Magazine article The Exceptional Parent

Selecting a Seating System

Magazine article The Exceptional Parent

Selecting a Seating System

Article excerpt

It is critical that children be sitting as well as possible before considering their potential for access to other technologies, such as mobility devices. Because the child usually controls other technology (e.g. adapted toys, communication devices, computers) from the wheelchair, selection of the seating system for the wheelchair is most important.

The process of assessing a child for a seating system must include all people who interact with the child on a daily basis (i.e., family members, peers, teachers, teacher assistants, therapists, etc.) because these people know the level of function expected of the child. Physical and occupational therapists, rehabilitation technology suppliers, and rehabilitation engineers can be especially helpful in translating the child's functional ability and positioning needs into technological solutions. Following their evaluation, the seating team will make recommendations to the family regarding the type of system, the support contours, and the components appropriate for a given child.

The assessment results will indicate the technology that will best meet the child's needs. As there are so many choices of seating systems and wheelchairs, and because prices can range from hundreds to thousands of dollars for each component, the technology selection must be made carefully. Mistakes are costly, and children may be forced to use inappropriate technology for years until new financing is found.

In selecting the seating system, the team will look at the physical, psychosocial, economic, growth, and height considerations that will affect the child.

Physical considerations

Children with physical disabilities have somewhat predictable physical conditions.

* Those with spinal cord injuries have no or partial sensation or muscle activity below the level of their injury. If the spinal cord is damaged just above the waist, then the legs and lower trunk are paralyzed and there is no feeling or voluntary movement below the site of the damage. If the injury is to the neck, the arms and trunk also experience motor and sensory loss. Therefore, the seating system should be selected for its ability to relieve pressure, thus preventing skin breakdowns from occuring, and for its ability to provide sufficient support to ensure a stable midline posture.

* Children with spina bifida, a congenital lesion of the spinal cord, have no sensation or muscle ability below the level of their spinal deformity; often, they have very thin skin over the areas on the back where surgery has been performed to repair the birth defect. Again, the seating system must prevent skin breakdown. Being seated on a good quality cushion or foam helps prevent injury under the buttocks; custom contouring is often needed to accommodate the abnormal curvature of the spine. Alternate floor-level mobility, such as caster carts or hand-propelled mobility devices, help prevent injury to the legs and heels that occur as the children pull themselves around on the floor. Children with spina bifida or spinal cord injuries are also incontinent, so seating materials must be soil-resistant until a routine is established to manage bowel and bladder care.

* Children with cerebral palsy have problems with muscle tone and/or muscle coordination. If they have too much tone, their bodies will be stiff. …

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