Figure 63: Two Types of Dynamic Backs
Figure 64: Dynamic Footrest Hangers
Note . Figure 64b is from Seating Dynamics, n.d.a, retrieved from http://www.seatingdynamics.com. © Seating Dynamics. Reprinted with permission. Figure 65: Dynamic Head Support Hardware
Note . Figure 63b is from “Dynamic Rocker Back,” by Seating Dynamics, n.d.b, retrieved from http://www.seatingdynamics.com/ rocker-back.html. © Seating Dynamics. Reprinted with permission. Dynamic components at the back open the seat-to-back angle in response to extension at the hips, diffusing force and returning the client to an upright position. Dynamic components at the knee extend in response to extension of the leg, again diffusing force. This movement is in an arc, so the component must move down and forward. One system also provides movement into dorsi and plantar flexion (Figure 64). Dynamic components placed behind the head support diffuse forces from neck extension, which is often part of a global extension pattern. Diffusing force in this location can reduce overall extensor tone as well as protect head support hardware and prevent the client from moving the head support out of position (Figure 65). These dynamic options can be used with a variety of head support pads. Pediatric seating Much of pediatric seating is similar to seating someone of any age. One of the major differences, of course, is growth. Children can experience growth spurts that require new pants, shoes, and even seating systems. Tone management can change seating needs in children with increased muscle tone. Changes to range of motion and orthopedic changes also occur with growth. Some children have progressive conditions that may require ongoing seating intervention over time (Furumasu, 2018). Goals of pediatric seating Pediatric seating is very dependent upon the type of mobility base used. Some of these seating systems and bases can accommodate infants. The mobility base often has more growth than is available in the seating system itself. For this reason, it is not uncommon for the seating system to be grown and replaced within the original mobility base. Linear systems offer the most growth and so are commonly used in pediatrics (Furumasu, 2018). Adaptive strollers and seating Adaptive strollers are commonly used with very young children (Figure 66a). These mobility bases are not designed for self- propulsion. Strollers work well for very young and very small children. An adaptive stroller may be recommended for an infant leaving the Neonatal Intensive Care Unit. The seat can often be reversed to face the caregiver so that a medically fragile infant or child can be monitored. Many strollers can accommodate medical equipment, including oxygen and ventilators. Tilt and recline functions may also be included. These features are important for an infant who is not yet able to tolerate upright sitting. Parents often accept adaptive strollers more readily than a wheelchair, as the strollers are perceived as more age appropriate for a very young child and more “typical.” Strollers are usually lightweight and fold easily for transport. Most families with young children who require adaptive seating do not have an accessible home or vehicle, as this has not yet been a need.
Adaptive strollers do, however, have limitations. Many strollers offer minimal seating options and therefore are appropriate only for children who have minimal postural support needs or who are seated in the stroller only for short periods of time, such as for quick trips. The seating system can sometimes be removed and placed on an indoor hi/lo base to allow the child to sit supported at floor level with peers or up at a table for meals. Many strollers have a fixed posterior tilt, which may assist with trunk and head control but places the child in a position of rest, rather than a position of function. Some strollers offer much less growth than wheelchair frames and, as a result, are outgrown quickly. Very young children can grow rapidly and may quickly require a new mobility base, including one that they can self- propel, if possible, and when functionally appropriate for normal development. Overall, strollers typically allow for little frame adjustment, which minimizes seating options. Figure 66a: Adaptive Stroller
Note . From Sunrise Medical, n.d., retrieved from http://www.sunrisemedical.com. © Sunrise Medical. Reprinted with permission.
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Book Code: PTNC1023
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