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Selecting a seating system.

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. Too little tone results in floppy "rag doll" postures. Those having spastic cerebral palsy most often have too little tone in their trunks and too much tone in their arms. They have difficulty sitting and using their arms or hands. For them, seating must be firm with sufficient trunk support so they will be able to move without fear. Children with athetoid cerebral palsy generally have too little tone most of the time, with sudden bursts of too much tone.

In these cases, the seating system should offer firm support and should restrict some of the extra movement. These abnormal tone patterns vary in degree from mild to severe and affect the amount of physical control the child has to perform functional activities.

Children with cerebral palsy also must deal with primitive motor patterns that resolve at an early age in children developing in a more typical fashion.

Not every child exhibits every reflex, and the intensity will vary by child. A teacher and family can consult with the child's clinicians to determine management procedures that will minimize the effects of these reflexes on the child's posture. These reflex patterns, as might be assumed, also affect a child's ability to activate a switch or participate in any activity that requires body motion.

The provision of a proper seating system will enhance the child's functional abilities. Improved posture will allow the child to focus attention on classroom activities. lt will also provide an added security and stability that will enable the child to use his or her hands for eating, activating a communication device, using a computer, manipulating classroom materials, or playing. In selecting technology for young children, it is important to remember that one device can never meet all the needs of an active, growing child. Besides the primary seating system, there are other devices that can provide access to many activities.

This material was excerpted from Technology in the Classroom: Applications and Strategies for the Education of Children with Severe Disabilities, Positioning, Access, and Mobility Module, one of four in a series of modules from the Technology in the Classroom kit, available only from the American Speech-Language-Hearing Association. The purpose of this module is to provide information about assistive technology that will be helpful in serving children with disabilities.

This 57-page manual provides basic principles regarding a child's positioning and mobility needs and the use of assistive technology to meet those needs. A suggested format for assessing and providing technology that will help a child access technical devices is provided, as is a discussion about using technology for environmental control.

Along with the overview and basic principles, orthopedic conditions, sensory status, functional skills, alternative equipment, psychosocial considerations and economic issues are discussed. The seven appendices provide resources for the technology, funding options, fact sheets and a case study.

For ordering information or to receive a free catalog, contact ASHA Fulfillment Operations, 10801 Rockville Pike, Rockville, Md. 20852-3279, (301) 897-5700, ext. 218 (8:30 a.m. to 5 p.m. EST).
COPYRIGHT 1993 EP Global Communications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1993 Gale, Cengage Learning. All rights reserved.

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Title Annotation:wheelchair evaluation
Author:Trefler, Elaine
Publication:The Exceptional Parent
Date:Jun 1, 1993
Words:1016
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