Specific seating options in adaptive strollers include sling, linear, and after-market options (using another manufacturer’s seating products on the stroller base). Sling seating is common and provides little postural support (Figure 66b). In fact, sling seating actually encourages a posterior pelvic tilt, lower extremity adduction and internal rotation, trunk flexion, scapular protraction, and neck flexion. Over time, this sling seat and back tend to stretch out, and posture may worsen. Stroller sling seating often is too short in seat depth and too tall in back height. The extra height in the back may serve as a headrest. Some strollers offer linear seat and back surfaces as well as other seating components, such as lateral trunk supports and pelvic positioning belts. A one-piece molded seating system can be placed on top of sling seating. The frame shape and diameters, as well as strength, of most strollers make mounting other after- market seating difficult. Figure 66b: Stroller with Sling Seating
a seat molded to the client, changes in size (due to growth) cannot be accommodated as easily as with a linear system. Also, molded seating is useful for clients with orthopedic asymmetries, and children may remain fairly symmetrical in their early years. Molded seating is appropriate for children when they are at high risk for developing asymmetries, such as a scoliosis; a molded system may lessen that risk by preventing postural collapse. Some children with profound muscle weakness or very low tone in the trunk may require molded seating to provide optimal postural support. Furthermore, the amount of intimate contact provided by this seating can control increased muscle tone and provide stability for children with athetosis or dystonia. Seating for a child who is self-propelling a manual wheelchair needs to be as lightweight as possible. Sometimes the combined weight of the wheelchair and seating system may exceed that of the child. The back height may need to be lower (below scapulae) to facilitate self-propulsion, as long as this height also provides adequate postural support. Some pediatric chairs are designed to provide self-propulsion for very small children; on these chairs the large wheel is sometimes placed in the front to accommodate a shorter arm stroke (Figure 67). These frames may offer less growth. Figure 67: Front Wheel Configuration for Small Children
Note. From “Cruiser Wheelchair,” by Convaid, n.d.a, retrieved from http://www.convaid.com/convaid-cruiser-wheelchair.html. © Convaid. Reprinted with permission. Pediatric manual wheelchairs and seating Pediatric manual wheelchairs typically offer significant growth in the frame and frame adjustments to support positional needs. Tilt-in-space manual wheelchairs are not designed for self-propulsion. These wheelchairs provide other positional benefits as well as pressure redistribution, fatigue management, and medical management (Cole, 2018). Recline is not typically available on pediatric manual wheelchairs, though the seat- to-back angle can usually be adjusted. Most children use 90° footrest hangers, placing the knee in approximately 90° of flexion. Although this positioning can lead to caster interference in teens and adults, children’s legs are short enough that this is not an issue. Pediatric manual wheelchairs rarely offer sling seating. Linear seating is common, as it can be mounted in such a way as to provide future growth. However, the therapist needs to make sure that appropriate pressure distribution is provided, especially for a client who is insensate and/or has bony prominences. Linear seating may include a seat depth that is overlong for the client, but if the excess length is positioned under and behind the back, this can be brought forward later as the child grows. Lateral trunk supports and lateral hip supports are sometimes placed on top of the seat and back, rather than to the sides. These can then be moved out laterally as the child grows in width. Built-in growth-for-width adjustment may not be appropriate for a child who self-propels in a manual wheelchair, as the overall width of the wheelchair may be too wide for the child to functionally reach the rear wheels for propulsion. It is never appropriate, in order to accommodate future growth, to recommend a seating system that is too large for a child, as current postural support needs and function will not be met (Furumasu, 2018). Off-the-shelf cushions and backs are also often used with the pediatric population, as long as these meet the client’s postural needs. Seating that provides some contouring to the body is desirable for comfort and midline alignment. For several reasons, molded seating is not as commonly used with children. With
Note . From Sunrise Medical, n.d., retrieved from http://www.sunrisemedical.com. © Sunrise Medical. Reprinted with permission. Ultra-lightweight manual wheelchairs are the lightest weight and most efficient for self-propulsion. In these situations, the seat-to- back angle may be more closed and the back shorter to optimize self-propulsion. This requires the child to have more trunk control. Few of these frames are crash-tested, and tie-down attachment hardware may not be present as this adds weight to the frame. The assumption is that a client using this level of wheelchair is able to transfer to a standard vehicle seat. These frames offer less growth, as growth capabilities add weight. If the child grows past a certain point, an entire new frame may be required. Dynamic seating with children Dynamic seating is sometimes used with children to provide movement within the seating system. This movement provides vestibular stimulation, may increase sitting tolerance, and diffuses muscle tone. Dynamic seating is available on several adaptive strollers and on most manual wheelchairs. However, it is important to keep in mind that these components do add weight. Power wheelchairs and seating Pediatric power wheelchairs support off-the-shelf cushions and backs, linear seating systems, and molded seating systems. A few of these also offer a standard “captain’s chair” style of seating system if the child’s postural needs are minimal. Power tilt and/or recline is often an option and complements the seating system by providing independent change to the seated angles. In general, power wheelchairs can support any seating system that is optimal for a child.
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Book Code: PTNC1023
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