Adaptive Seating for Children

Original Editor - Robin Tacchetti based on the course by Dana Mather
Top Contributors - Robin Tacchetti and Jess Bell

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 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]

  • Adaptive playground swings
  • Chairlifts to enter pools
  • Adaptive bike seats
  • Strollers - these are like wheelchairs, but they fold easily and are lighter weight
  • 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.[5]
  • corner chair

  • bolster chair

  • sensory cushion

  • swiss ball chair

  • adaptive swing

Wheelchairs[edit | edit source]

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

  • Postural alignment
  • Transfers
  • Contractures
  • Function
  • Orthopaedic deformities
  • Oedema
  • Pressure relief
  • Comfort
  • Dynamic movement
  • Oher biomechanical issues[1]

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.