Focus on Positioning Strollers

Choosing a Stroller That Works for Everyone

• By Laurie Watanabe
• Apr 01, 2021

A positioning stroller can be liberating for a family whose child needs significant postural support. These strollers, however, aren’t always embraced by parents who had been envisioning cute little strollers commonly seen on baby shower lists.

We asked a positioning stroller manufacturer, a seating clinician, and an ATP supplier how they work with parents who balk at positioning strollers.

The Manufacturer’s Perspective

Josh Tucker is the National Sales Manager for Leggero.

“The most common thing I hear from parents is they want their child to have the seating and positioning of a wheelchair, but without the ‘wheelchair’ look,’” Tucker said. “For parents, the aesthetics are important. We all want our children to roll around in equipment that looks like a stroller, if they can.”

But while manufacturers have to please many stakeholders, Tucker said, “Clinicians are such an important part of our industry. They interact with the parents more than any of us and know the child’s capabilities and limitations. My personal experience: Always go with the therapist.

“At the end of the day, the goal is to do what’s best for the child, not what looks the best. We need to hear and understand Mom and Dad’s wants, but if an ATP, a therapist and a sales rep are involved, then there are obviously some needs that have to be addressed.”

The Clinician’s Perspective

Andrina Sabet, PT, ATP, is Director of the seating clinic at Cleveland Clinic Children’s Hospital for Rehabilitation and is the owner of Mobility Matters LLC.

“I try to employ the ICF model [International Classification of Functioning, Disability & Health] in working with families on any kind of equipment that impacts their positioning and mobility needs,” Sabet said. “I think that model creates an opportunity for a landscape view because it looks at the interaction of the child’s body, structure and function. But it also takes into account their activities, their participation, their particular environment, their personal family factors. It brings everything together under one umbrella.”

Sabet said she prefers to start by talking generally about a family’s goals or preferences. “I try not to start with equipment when I look for equipment,” she noted. “A lot of times, a family can come in and say, ‘I want that stroller’ or ‘I want that wheelchair.’ I think it’s pretty cool to step back and discuss goals that aren’t really related to one particular piece of equipment on the market. Some examples of goals might be ‘It can be accommodated in the trunk of my car,’ or ‘The child can sit all day at the zoo,’ or ‘We can use it on the bus.’

“So instead of looking at things that are product specific, we look at what the equipment needs to accomplish. When I can start with families from that perspective, we really just have a good discussion about goals, and we save talking about products until the very end of the discussion. It gives us an opportunity to come to a better consensus of what the needs are. And it tends to get better results in the end.”

The ATP Supplier’s Perspective

David Butcher, ATP, CRTS, works in National Seating & Mobility’s Houston office. “I run a very large pediatric clinic in Houston with Texas Children’s Hospital, as well as their in-patient NICU/TICU departments, so I do use multiple stroller manufacturers,” he said.

“In my experience clinicians are first and foremost looking at the positioning needs of the clients. That can range from maximal to minimal, and we discuss the stroller options in the appropriate categories. Once we have decided on the level of positioning required, we then address what medical devices the stroller must be able to accommodate. Do they have a vent (which type)? Do they require an IV pole, oxygen tank, a place to carry the suction machine, pulse oximeter, diaper bag, or medical necessity bag?”

Next, Butcher said, the team typically addresses “how easy it will be for the family to transport, fold, maneuver, etc. This doesn’t mean that folding and transportation isn’t important, because it is. To the family, this is probably the most important factor. However, if the stroller doesn’t provide the support or the ability to transport the life-supporting devices they need to take, then the weight and foldability won’t matter.”

The Negotiation Process

But identifying goals, product choices, and transportability is just the first step.

“There is a lot of give and take between Mom/Dad and the therapist,” Tucker said. “We know positioning is paramount — so in my eyes, that needs to come first. That has been our way of doing business since day one. If we can offer all the functions of a wheelchair — tilt, recline, laterals, thigh guides, medial blocks, etc. — on a stroller-type frame, everyone is happy.”

“When I do show families equipment,” Sabet said, “I might say, ‘This fits one goal you told me: This umbrella stroller makes it easy for you to go as a family. But this stroller over here is something your child is more likely to be comfortable in if you’re out all day because it provides this type of support.’ So it’s letting them see the difference and really giving them the power to be a big part of that decision. Then it’s not necessarily my recommendation. It’s ‘Here are these considerations: This is really awesome for your family because you’re on the go. This is really more comfortable for your child and maybe is more beneficial long term because it provides more positioning.’ And then you can have a conversation about that, and it’s very different from coming at it from a standpoint of ‘This is my recommendation; you can accept that or go a different road.’”

“Most — not all, but most — parents are very focused on weight and the ability to transport the stroller,” Butcher said. “This seems to be the biggest concern for them, and we try to dig down into exactly how they are planning on using the device, and what vehicle it will be going in. Sometimes this will push us one direction because of the constraints of the vehicle it must go in. If the ideal stroller won’t fit in the vehicle it must go in, then it really isn’t an option, and we need to find something that will fit and provides the positioning and medical needs required.”

Butcher said appearance is enormously important to parents: “If this is a first-time device, almost 100 percent are concerned with how it looks. They do not want an institutional-looking device that makes their child look ‘handicapped.’ The parents are dealing with a lot of emotions or denial, and how their child appears to others is important.”

On a practical level, Butcher added, “What the device can carry is important to them as well, as they usually are coming into clinic in a baby stroller with a very large boot (basket) underneath that is filled with items. The stroller has become a pack horse that needs to carry a lot of extras. We have had this be the deciding factor between two equal strollers.”

So what is most important to the clinician, supplier and manufacturer isn’t necessarily what’s most important to the family. “Most of the time, the positioning aspects seem to be least important to the parents,” Butcher said. “This is not to say that the parents do not care about how their child is positioned, but it certainly isn’t what they want to address first.”

Reaching a Consensus

Sabet said trying strollers in real-world settings can be helpful in reaching a final decision. “A lot of times, we come into a clinic with a lot of preconceived ideas,” she said. “The way I like to get around that is we do a lot of equipment trials. So if a family is very interested in a standard basic stroller, we often can create an opportunity where they can try that over a weekend, and we will give them a form to fill out: Rate how easy it is to get in and out of your car, how you felt your child was positioned throughout the day. Were they able to function, were they able to participate? Sometimes that trial really is an eye-opener for families.”

“When there is a difference of opinion on what the family wants and what the team is prescribing, we will usually go through the medical requirements again,” Butcher said. “If the family still wants a device that is not going to be safe/appropriate, we will do several things.”

That includes telling the family the physician won’t approve a medically inappropriate device; offering to provide an appropriate device via the payor, but helping the family find a more basic device via another funding source, such as a charity, if doing so won’t endanger the child; giving the family time to do their own research; and suggesting the family self-purchase a simpler device and return to clinic if they later want a positioning stroller.

“We try to be resources for them, and we never force them into getting a device when they are not sure,” Butcher said. “We have some families who leave without making a decision, then return once they have had a chance to research on their own or speak with other families.”

This article originally appeared in the Mar/Apr 2021 issue of Mobility Management.