The Roles of Seating & Wheeled Mobility
For the child with a brain injury, optimally
fitted seating and wheeled mobility can
facilitate so many critical activities, from
reaching to playing and exploring.
One Child, Multiple
Everyday Environments
“Appropriate seating is essential for motor
function, cognition, feeding and communication,”
said Kristen Wagner, PT, DPT,
Certified Brain Injury Specialist and Team
Lead at Children’s Healthcare of Atlanta —
Scottish Rite. “We know that motor
function and cognitive skill acquisition are
linked, so as a PT, it is so important that my
patients have a way to access and explore
their environment.”
That includes, Wagner added, the many
environments a child can experience each
day: “We have to consider seating systems
to assist with transportation (personal vehicles
and school bus), feeding, communication,
weight bearing/upright standing, and
access in their home, daycare, or school.
Children with brain injury require seating
systems that are adaptable to their growing
skeletal system, and help to prevent further
deformity. Hip instability and scoliosis are
common in patients with high tone and
with poor postural control, so we really rely
on a good seating system to decrease or
minimize the occurrence. Seating and positioning
systems are really the key for a child
to participate in age-appropriate activities,
keep up with their peers, and engage with
their environment.”
Seating That Also Repositions
Ryan Rhodes, OTR/L, ATP/SMS, Pediatric
Sales Specialist for Sunrise Medical, noted
that children with brain injuries often inadvertently
move out of position, then can’t
reposition themselves. Dynamic seating
components can help in those situations.
“Two of the biggest focuses are keeping
the child safe and not letting them injure
themselves, and also maintaining the
integrity of the equipment that they’re
using,” Rhodes pointed out. “So sometimes
we’ll put a dynamic backrest on,
which is available on our activity chairs as
well as our Zippie line. We have dynamic
headrests and dynamic legrests. Those
two factors, protecting the equipment and
the patient, are the primary focuses.
“But even if they aren’t injuring
themselves or damaging their equipment,
[spasticity and extension] can still move
them out of the appropriate seated position.
Extension tone is a huge, common
activity that we see as a result of a brain
injury or spasticity: It causes them to bridge
across their chair, or if they’re sliding their
behind forward, it can result in a posterior
pelvic tilt or even shearing of the seating
surface interface. If they’re reliant on lateral
supports inside their chairs to sit upright,
now they’re in a lower position.”
That puts the child in a much less functional
position that can also raise the risk
for other complications. Adding dynamic
components to the seating system can
help to return the child to an optimal and
functional position once the extension
episode has passed.
“There’s a number of ways these kiddos
can move themselves out of their seated
position, and more often than not, they’re
unable to reposition themselves independently,”
Rhodes said. “So without a very
avid caregiver, we could start to see postural
deformities if they’re sitting inappropriately
for 12 hours through a school day, despite
all of our efforts at custom seating.”
This article originally appeared in the Oct/Nov 2020 issue of Mobility Management.