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Seating and positioning.

The bulk of available information on postural control relates to children with cerebral palsy, while the pressure relief field tends to focus on adults who have sustained a spinal cord injury Much of what is written in both areas is also broadly applicable to wider age ranges and to other disability categories.

Seating, whether for pressure relief or for postural control, is not only an area of major concern, but one of tremendous controversy. Everyone seems to have their own opinions about what works and what doesn't.

Although one of the important functions of a wheelchair cushion is the prevention of pressure sores, there are other functions which, for some people, are more relevant. In a survey conducted by RESNA, we asked people why they had been given wheelchair cushions. Forty-four percent replied that this was to make sitting more comfortable. Twenty-two percent said that it was to reduce the likelihood of tissue damage and the resultant pressure sores. Occasionally, and quite wrongfully, a cushion was prescribed to compensate for a wheelchair which was the wrong size for the individual.

In addition to providing a stable seat, the wheelchair cushion improves comfort, aids posture and reduces the transmission of shock during propulsion over uneven surfaces. Wheelchair cushions also provide aid to patients when they are being transferred to other support surfaces and, for a relatively small proportion of wheelchair users, the wheelchair cushion provides a vital function by reducing local concentration of stress in tissue to prevent tissue ulceration.

Not all these functions apply to every wheelchair user, and not all cushions fulfill every function. Nevertheless, a sling seat would not normally be chosen for prolonged sitting. It is probable that if all patients were properly assessed, cushions would be automatically prescribed with most wheelchairs - unless there were definite contradictions.

The social costs associated with pressure sores are even greater than the medical costs. These costs include: (1) time lost from a productive vocation with its attendant economic impact on individual and family; (2) time lost from school, which has far-reaching and long-term impact because the person with a disability's vocational potential is limited, which generates long-term dependency; (3) loss of time from the family, which can have a significant psychological impact on the person's social development; and (4) loss of general personal independence and productivity that ultimately contributes to a serious loss of self-esteem and self-worth.

The most commonly cited causes of pressure sores included:
 1. Prolonged sitting during daily activities, such as
 card playing and video games.
 2. Use of old, deteriorated wheelchair cushions.
 3. Activities that involve sitting on uncushioned
 areas, such as a bathtub, or sitting on a floor to
 play with young members of the family.
 4. Falls while transferring from a wheelchair or bed.
 5. Sitting too soon after a surgical procedure to
 correct a vertebral defect or even during the
 comprehensive rehabilitation process.
 6. Excessive sweating or irregular attention to a skin
 condition.
 7. Wearing clothing that has exaggerated seamlines
 (such as jeans), which can cause pressure to
 concentrate on areas that would normally not carry
 significant loads.


In the early 70's, specialized seating was recognized as a means to work toward therapeutic goals outside of regular therapy. Proper positioning helped the client with neuromuscular involvement fulfill the basic therapeutic goals of achieving maximum function and comfort with minimal abnormal movement. Seating and positioning technology now encompasses a wider range of needs, yet basic criteria must still be considered, including:
 * comfort, to allow the person to sit safely for six to
 eight hours at a time
 * tissue protection, to reduce the risk of pressure sores
 * function, to maximize the individual's potential for
 activity
 * practicality, to allow easy access to their
 environment
 * physiology and anatomy, to diminish the progress
 of deformity
 * mobility, providing as much independence as
 possible
 * cosmesis, to promote acceptance of the equipment
 by the individual.


A seating system is an intimate part of a person's life and must, therefore, be selected with great care. The complexity involved requires seating clinics to be staffed by a multi-disciplinary team.

The process begins with a consideration of the pelvic position, with the goal of providing a firm, stable and symmetrical base of support. The trunk and head are then considered in order to maximize function of the upper extremities and decrease the danger of developing deformities. Proper positioning of the lower extremities is also important.

However, emphasizing the use of commercially available systems decreases technical costs and allows the therapists greater involvement in fitting the system to the client. To help simplify the discussion of commercially available products, they are categorized into two groups, modular and custom:

1. Modular Seating Systems can be characterized as prefabricated standardized components which are available in a variety of shapes and sizes. Seating components can be purchased as a unit from a single company or separately from various companies. Companies often offer additional support components designed to attach easily to the basic system. Components from other companies, such as seat cushions, seat backs, trunk supports, pelvic positioners, shoulder positioners, lap trays, etc., can often be found that provide "just the right kind of support."

2. Custom Seating Systems entail the fabrication of contoured support surfaces that meet the customized needs of an individual. Custom contoured systems are now available that can be completed in one day.

Consideration must be given to the mobility base in which the seat will be placed. Manufacturers, listening to the needs expressed by seating specialists, are developing wheelchair bases with features specifically designed for improved seating and positioning.

Meeting the seating needs of individuals with disabilities can be a difficult but very important task. Tremendous progress has been made in providing technological solutions to enable seating programs to effectively respond to the needs of their clients.

Under development are expert computer systems used to assist clinicians in prescribing seat cushions, as well as computer-based devices to measure seating interface pressure and contours.

Although there is more consensus than there used to be, there is still considerable controversy about the most appropriate ways to achieve seated postural stability and pressure relief.

