Specialist Seating
Why do we need specialist seating?
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Specialist Seating
Why do we need specialist seating??
Background
Most of the children who are in our centres have some form of difficulty caused by damage to their brain,
either from birth, or as a result of trauma to their brain after birth, or related to their diagnosis. Most have
physical problems, and struggle to sit up or move on their own. They struggle to eat and need help, and many
won’t learn to talk or walk.
Specialist seating is not just and alternative chair because a child will fall out of an ordinary one!
It is an important therapeutic tool to help reduce deformities of the skeleton, and
dislocations of joints. It’s there to help reduce pain and make certain that a child’s internal
organs such as stomach, bowel and lungs do not get squashed by poor posture and twisted
skeleton.
Why do children’s bodies become twisted?
The brain is a very complex organ and it
controls our movement and how our
muscles move (flex and extend.)
All our muscle work in pairs. One pulls
whilst the other stretches - this moves our
bone.
Electrical pulses are sent from our brains to
tell the muscle to contract, when this
happens the muscle pulls and moves the
bone
Why do we need specialist seating?
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Specialist Seating
When damage to the motor control centres
of the brain happens, the nerve cells
(neurons) in these areas die, the
appropriate signals can no longer be sent to
the muscles under their control. The
resulting poor control of these muscles
causes the symptoms we see.
There are lots of sub types of muscle
damage caused by brain trauma, but for
the purpose of seating in this booklet it
focusing on two
Spasticity - Which is when we see children
with tight limbs. Hypotonic--Muscles are
floppy, without tone.
Our muscles control our skeleton; as they
continue to pull the skeleton into flexed,
tight position the bones start to dislocate or
fix.
Spastic. Muscles are rigid,
posture may be abnormal,
and fine motor control is
Scoliosis impaired
This does cause pain!!
Scoliosis (twisted spin /back) causes
changes in posture, and damage to internal
organs.
Once the skeleton starts to twist it pushes
our internal organs like stomach and
bowels, making it difficult to eat and
defecate. It also pushes on the lungs
making it more difficult to breath
Hypotonic--Muscles are floppy, without
tone. Children with hypotonia have
noticeably “floppy” muscles and limited
control of their head. The arms and legs
hang down like a “rag doll.” Joints may be
lax. Reflexes may be poor, and walking is
usually difficult. The condition causes
postural problems and may cause breathing
and swallowing difficulties.
All these problems happen on a scale,
meaning they can have the difficulties a
little bit (mildly) or more severely.
All types of muscle difficulties have an
impact on the child’s ability to eat, drink
and breath; a child can have longer term
problems such as deformities of the
skeleton and pain.
Why do we need specialist seating?
Mild
Severe
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Specialist Seating
Specialist Seating
A specialist seat can help prevent the
difficulties with these problems. If a child is
seated correctly the chair can help to
reduce the effects of tightening muscle,
and support a floppy body. If used correctly
then a child’s health can be maintained.
Pelvic Stability
The most important feature of any seating
or mobility system is ensuring you can
maintain good pelvic position
1.
The back of the seat must be
upright in a 90 degree position.
Child must have their bottom at
the back of the seat. Once this 90
degree angle is achieved the whole
chair can be’ tilted in space’,
particularly for a child with low
muscle tone.
2.
Ensure that the pelvic strap is fixed
firmly across the child’s hip to
prevent slipping
3.
Feet must be positioned and
resting on a footplate promoting
pelvic stability.
Why do we need specialist seating?
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Specialist Seating
Reconditioned seating
Many of the chairs that arrive in the centre
are chairs that have come from other
places.
This chair is then adapted to fit the needs
of the specific child.
When seating a child we need to ensure
that the legs are kept in a straight line, from
pelvis to knee.
To ensure the seat is a good fit for the child
You will need to focus on the seat depth,
seat width, seat back height, seat to
footrest. To make this more accurate you
need to measure the child.
1.
Seat depth –measure from bottom
to just behind the knee –there
needs to be a two finger gap from
behind the knee to edge of seat.
2.
Seat to foot reset –measure from
back of knee to bottom of foot
3.
Seat width –measure across hip
width
4.
Seat back height. This is from the
bottom to back of shoulders
4
1
3
2
As many of the children do not walk and
spend most of their day in their seating, or
in bed, the muscles in their legs are weak. It
is our muscles that help keep our joints in a
good position, and prevent dislocations and
contractures.
When children sit in a chair in a ‘frog
legged’ positions (where the femur is
externally rotated, flexed and abducted)
this loosens the muscles and will lead to hip
dislocations and pain.
To help prevent this we need to ensure the
child has lateral side support on the
seating, which will help keep the legs in a
forward position, preventing the ‘frog’
position
Femur
Additional side laterals
Some chairs will have lateral pads which
can be moved in. These laterals move in to
be a snug fit against the child’s legs
ensuring they can not return to a ‘frog’
legged position.
