Guidance on Assessment and Provision of Specialised Seating for children and young people
Course Aims and Objectives • To provide inexperienced staff with a guideline for the assessment and provision of seating to children. • To streamline the assessment process for seating provision. • To standardise the provision of seating throughout the Partnership • To promote Best Value in seating provision
It is important to understand the significant milestones in the development of ‘Normal’ movement in children. Reference - From birth to five years ; Children's Developmental Progress by Mary D Sheridan. . 1 month : supine - lies with head to one side. Pulled to sit: head lags until body upright when head momentarily held erect. Held sitting, back is one complete curve. 3 months: prefers to lie with head in midline. Pulled to sit: little or no head lag. Held sitting: back is straight except in lumbar region. Head held erect and steady for several seconds.
6 months: Sits with support, in cot or buggy turns head to look around. Rolls on floor. Held in sitting. Head is firmly erect and back straight. 9 months: sits alone, 10-15 minutes on floor. Can lean forward without losing balance. Attempts to crawl. Pulls to stand holding onto support 12 months: sits well on floor for indefinite time. Transitions between positions, lying to sitting, sitting to crawling or standing. 15 months: walks alone. May climb onto low furniture. 18 months: Backs or slides sideways into small chair. Climbs forward onto adult chair then turns and sits.
Principles of Seating and Posture Management Good seating can be achieved by: • Considering a child’s postural control & matching this with the correct level of support in a chair (not too little support & not too much). • It should minimise postural abnormality and enhance function. • It should maintain postural symmetry and comfort. • Should take any progressive element of a condition into consideration.
Poor seating can cause negative Social and Educational repercussions Adoption of poor postural positions can result in :- • Decreased motor function due to spasticity, muscle loss, or weakness • Abnormal curvature of the spine e.g. scoliosis, kyphosis • Contractures, deformities of the arms and/or legs • Fatigue • General discomfort • Risk of pressure damage • Reduction of possible independent mobility • Difficulty in attending to white boards etc [eye contact?] • Detriment to hand/ eye coordination • Poor concentration These result in poor participation in Educational activities and inhibit participation in Social interaction
General Points to Consider in Assessment • Level of postural support required • Activities to be done in the chair • Space for the chair within the home/class. • Child’s ability to transfer into/out of chair (standing transfer/hoist transfer) • Can the chair be manoeuvred easily by the carer. • Feeding skills • Respiratory problems. • Growth potential of the child. • Skin sensation and history of skin condition
Assessing the Child • How do you currently assess a child for seating?
Assessing the Child • Initial assessment prior to selecting a chair • Information re: size of the child, level of support required, purpose of the chair, tolerance of sitting.
Four Parts to Assessment: • General Observation & Information gathering. • Assessment in supine • Assessment in unsupported sitting • Measurement
General Observations • What are some of the things you w ill be looking for w hen first meeting a child for a seating assessment?
General Observations • Note w hat position the child is in on your arrival. • What is the child’s current level of mobility • Ask the parent w hat the child’s preferred position is for play • Ask about medical history & future planned surgery • Feeding
Assessment in Supine • Lie the child on the floor or on a plinth. The purpose of this is to observe & assess asymmetries; the influence of gravity on posture & tone.
Assessment in Supine Note the position the child assumes in supine: • Head – In midline or to the side, voluntary control • Arms – Does the child bring hands to midline against gravity • Legs – Are they straight, w indsw ept, scissor or frog
Assessment in Supine Cont. • Pelvis – Feel the pelvis. Does it move freely under your hands or is it fixed? What happens to the legs w hen you do this? • Bend the knee into flexion – is it easy or difficult (w hat is the influence of tone)?
Unsupported Sitting • Infant: sit the infant on your knee. • Older child: sit the child on a stool, or on a chair; or coffee table or on a dining room table w ith child’s feet resting on a chair. • Support the child from behind (or have a carer support the child so you can observe from the front).
Unsupported Sitting cont. • How much support does the child require • What influence does tone & extension patterns have on the child • Feel for the child’s pelvis: Rotation, anterior or posterior tilt (can you correct this) • Trunk: lateral flexion, forw ard flexion, scoliosis (w hich side) • Can the child sit w ith hands free • Head position
Measurement • Back of pelvis to back of knee • Back of knee to floor • Seat to axilla • Top of shoulder to pelvis • Across pelvis • Widest part of thighs
Now it’s your turn! Group Session
Implications and considerations for seating • Proximal Stability –a pre-requisite for distal control i.e. stable base (pelvis/trunk) required for fine motor control (eyes/swallow/hands) • Maintenance of a symmetrical position-reflex inhibiting posture • NB: Purpose of seating is NOT to increase range of motion. Child should not be at the limits of ROM e.g. hamstrings
Features of Supportive Chairs Specialist chairs have a range of accessories to support different parts of the body including: • Pelvis • Legs • Trunk & Shoulders • Head
Pelvis • What is needed to achieve an optimum sitting position?
Pelvis • Key point of control: It’s the first part of the body to secure. • Lap straps (pelvic harness): - Tw o point - Four point - Pelvic Cradles • Pelvis right back in seat w ell, harness secured firmly
Legs • Scissor gait: Leg gutters or pommel • Windsw eep: Leg gutters, long lateral supports & a pommel • Leg length discrepancy: Split seat, individual foot rest. • Foot rest essential if child’s feet do not reach the floor: Sandals or ankle huggers if child’s legs extend
Trunk & Shoulders • Trunk should be in contact w ith back of the seat. Top of the seat level w ith top of the shoulders • Poor trunk control: Child requires lateral supports • Trunk harness: small chest piece or full harness if child has poor head control or extends a lot. • Tray can assist trunk control as child props against it
Head • Head is the last area to look at as its heavily influenced by positioning of the body. • Ensure that pelvis & trunk are correctly positioned & w ell supported • Range of head rests available depending on level of support required.
Questions?
Case Study • You are now going to look at several case studies. For each case consider the seating needs of the child and w hat type of features the child may need on his/her chair.
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