A Pediatric Case Study: Meeting Multiple Needs, Including Aesthetic Ones
- By Jeff Auter
- May 01, 2017
I received a call from Heather, a
physical therapist working with the
Birth-to-3 program for one of the
counties in Wisconsin.
She told me of a child, Bianka,
born Dec. 4, 2014. At the time I
received that call from Heather,
Bianka was just over 2 years old
and already had a very significant
Bianka’s Story So Far
Bianka was born full term, but was
transferred to a hospital shortly after
birth. There were concerns with her
temperature, blood sugar levels,
head size and eating.
A front view of Bianka in her color-coordinated
Little Wave Flip wheelchair.
A brain MRI indicated a
(abnormal enlargement of brain
ventricles), hydrocephalus, and
septo-optic dysplasia (a brain development
disorder that can include
underdevelopment of the optic
nerve, dysfunction of the pituitary
gland and/or an absent septum
pellucidum in the brain).
Bianka was then transferred to a
children’s hospital and remained
in its neonatal intensive care
unit for five weeks. She had a
gastronomy tube placed and a
Nissen procedure (to prevent reflux)
on Dec. 30, 2014.
Today, Bianka is quite large for her
age. She began to have infantile
spasms and seizures in late 2015.
These spasms can be quite hard
and fast. Her mother and her occupational
therapist have reported that
Bianka has lost a lot of function since
the spasms started, and her vision is
Bianka has significant motor
impairments and prefers supine or
supported positions. Her tolerance
of prone and ability in prone are fair.
Bianka requires maximum assistance
to floor sit, and she avoids
taking weight through her upper
extremities. She will not take weight
through her upper extremities when
held in a stance.
At the time I met Bianka, she sat in
a commercially available highchair
with props, a Rifton adaptive chair
(on loan) and a commercially available
stroller. While seated, her pelvis
is posteriorly tilted, and her bottom is
scooted forward to the edge of the
seat. She demonstrates poor posture
in her stroller.
Nothing That “Looks” Like
Heather informed me that the
family was looking for an adaptive
stroller, something that did not look
like a wheelchair.
A side view shows Bianka’s improved
positioning in her new system.
(I have been doing specialized
wheelchairs for 43 years, and I still
wonder what a wheelchair “looks
like” or doesn’t look like in the mind
of the parents. When the word
wheelchair is mentioned, we all get
a different image in our brain of what
that looks like.)
The issue with traditional adaptive
strollers is that they are very wide
and do not come into the home very
easily. Many units have the seating
tilt and recline located between the
push handle tubes. This causes the strollers to be too wide to accept
multiple seat and back sizes. Other
strollers do not provide critical
seating without customized systems.
Some companies’ tilt-in-space
wheelchair frames are smaller
versions of their adult tilt-in-space
frames. They are heavy and
awkward to fold, and most often
you must totally remove the seating
before you can attempt to fold
When presented with a child’s
seating needs such as Bianka’s, both
the therapist and I get concerned
about providing an adaptive stroller,
as we need critical positioning to
address the child’s needs, and that
positioning is often compromised in
an adaptive stroller. Clinicians want
a base that is small or narrow and
that can come into the home; that
performs well outdoors; and that
accepts critical seating components,
such as properly shaped
seats and backs for our children’s
body dimensions, as well as a variety
of headrests, head supports, lateral
pads and other components.
When meeting with the family to
pick out a mobility base for a very
young child, we try to educate the
family on the fact that these bases
must grow for a minimum of five
years. A family’s first thought is not
about positioning a birth-to-3 child
in the home, as they are still holding
and carrying their baby around.
Instead, their concern is how they
can leave their home and go out
into the world without having their
child looking different. Meanwhile,
clinicians are looking for both indoor
and outdoor functions, as we know
that a good seating system will
support the child and provide an
adjunct to therapy intervention.
A good seating system is almost
orthotic, and with good upper
extremities, this gives the child a
place work and strengthen from.
The family’s lifestyle considerations included
the mobility system’s aesthetics and how
easily and quickly it could be folded and
transported during their busy days.
In my experience the families who
choose adaptive strollers most often
are looking for a replacement in two
to three years. Those families who
choose a traditional wheelchair
frame often do not know how to fold
it, or they give up on it due to the
time it takes to fold and how heavy
and awkward the base is to put into
a car or minivan.
A Wheelchair to Meet
Ki Mobility has finally come up with
a solution to these diverse, longtime
problems. The Little Wave Flip
mobility base can look exactly like
an adaptive stroller or a traditional
tilt-in-space chair, depending on
how you order it. During the evaluation
for Bianka, the Little Wave Flip
base was recommended.
Her mother felt it looked like an
adaptive stroller. She could easily
and rapidly fold it just like a commercial
stroller (she already knew how
to do it). The family also loved the
Little Wave Flip’s aesthetic options,
as they could order two colors and/or colored wheels, making it fun for
Ki Mobility understands their job is
to manufacture a mobility base and
let the clinicians choose the type of
seating to be interfaced. This allows me
to use whatever seating is necessary to
meet a child’s supportive needs.
Ki Mobility has also made a frame
that is almost impossible to outgrow.
The Little Wave Flip can be ordered
from a seat size of 10" to 18" wide
and 12" to 20" deep, with a user
weight limit of 165 pounds. Most of
my patients with this level of involvement
never make it to more than
150 pounds. So this base can be
used for almost anybody.
The Ki Mobility Little Wave Flip is
the chair I use 90 percent of the
time for these children who need
tilt. This mobility base is truly a
This article originally appeared in the May 2017 issue of Mobility Management.