Adaptive Seating for Children

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.

A commonly used intervention to enhance head and trunk stability in children with physical challenges is adaptive seating. 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. Studies have shown that individuals using adaptive seating often have positive experiences including increases in performance of activities of daily living and social interaction.. This improvement in function is often maintained even after the use of the intervention.

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:

• 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

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

Positioning

Physiotherapists can be involved in recommending adaptive seating to facilitate functional positioning, improve performance of manipulative skills and increase sitting comfort.A thorough posture evaluation looking at the pelvis, trunk, head and extremities is necessary to determine optimal seating. Traditional seating guidelines encompass 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
• both arms resting comfortable on desk without causing shoulders to shrug

** The fit is appropriate if the child fits within these parameters.

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)

© 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.

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.

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

RESNA