Seating can be as important as mobility in selecting the right system for your child. The challenge for parents and health professionals alike is to create a seating and mobility equation that will optimize function and enhance your child’s quality of life.
By Lyndel Hill, BScOT
Providing appropriate seating for a child or young adult with severe disabilities who uses a wheelchair is a lifelong process of adjustment and compromise. What professionals refer to as “positioning to enhance function” is a process that continues to change and challenge throughout your child’s development. Appropriate seating enables your child to participate in life, helping to normalize muscle tone and minimize problems.
When seated in a chair, your child’s pelvis should be level with the buttocks against the backrest. The pelvic strap should be firmly in place across the hips. The trunk should be well supported laterally so that the spine is straight with a head support that assists your child to keep his or her head up to view the world. The thighs should be well supported.
There should be enough space to place two fingers between the back of the knees and the seat to ensure that the knees can bend without pressure behind them. Feet should be supported by the footrest. Chest or shoulder straps may help to position the child, and a tray may be beneficial for added trunk support.
As parents of a child with special needs, there are many decisions that you should make when determining the best wheelchair and seating system for your child and for the lifestyle of your family. Appraising your child’s needs and becoming a knowledgeable consumer is essential.
Choosing a device is like buying a car. There are many designs with a variety of options and upgrades. It can be confusing. Take time to explore options and obtain advice about products from therapists, vendors and other consumers. Ask for clarification of terms used to describe models and mechanisms.
Try out the device for a couple of weeks. Most vendors are willing to lend demonstration models. Ask questions regarding the adaptability of the equipment, durability, ease of folding, and maintenance. Most strollers are designed to seat children up to a recommended weight. If a seating insert is required, remember to add this into your calculation.
Time for school
By school age, your child may be too large for a stroller and may require greater support when sitting. Changing from a stroller to a wheelchair does mean added weight to lift and more complexity in dismantling the chair to place in the car.
There will also be external factors to consider when choosing a chair for your child. Busing to school means transporting the child safely. Bus companies must comply with the latest transport safety guidelines. All chairs must be tied down and strollers crash tested.
When your child is small, lifting, carrying and positioning can be done by one adult. With increased growth and weight, this eventually is neither safe for the parent nor the child. A two-person lift or a mechanical hoist becomes necessary to transfer and position the child appropriately.
If a child is comfortable and well supported in a seating system, less repositioning will be required throughout the day. Fewer lifts mean that parents will feel less physically tired.
Lyndel Hill, BScOT, is an occupational therapist at New Visions Toronto in Toronto, ON.