A Provider’s Perspective

Dynamic Seating

A Discussion with Mike Mowry, ATG Rehab

Mike MowryMike Mowry, ATP, has been with ATG Rehab for more than seven years. A graduate from Quinnipiac University with a degree in health science and gerontology, he provides seating & mobility services to the Connecticut and New York areas.

Before joining ATG Rehab in 2003, Mowry worked in the private sector as an administrator providing services to adults and children with special needs. With ATG, he has worked with a diverse group of consumers, including seniors. But most of his clients now are children and young people with diagnoses ranging from cerebral palsy to muscular dystrophy and spinal muscular atrophy.

His current beat includes Thursday visits to a clinic “where about 80 percent of the kids I see are CP.” A big believer in the potential benefits of dynamic seating, most of his experience has been with the Kids Rock system.

Why Dynamic Seating Works

You take a child that’s got a high level of tone and a traditional, linear seating system — which our industry is quite familiar with — and you lock them into the old philosophy of a “90-90-90” positioning in the chair, and then you take a child that has perhaps tight hamstrings, tight hip fl exors, and you’re locking them into position. You’re forcing them to maintain that positioning for long periods of time.

By implementing dynamic seating and having basically a free-flowing seating system, they’re able to use their hip fl exors, they’re able to work their hamstrings, so they can increase the range, increase their strength as opposed to just being completely locked out and being basically rigid in the chair.

Potential Benefits

Some of the things that I’ve seen and the clinicians I’ve worked with have seen, is it helps with increasing strength and range in the hips and the knees. It helps in reducing spasticity when they have a higher level of tone and helps with some of the range limitations that they might currently have.

When you start having some of these developmental disabilities and particularly with CP, (the kids) can have some digestion issues as well. You now start to give them some active movement within dynamic seating — there have been some studies as far as the significance on digestion, and does that aid in a child’s discomfort when sitting? Quite possibly. As far as increasing tolerance in sitting, it very easily can have an impact on it, absolutely.

Dynamic Seating Strategies

Sometimes even if you have a child who’s in linear seating, depending on what their tone is, there are aftermarket products that you can incorporate on the seating system.

Miller’s Adaptive Technologies makes hydraulic tension hardware for the legrest, so if you have a child who wants to do a lot of extension tone in their lower extremities, you can use Miller’s product to kind of absorb it, versus a regular legrest that’s just non-moving. One, it cuts down on the breaking of footplates and everything else, but two — it allows some absorption within their body as they’re sitting to basically radiate the energy that they’re creating with their tone. The tone would start at their pelvis and just radiate through their legs. (With) a dynamic footrest, the energy is just expended as far as the strain on their muscles and on the product itself, and it dissipates.

It’s a similar practice within seating, where you’re talking about a backrest and a cushion that they’re sitting on. You have a child who has a lot of tone: One of the things you want to do is try to give them some submersion or some relief. Picture a child that wants to go into extension constantly: If you put them onto a hard, firm seating system, they’re going to feed off of it constantly. Something’s fighting against them as their tone kicks in. If you can give them something that’s a little more plush and a little bit more absorbing for what they’re sitting on, it helps dissipate that energy they’re creating. They’re able to alleviate that resistance that they’re getting from something that’s solid.

When Dynamic Seating May Not Work

We had two kids through the clinic that tried dynamic seating, and they tore (their chairs) apart. One of them is 12 or 13 years old, the other gentleman is a little older, probably 16 or 17. Their tone and their active movement are so severe. The little guy, if you put him into his original chair, he literally could rock that chair sideways. If you stabilized his pelvis, he would take that chair and from side to side, get it off the ground 3 to 4 inches and rock it.

The other gentleman, he has a 12-pack for abs. He literally snaps armrests off the chair as he tries to grip them and maintain his tone. He will snap them right off the chair.

It’s not for every child. I’m fortunate with this clinic where I’m able to have the product there, and the therapists treat these kids two, three, sometimes four times a week. They can set up the chair and use the chair when they’re in a classroom setting for observation to determine if it’s an appropriate fit.

Dynamic Success Story

I’m thinking of one particular child: We had put him into a Kids Up. He was in a reverse-configuration manual wheelchair, and he was a self-propeller.

When he first got into it, his tone was increased initially. He’s a smart little guy, and he was just trying to get that feedback off of what the seating system was allowing him to do. Over a period of time, as he settled in and realized what the seating system was going to allow him to do, he became a much more functional propeller and more independent in propelling his chair. His tone while he was sitting had decreased some, so he wasn’t constantly trying to fight his spasticity to maintain positioning in the chair, and then trying to propel his chair at the same time.

So basically the end result was his tone had decreased, and he was able to isolate what he was trying to do, i.e., his self propulsion.

This article originally appeared in the February 2011 issue of Mobility Management.

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