Clinical Blog: The Use of Equipment to Improve Future Outcomes

emmy is a star

Convaid user Emmy, diagnosed with Quad Dystonic Cerebral Palsy is pictured in her Convaid Cruiser.

By K. Missy Ball,  MT, PT, ATP, Certified Pediatric NDT | Seating & mobility equipment can aide normal skeletal development and reduce progression of structural deformities of the pelvis, spine and extremities as well as encourage effective postural control. It can promote more effective oral motor, gastrointestinal and respiratory function via musculoskeletal management.

Research by Gunnar Hagglund M.D., Ph.D on hip migration in the cerebral palsy population GMCSC Level III- V, makes a case for 24-hour positioning to promote hip integrity. Positioning the clients in 10 to 15-degree hip abduction with 5 to 15-degree ER has shown impressive results with regard to reduction in hip migration and surgical intervention.

Good skeletal alignment is crucial for effective sensory-motor strategy attainment. When seated, the pelvis is the initiator of weight shifts. The more controlled fluidity, the greater the functional capability of the client. When pelvic motion is limited due to weakness, muscular dyscoordination or static pelvic positioning the function suffers. Pelvic stasis such as posterior tilt, anterior tilt, obliquity or rotation can seriously impact the client. Seating to prevent or reduce this from happening is available.

Posterior tilt produced as a result of hip extensor spasticity and/or a reflexive pattern of movement (extensor thrust) can be reduced with an anti-thrust seat like Convaid’s position cushion. This cushion promotes an increase in hip flexion, which over lengthens the hip extensors and weakens their force. An effective pelvic belt positioned anywhere within 45 to 60-degree angle under the anterior superior iliac crest can facilitate a neutral pelvic tilt and reduce anterior and posterior tilt extremes.

A firm support base for a client to sit on is crucial for pelvic stability and controlled mobility. Convaid’s Self-tensio provides a firm base on a very lightweight frame, without the hammock effect seen in other medical or commercial strollers.

Convaid offers multiple seating options to address pelvic obliquity and to address un-level of the pelvis. The use of foam of different thickness and characteristics under the low side of a flexible pelvic obliquity can minimize or eliminate this un-level pelvis, hence preventing lateral curvature of the spine or scoliosis. The body is holistic and as such one area impacts areas which are interconnected to it. Scoliosis left unchecked can cause structural changes in the spine and the rib cage. The rib cage impacts the thoracic cavity which houses the lungs, heart, and esophagus. Distortions in rib cage can affect lung expansion and thoracic cavity pressures.

Mac Neela (1987) and Nwaobi and Smith (1986) have shown functional seating to improve respiratory function of the school-age child in vital capacity and forced expiratory volume for clients with spastic CP seated in a specialized chair with adjustable seat angles. The researchers concluded that pulmonary function improved as a result of better skeletal alignment, particularly at trunk, neck and head. It reduced airway obstruction and detrimental changes to the thoracic and abdominal cavity shape and function. Biomechanically it facilitated a more effective use of the respiratory muscles.

A slight anterior tilt to the seat – intermittently throughout the day – can produce functional, active seating. This can elicit a righting response of hip and spinal extension in some clients. This can expand the anterior chest, elongate the abdominal musculature and allow their activation. When a more normal synergistic activity at the pelvis (the seed of postural control) is facilitated, this will have an effect on and improve gross and fine motor development. A better tongue base for oral motor feeding and speech, as well as endurance for functional activities in the classroom will be positively affected as well (Redstone 2004).

In the article, Functional Seating for School-Age Children with Cerebral Palsy by Costigan and Light (April 2011), the authors explain the numerous benefits of functional seating. Benefits include increased speech production, intelligibility, and feeding. The Trekker by Convaid has 5-degree anterior tilt to 45-degree posterior tilt for change in orientation throughout the day. The anterior tilt can possibly be used during eating and fine motor tasks, the posterior tilt can be used for relaxation and pressure relief.

In summary, seating & mobility can promote more effective skeletal alignment. It can maintain soft tissue length/balance by diminishing excessive tone or abnormal reflexive patterns. It encourages active postural control starting at the pelvis. This in turn improves the quality of life for the client in movement, feeding, speech, fine motor, and respiration.

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For those wanting to learn more, Convaid is offering a for-CEU webinar on this topic on March 17, 2016 at 8AM PST, 11AM EST. Attendance is free, however, there is a $20 fee to process CEU credits for the course. The link will lead you to more information and a registration portal.

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