options ===
<gallery>
File:Cornerseatonrollingwoodenbase.jpg|corner chair
File:Greenbolsterchaironmovingwoodenbase.jpg|bolster chair
File:Sensorywobblebluecushionsensoryneed.jpg|sensory cushion
File:Swissballseatingwithbacksupport.jpg|swiss ball chair
File:Adaptiveswing.jpeg|adaptive swing
</gallery>


''Seat Inserts''
* Adaptive playground swings


''© www.especialneeds.com''
* Chairlifts to enter pools
* Adaptive bike seats
* Strollers - these are like wheelchairs, but they fold easily and are lighter weight
*[https://www.physio-pedia.com/Shower_and_Toilet_Chairs Toilet and shower chairs]
* Feeding chairs
* Activity chairs
* Saddle chairs: help maintain hip flexion - they are useful for individuals with stiffness in their legs
* Corner chairs: useful for individuals who require more support - they assist with visual scanning, breathing, eating, and arm mobility and are ideal for children who lack postural control of the head, neck, or trunk.<ref name=":3" />
* [https://www.resna.org/sites/default/files/conference/2018/wheelchair_seating/Sittidech.html Examples of a Low Cost Adaptive Seating Solution In Child With Cerebral Palsy Child]
* [https://www.perkins.org/resource/how-to-make-an-adapted-chair/ Step by step directions on how to build an adapted chair from cardboard]


''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.''
=== Wheelchairs ===
Wheelchair adaptive seating options include cushions, power tilt, recline, elevating leg rests, elevating seating and back/trunk supports. These adjustable features can help address a host of issues including:


''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.''
* Postural alignment
 
* Postural control
''External Supports''
* Transfers
 
* Contractures
''© www.especialneeds.com''
* Function
 
* Orthopaedic deformities
''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.''
* Oedema
 
* Pressure relief
''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.''
* Comfort
 
* Dynamic movement
''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.''
* Other biomechanical issues<ref name=":2" />
 
* Feeding
''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.''
* Dressing
 
* Socialising
''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.''
* Engagement in the learning environment
 
* Engagement in play
== ''Benefits of Adaptive Seating Devices'' ==
Another adaptation is residual limb positioning to avoid knee contractures.  
''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.''
[[File:Amputee Wheelchair - Adapted Shutterstock - ID 39150271.jpg|center|thumb|248x248px]]
 
''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.''<ref>CPFamilyNetwork.org 2009.  Available at https://cpfamilynetwork.org/resources/blog/adaptive-seating-devices-for-children-with-cp/</ref>
 
 
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.<ref name=":2">Gierach J. [https://www.wati.org/free-publications/assessing-students-needs-for-assistive-technology/ Assessing students’ needs for assistive technology (ASNAT)]. Madison, WI: Wisconsin Assistive Technology Initiative (WATI) and the Wisconsin Department of Public Instruction (DPI). 2009 Jun.</ref>
 
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 <nowiki>http://www.atilange.com</nowiki> 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 ==
== Resources ==
http://www.atilange.com/resources.html
* [[Shower and Toilet Chairs]]
* [[Standers]]


RESNA
== References ==
<references />


== ''References'' ==
[[Category:Assistive Technology]]
[[Category:Rehabilitation]]
[[Category:ReLAB-HS Course Page]]
[[Category:Course Pages]]
[[Category:Paediatrics]]
[[Category:Positioning]]

Latest revision as of 10:32, 8 November 2023

Original Editor - Robin Tacchetti based on the course by Dana Mather
Top Contributors - Robin Tacchetti, Jess Bell, Tarina van der Stockt, Naomi O'Reilly and Kim Jackson

Introduction[edit | edit source]

Children with physical disabilities can have difficulty maintaining their body position in a seated position during the school day. The effort to maintain their body position shifts their attention away from learning. Children with mild motor impairment may display excessive movement in and around their seat. Children with significant motor involvement may struggle to manage components of their body, which can affect head and trunk control and the positioning of their extremities.[1]

A commonly used intervention to enhance head and trunk stability in children with physical disabilities is adaptive seating.[2][3] The use of adaptive seating can help develop motor skills, facilitate arm and hand mobility, self-feeding, visual scanning and tracking and reduce the need for assistance from caregivers.[3] Studies have shown that individuals using adaptive seating often have positive experiences, including increased performance of activities of daily living and social interaction.[4]

Behaviours[edit | edit source]

Children with mild disability may have issues with core strength, vision, fatigue or muscle tone. Some observable behaviours that may indicate that adaptive seating is necessary include:[1]

  • Falling out of a chair
  • Getting in and out of their seat beyond what is allowed / acceptable
  • Frequent position changes
  • Wrapping legs around chair legs
  • Slumping over their desk
  • Propping themselves on their desk
  • Holding their head on their hand


** Children with significant disabilities will often have more than one seating or positioning device such as a stander, wheelchair and/or walker.[1]

Positioning[edit | edit source]

Physiotherapists and Occupational Therapsits can be involved in recommending adaptive seating to facilitate functional positioning, improve performance of manipulative skills and increase sitting comfort.[2] A thorough posture evaluation looking at the pelvis, trunk, head and extremities is necessary to determine optimal seating. Traditional seating guidelines encourage 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[1]
  • Both arms resting comfortably on the desk without causing the shoulders to elevate / shrug


** The fit is considered appropriate if the child sits in the chair within these parameters.[1]

Assessment[edit | edit source]

