Clinically Speaking

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 medical history.

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 brain MRI indicated a malformation, ventrioulomegaly (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 very limited.

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 a Wheelchair

Heather informed me that the family was looking for an adaptive stroller, something that did not look like a wheelchair.

(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 the frame.

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.

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 Multiple Needs

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 the family.

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 game changer.

This article originally appeared in the May 2017 issue of Mobility Management.