Why do we need specialist seating?
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Specialist Seating
If there is no lateral side support option on
the chair then rolled towels or pieces of
rolled clothing can help.
Children can also have tight muscle which
causes a scissoring effect on their legs.
They have a very stiff feel to their legs and
it is difficult to place them.
With these children, seating is more
difficult. We can help the scissoring by
placing pommels between their legs.
If you don’t have a pommel for the seat
then again a rolled towel, or soft toy can
help.
Pommel
If a child has a spine deformity, such as a
scoliosis, in the absence of a moulded
seating system it helps to support the back
by tilting the chair at a slight angle and
placing cushions/soft toys in the spinal gaps
offering some form of relief. DO not make
the stuffing firm, just soft and supportive.
Shoes and Boots
Many of the children in St Margaret’s do no
walk. Yet it is still very important that they
wear shoes
??Why
Shoes for these children help with two
things.
Firstly they help stretch the muscles. This
begins the process of correcting the foot
position. This is very beneficial to them.
Secondly when they sit in their specialty
seat the boots and shoes help ensure they
stay in a good seated position. If their feet
are fixed on a foot plate, their hips are kept
more inline.
Why do we need specialist seating?
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Specialist Seating
Without good foot placement the child will
often slip forward and their hips will not be
in a good position, and the child is then at
greater risk of hip dislocation, contractures
and deformities.
Why do we need specialist seating?
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Specialist Seating
Additional Information
Goals of Special Seating
Areas for consideration when customizing a seating system include the headrest, seat and back inserts,
anterior and lateral trunk supports, arm supports, and leg supports.
A seating system that allows change in orientation in space is a consideration for children who are unable to
fully control movement of the head and trunk, and have respiratory and/or gastrointestinal problems such as
reflux.
Children who have limitations with movement may require pressure relief in sitting. Skeletal asymmetries, skin
temperature, moisture and shear and compressive forces can contribute to the development of pressure sores
(Crenshaw & Vistnes, 1989). There are a variety of cushion materials available to meet the individual
requirements for pressure relief, including air
Research indicates that being more upright can improve pulmonary function (Nwaobi & Smith, 1986), oral
motor control during eating and drinking (Hulme, Shaver, Acher, Mullette, & Eggert, 1987), and social
participation (Hulme, Poor, Schulein, & Pezzino, 1983). Children who spent more time sitting and less time
lying down were reported to maintain better alignment in sitting and have more social interaction (Hulme et
al., 1983; Hulme et al., 1987).
Based on clinical and research evidence, it is widely accepted and common practice for the general goals of
seating and positioning to include:
1 Normalising tone or decreasing its abnormal influence on the body
2 Maintaining skeletal alignment
3 Preventing or accommodating skeletal deformity
4 Providing a stable base of support to promote function
5 Promoting increased tolerance of the desired position
6 Promoting comfort and relaxation.
7 Facilitating normal movement patterns or controlling abnormal movement patterns
8 Managing pressure or preventing the development of pressure sores.
9 Decreasing fatigue
10 Enhancing autonomic nervous system function (cardiac, digestive and respiratory function)
11 Facilitating maximum function with minimum pathology (Jones and Gray 2005).
The outcomes of poor postural management are well documented as increased dependency (Turner, 2001),
tissue trauma (Turner, 2001; Gilinsky, 2006; McClinton, 2007), contractures and spasticity (Gilinsky, 2006;
McClinton, 2007), poor systemic function, for example respiratory, cardiovascular and digestive functions
(Turner, 2001; Gilinsky, 2006); immobility (Cutter, 1997; McClinton, 2007), increased pain and discomfort, and
muscular fatigue (Cutter, 1997; Turner, 2001). As postural control is a pre-requisite for most functional tasks,
the inability to control posture has a significant impact on function (Hong, 2002). A seating system that does
not match the needs of the user is less likely to provide adequate postural support and may therefore limit
function rather than promote it (Di Marco, 2003).
In addition, children and young people with physical disabilities are often placed in their seating systems for
several hours per day (Janson, 2005) further increasing the importance of optimum postural support and
positioning to prevent unnecessary dependency, skin breakdown, pain, fatigue, immobility, and to improve
function.
Why do we need specialist seating?
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Specialist Seating
Aim of a seat
The goal is to achieve maximum symmetry between left and right sides of the body via a neutral pelvis to avoid
obliquity, rotation and posterior tilt of the pelvis (Lange 2001).
Research literature: Historically, the 90-90-90 posture (90 degrees of flexion at the hips, knees and ankles) was
seen as the ideal seating position. However, more recent practice views this simply as a useful ergonomic
perspective (Engström, 2002).
The seats for CID will be set before the therapists leave and should not be adjusted by any other person who
is not a qualified therapist.
Why do we need specialist seating?
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