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.

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