The SATCO (Segmental Assessment of Trunk Control) and the PPAS (Posture and Postural Ability Scale) are two free tests used for adaptive equipment selection and implementation.[5]

The SATCO is designed to test the degree of trunk control. The examiner progressively alters the level of trunk support, moving from fully supported sitting to free sitting. It assess control proximally from the head to the lumbar spine, and measures static control, active / anticipatory control, and reactive control. This assessment enables the clinician to determine at which level trunk control issues arise and enables a "level-by-level" treatment approach.[6] More information on the SATCO is available in this article: Refinement, reliability, and validity of the Segmental Assessment of Trunk Control[6]

The Posture and Postural Ability Scale (PPAS) assesses quantity and quality of posture in supine, prone, sitting and standing. 'Quantity' is an individual's ability to stabilise their body segments in relation to each other / the supporting surface while 'quality' is the alignment of body segments.[7] Thus, this scale allows for posture and postural ability to be assessed separately. More information on the PPAS is available in this article: Psychometric evaluation of the Posture and Postural Ability Scale for children with cerebral palsy[7]

Modifications to Seating[edit | edit source]

Stabilisers[edit | edit source]

  1. Nonslip surfaces: applied to the seat of the chair to prevent sliding
  2. Theraband: stretched between the legs of the chair allows students to stabilise their feet rather than wrapping them around the chair
  3. Seat cushions: can be smooth or bumpy and/or inflated to different levels; can provide sensory input[2]
  4. Foot support: raises a student's feet to prevent them from dangling; can use wooden box or cardboard
  5. Desk modifications: change the angle of the writing surface; help with low tone, abnormal reflexes or poor grip patterns-grip strength can be improved when the wrist is in extension (a three-ring binder turned sideways or a slant board can help to achieve this position)
  6. Chair with arms: helps with lateral support and provides boundaries
  7. Additional stabilisers include: rolled towel, blocks, cushions, and bolsters - these can all provide positional support[1]

Movement Enhancers[edit | edit source]

  1. Seat cushion: disc cushions with a non-slip surface. The amount of air in the cushion provides different degrees of movement, which can help a child stay alert.[1] They also provide sensory input.[1][2]
  2. Chair leg modifications: tennis balls are placed on opposite legs of the chair to create a safe rocking motion (vs tipping the chair on two legs).[1]

Alternative Chairs[edit | edit source]

  1. T-stool: a wooden one-legged stool made in the shape of "T". It can help with engagement, focus, balance and perceptual motor skills.[1][5]
  2. Beanbag chair: good for listening and silent reading tasks. It is useful for students with fatigue issues,[1] and can help to decrease hyperactivity in children with autism.[5]
  3. Ball chairs: help to increase attention of students who have difficulty attending. They can improve vestibular and proprioceptive sense.[1][2]

Other Seating Options[edit | edit source]

  • corner chair

    corner chair

  • bolster chair

    bolster chair

  • sensory cushion

    sensory cushion

  • swiss ball chair

    swiss ball chair

  • adaptive swing

    adaptive swing

  • Adaptive playground swings

Wheelchairs[edit | edit source]

Wheelchair adaptive seating options include cushions, power tilt, recline, elevating leg rests, elevating seating and back/trunk supports. These adjustable features can help address a host of issues including:

  • Postural alignment
  • Postural control
  • Transfers
  • Contractures
  • Function
  • Orthopaedic deformities
  • Oedema
  • Pressure relief
  • Comfort
  • Dynamic movement
  • Other biomechanical issues[1]
  • Feeding
  • Dressing
  • Socialising
  • Engagement in the learning environment
  • Engagement in play

Another adaptation is residual limb positioning to avoid knee contractures.

Amputee Wheelchair - Adapted Shutterstock - ID 39150271.jpg

Resources[edit | edit source]

References[edit | edit source]

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Gierach J. Assessing students’ needs for assistive technology (ASNAT). Madison, WI: Wisconsin Assistive Technology Initiative (WATI) and the Wisconsin Department of Public Instruction (DPI). 2009 Jun.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Elsayed AM, Salem EE, Eldin SM, Abbass ME. Effect of using adaptive seating equipment on grasping and visual motor integration in children with hemiparetic cerebral palsy: a randomized controlled trial. Bulletin of Faculty of Physical Therapy. 2021 Dec;26(1):1-8.
  3. ↑ 3.0 3.1 Inthachom R, Prasertsukdee S, Ryan SE, Kaewkungwal J, Limpaninlachat S. Evaluation of the multidimensional effects of adaptive seating interventions for young children with non-ambulatory cerebral palsy. Disability and Rehabilitation: Assistive Technology. 2021 Oct 3;16(7):780-8.
  4. ↑ CPFamilyNetwork.org 2009. Available at https://cpfamilynetwork.org/resources/blog/adaptive-seating-devices-for-children-with-cp/
  5. ↑ 5.0 5.1 5.2 5.3 Mather D. Adaptive Seating Course. Plus. 2023.
  6. ↑ 6.0 6.1 Butler P, Saavedra MS, Sofranac MM, Jarvis MS, Woollacott M. Refinement, reliability and validity of the segmental assessment of trunk control (SATCo). Pediatric physical therapy: the official publication of the Section on Pediatrics of the American Physical Therapy Association. 2010;22(3):246.
  7. ↑ 7.0 7.1 Rodby-Bousquet E, Persson-Bunke M, Czuba T. Psychometric evaluation of the Posture and Postural Ability Scale for children with cerebral palsy. Clinical rehabilitation. 2016 Jul;30(7):697-704.
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