Adaptive Seating for Children
Introduction[edit | edit source]
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.[1]
A commonly used intervention to enhance head and trunk stability in children with physical challenges 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 increases in performance of activities of daily living and social interaction.[4]. This improvement in function is often maintained even after the use of the intervention.[2]
Behaviours[edit | edit source]
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[1]
** 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 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 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[1]
- both arms resting comfortable on desk without causing shoulders to shrug
** The fit is appropriate if the child fits 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 from head to thoracic to lumbar to none. This assessment provides specified level of trunk control difficulties leading to correct level treatment approach.[6]
The Posture and Postural Ability Scale (PPAS) assesses quantity and quality of posture individually in supine, prone, sitting and standing. Quantity is defined by the ability to stabilise the body segments while quality refers to the alignment. [7]Thus, this examination allows for posture and posture ability to assessed seperately.
Modifications to Seating[edit | edit source]
Stabilisers[edit | edit source]
The following examples are ways to help stabilise a child in their chair:
- Nonslip surfaces: applied to the seat of the chair to prevent sliding
- Theraband: stretched between the legs of the chair allowing student to stabilise feet rather thank wrapping around chair
- Seat cushions: can be smooth or bumpy and/or inflated to different levels; can provide sensory input[2]
- Foot support: raises student's feet to prevent feet from dangling; can use wooden box or cardboard
- Desk modifications: change the angle of the writing surface; helps with low tone, abnormal reflexes or poor grip patterns-grip strength can be strengthened when the wrist is in extension (three-ring binder turned sideways or a slant board can help achieve this position)
- Chairs with arms: helps with lateral support and provides boundaries
- Additional stabilisers: rolled towel, blocks, cushions, bolsters can provide positional support[1]
Movement Enhancers[edit | edit source]
The following are ways to enhance movement when seated:
- Seat cushion: disc cushions with a non-slip surface; different level of air in cushion provides different movement degree and can provide sensory input[1][2]
- Chair leg modifcations: tennis ball placed on opposite chair legs to create a safe rocking motion as opposed to tipping on two legs[1]
Alternative Chairs[edit | edit source]
- T-stool: wooden one-legged stool made in the shape of "T"; help with engagement, focus, balance and perceptual motor skills[1][5]
- Beanbag chair: good for listening and silent reading tasks; good for students with fatigue issues[1]
- Ball chairs: increase attention for students who have difficulty attending; can improve vestibular and proprioceptive sense[1][2]
Various Other Seating[edit | edit source]
- playground swings
- chairlifts to enter pools
- adaptive bike seats
- stroller-like wheelchairs that fold easily and are lighter weight
- toilet and shower chairs
- feeding chairs
- activity chairs
- saddle chairs: help maintain hip flexion; individuals with stiffness in legs
- corner chairs: individuals who require more support; assist with visual scanning, breathing, eating, and arm mobility; ideal for children who lack postural control of the head, neck, or trunk. [5]
Wheelchair[edit | edit source]
Wheelchairs offer modifications to include cushions, power tilt, recline and elevating legs rests. These adjustable features an help address the various issues:
- postural alignment
- transfers
- contractures
- function
- orthopaedic deformities
- oedema
- pressure relief
- comfort
- dynamic movement
- other biomechanical issues[1]
Resources[edit | edit source]
http://www.atilange.com/resources.html
RESNA
References[edit | edit source]
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 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.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 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.
- ↑ 3.0 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.
- ↑ CPFamilyNetwork.org 2009. Available at https://cpfamilynetwork.org/resources/blog/adaptive-seating-devices-for-children-with-cp/
- ↑ 5.0 5.1 5.2 Mather, D. Adaptive Seating. Plus. 2022
- ↑ Butler, P., Saavedra, M.S., Sofranac, M.M., Jarvis, M.S. and Woollacott, M., 2010. 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, 22(3), p.246.
- ↑ 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.
