Adaptive Seating for Children: Difference between revisions

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<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>
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Introduction ==
== Introduction ==
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">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>
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>


A commonly used intervention to enhance head and trunk stability in children with physical challenges 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 increases in 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>. This improvement in function is often maintained even after the use 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>  


=== Behaviours ===
== Behaviours ==
Children with mild disabilities may have issues with core strength, vision, fatigue or muscle tone. Some observable behaviours that indicate alternative seating is necessary include:  
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 the chair
* getting in and out of their seat beyond what is allowed
* frequent position changes
* wrapping legs around chair legs
* slumping over their desk
* propping themselves on the desk
* holding their head on their hand<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" />
<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" />


=== Positioning ===
== Positioning ==
Physiotherapists 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 encompass the following:
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:
 
* feet resting on the floor
* ankles dorsiflexed to 90 degrees
* knees flexed to 90 degrees
* hip flexed 90 degrees
* hips well back in chair<ref name=":2" />
* both arms resting comfortable on desk without causing shoulders to shrug
 
<nowiki>**</nowiki> The fit is appropriate if the child fits within these parameters. <ref name=":2" />
 
=== Modifications to Seating ===
 
==== Stabilisers ====
 
 
 
''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''<ref name=":0" />
 
. ''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" />''
 
''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<ref name=":1" />''
 
''addle Seats (Bolster Chairs)''
 
''© www.theradapt.com''
 
''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''
 
''© www.especialneeds.com''


''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.''
* 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" />


''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.''
== 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>


''External Supports''
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" />


''© www.especialneeds.com''
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" />


''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.''
== 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" />


''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.''
=== 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" />


''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.''
=== 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" />


''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.''
=== 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>


''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.''<ref name=":1" />
* Adaptive playground swings


* 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]


=== 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:


''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.<ref name=":2" />''
* Postural alignment
* Postural control
* Transfers
* Contractures
* Function
* Orthopaedic deformities
* Oedema
* Pressure relief
* Comfort
* Dynamic movement
* Other biomechanical issues<ref name=":2" />
* Feeding
* Dressing
* Socialising
* Engagement in the learning environment
* Engagement in play
Another adaptation is residual limb positioning to avoid knee contractures.
[[File:Amputee Wheelchair - Adapted Shutterstock - ID 39150271.jpg|center|thumb|248x248px]]


== 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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