This excerpt is adapted from Assistive Technology Sourcebook by RESNA Press, see page 74.
 CANADIAN POSTURE &
SEATING CENTER
15 Howard Place
P.O. Box 1473, Station C
Kitchener, Ontario N2G
4P2,Canada
(519) 743-8224
 CANADIAN WHEEL
-CHAIR MFG. LTD.
1316 Blundell Road
Mississauga, Ontario L4Y
1M5, Canada
(416) 275-3960
 COMMUNITY
PLAYTHINGS RIFTON
EQUIPMENT FOR THE
HANDICAPPED
Route 213, Rifton, N.Y 12471
(914) 658-3141
(914) 658-3143
 CONCEPT SEATING INC.
591 Warren Ave.
North Swansea, Mass. 02777
(401) 276-2631
(401) 272-4752
 CONSUMER CARE
PRODUCTS INC.
P.O. Box 684
Sheboygan, Wis. 53082
(414) 459-8353
DYNAMIC SYSTEMS INC.
Route 2, P.O. Box 182b
Leicester, N.C. 28748
(704) 683-3523
EQUIPMENT SHOP
P.O. Box 33
Bedford, Mass. 01730
(617) 275-7681
 EVEREST AND
JENNINGS INC.
3233 East Mission Oaks Blvd.
Camarillo, Calif. 93010
(800) 235-4661
(805) 987-6911
 G.E. MILLER INC.
540 Nepperhan Ave.
Yonkers, N.Y. 10701
(800) 431-2924
(914) 969-4036
 GUNNELL INC.
8440 State St.
Millington, Mich. 48746
(517) 871-4529
(800) 551-0055
 J.A. PRESTON CORP.
60 Page Road
Clifton, N.J. 07012
(201) 777-2700
(800) 631-7277
 JAY MEDICAL LTD.
P.O. Box 18656
Boulder, Colo. 80308-8656
(303) 442-5529
(800) 648-8282
 MEDICAL ARTS
4715 Dixie Highway
Draton Plain, Mich. 48020
(313) 853-1879
 MEDICAL EQUIPMENT
DISTRIBUTORS
Medical Services Dept.
3993 South Loop 289
Suite 150
Lubbock, Texas 79423
(800) 253-413
(806) 793-8421
 MOBILITY PLUS
P.O. Box 391
215 N 12th St.
Santa Paula, Calif. 93060
(805) 525-7165
 MULHOLLAND
POSITIONING SYSTEMS
215 North 12th St.
P.O. Box 391
Santa Paula, Calif. 93060
(805) 525-7165
 NADA CHAIR
2012 Como Ave. S.E.
Minneapolis, Minn. 55414
(800) 722-2587
 ORTHO KINETICS INC.
W220 N507 Springdale Rd.
P.O. Box 1647
Waukesha, Wis. 53187
(414) 542-6060
(800) 446-4522
 OTTO BOCK
3000 Xenium Lane N.
Minneapolis, Minn. 55441
(612) 21-3634
 PATIENT COMFORT
1421 Champion Dr.
Suite 311
Carrollton, Texas 75006
(214) 241-4340
 PIN DOT PRODUCTS
6001 Gross Point Road
Niles, 111. 60648-4027
 800) 451-3553
(312) 774-1700
 PREMIER SOLUTIONS
2150 S. Country Club #5
Mesa, Ariz. 85210
(800) 526-0982
(602) 967-4503
 PYRAMID
REHABILITATION
4993 Southern Ave.
Memphis, Tenn. 38117
(800) 962-7615
 QUICKIE DESIGNS INC.
2842 Business Park
Fresno, Calif. 93727
(800) 456-8168
(209) 292-2171
 R & H ADAPTIVE
EQUIPMENT CO.
P.O. Box 175
Thompson, Iowa 50478
(515) 584-2025
 REHAB CENTRE
FOR CHILDREN
633 Wellington Crescent
Winnipeg, Manitoba
R3M 0A8, Canada
(204) 452-4311
 SCOTT DESIGNS
1132 Ringwood Court
San Jose, Calif. 95131
(408) 433-3863
(408) 947-0431
 SNUG SEAT
P.O. Box 1141
648-B Mathews-Mint Hill Rd.
Mathews, N.C. 28106
(704) 847-0772
 SPECIAL HEALTH
SYSTEMS LTD.
225 Industrial Parkway S.
Aurora, Ontario L4G 3V5
Canada. (416) 841-1032
 THERADAPT
PRODUCTS INC.
17 W 163 Oak Lane Road
Bensenville, ILL. 60106
(708) 834-2461
 WHEEL RING INC.
175 Pine St.
Manchester, Conn. 06040
(203) 647-8596


In addition to this list, parents can obtain information on seating and positioning systems by contacting ABLEDATA. ABLEDATA (funded by the National Institute on Disability and Rehabilitation Research of the U.S. Department Of Education) is a database of over 15,000 products useful to persons with disabilities from over 1,900 companies. For further information, contact: ABLEDATA, Adaptive Equipment Center, Newington Children's Hospital, 181 East Cedar St. Newington, Conn. 06111, (800) 344-5405, (203) 667-5405, voice or TDD. Reports are free up to eight pages. There is a nominal charge for longer reports.
COPYRIGHT 1990 EP Global Communications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1990 Gale, Cengage Learning. All rights reserved.

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Title Annotation:includes list of companies which offer seating products for children with disabilities
Publication:The Exceptional Parent
Article Type:Directory
Date:Jul 1, 1990
Words:1565
Previous Article:Preparing Camille for surgery.
Next Article:The Pepper Commission on long-term health care.
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