extend to his sides, and when his mother attempts to feed him, his hands move to his mouth. Paul’s movements worsen with anxiety, such as worrying he may hurt his arms in the doorway – leading to the very movement he hopes to avoid. Paul’s mom came up with a great solution. She made two neoprene bracelets, one for each wrist. She then attached a cord to each bracelet and to the opposite footrest hanger. Paul could move his arms, but not out far enough to get near the door frame and not high enough to interfere with feeding. Once Paul knew that he could not move in these directions, his anxiety lessened, and these movements lessened. Addressing self-abusive movements Movements of the upper extremities that cause injury to clients themselves may be intentional or compulsive. Some clients engage in these behaviors as a form of self-stimulation or as a component of anxiety. Clients with diagnoses including Cornelia de Lange syndrome and Lesch- Nyhan syndrome have a compulsive drive to self-injure and, in the case of the latter, to injure others, that is involuntary (Harris, 2018). Interventions are similar to some used for uncontrolled movements. In severe cases, the client must be restrained to prevent self-harm. For clients who may be seeking stimulation, it is important to provide alternative sensory input, a means of communication, and independent control. The goals of addressing self-abusive movements are to reduce the risk of injury to the client or others and reduce anxiety by making the client feel safe.
Figure 61: Laterally Facing Cuff
Controlling or limiting uncontrolled movements of the upper extremities can reduce risk of injury to the client and others, reduce anxiety, and increase stability to allow for functional tasks. Case study Paul is a 10-year-old boy with the diagnosis of athetoid cerebral palsy. He has significant extraneous movement. Whenever he is pushed in his manual wheelchair toward a doorway, his arms Dynamic seating Dynamic seating allows movement of the client within the seating system. This is accomplished in two primary ways. First, the client moves away from and returns to the seating system. This most often occurs when a client is able to move the trunk away from the back of the seating system, either forward or to the side, and return to upright independently. In this case, the seating system itself does not move; only the client moves in relation to the seating system. Sometimes secondary seating components, particularly anterior trunk supports, are dynamic and allow movement of the client in relation to the primary support surfaces (such as by leaning forward). The dynamic feature of these supports is elasticity, allowing the material to stretch in response to client force and then assisting the client back to an upright posture. Second, the seating system itself may move in response to client force and then return the client to a neutral starting position. Movement is at the hips, knees, ankles, and/or neck. Goals of dynamic seating Dynamic seating may have many goals. Three main goals are as follows: 1. Provide client movement : Seating systems are typically static, and clients who require significant postural support have little movement. People in seating systems move for many reasons. Movement provides comfort while in a seated position by restoring blood flow to compressed tissues. Movement can increase alertness and reduce agitation. Movement also provides sensory stimulation (Ball et al., 2017b). 2. Diffuse force to reduce muscle tone : A client with increased muscle tone often extends against his or her seating system. Allowing movement of the components causes the force to diffuse, often reducing muscle tone (Ball et al., 2017a).
SPECIFIC APPLICATIONS FOR SEATED MOBILITY: DYNAMIC SEATING
3. Diffuse force to protect the client and seating equipment : A client who extends with significant force against his or her seating system often breaks components. Even children who are quite slight can exert enough force as a result of abnormal muscle tone to break mounting hardware. Dynamic components are sometimes designed specifically to protect the seating equipment itself (Ball et al., 2017a). Even more important is to protect the client from injury as a result of these significant forces. Functionally, dynamic seating diffuses force, which may reduce muscle tone, friction/shear, and energy expenditure. The resulting movement provides active range of motion, increases sitting tolerance, and may reduce agitation and increase alertness. Product options Some dynamic systems provide movement in more than one area at once, such as the hips and knees. Other systems provide movement at one location only, through hydraulics, springs, or elastomers (Figures 62 and 63). These systems can generally be used on more than one type of wheelchair frame. Figure 62: Dynamic Seating System
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Book Code: PTNC1023
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