Behavioral and postural changes observed with use of adaptive seating by clients with multiple handicaps

Effect of using adaptive seating equipment on grasping and visual motor integration in children with hemiparetic cerebral palsy: a randomized controlled trial

Background

Adaptive seating is commonly used as an intervention method to enhance postural control. The aim of this study is to investigate the effect of using therapy ball as a seat alternative to using typical chair on grasping and visual motor integration in the children with hemiparetic cerebral palsy. For this aim, thirty children with hemiparetic cerebral palsy from both sexes were included in this study. The children ages ranged from 3 to 6 years old. The degree of spasticity was 1 to 1+ according to modified Ashworth scale. The children were able to sit independently and follow instructions. Children were randomly assigned into two groups (experimental group and control group). Each child was evaluated before and after 3 successive months of selected occupational therapy exercises program. All the children of both groups received the same selected occupational therapy exercises program, but the children in the experimental group performed the exercises while sitting on therapy ball, and the children in the control group performed the exercises while sitting on typical chair.

Results

There was a significant improvement in the measured variables for both groups after treatment. The post-treatment results of the two groups of grasping and visual motor integration for age equivalent scores revealed significant difference (p=0.008 and p=0.011 respectively) in favor of the experimental group.

Conclusions

Therapy ball could be used as a seat alternative to using typical chair to facilitate visual motor integration and grasping in the children with hemiparetic cerebral palsy.

Thinking outside the cardboard box: insights from a course to train rural Kenyans to make postural support devices from appropriate paper-based technology (APT) for children with cerebral palsy

Purpose: Suitable assistive devices for children with cerebral palsy (CP) in low-income countries are often unavailable. Devices made from APT are in use in several countries but are unevaluated.Materials and methods: A 2-week training course focused on APT principles, measuring children and constructing postural support devices. Twenty-three Kenyans attended the course. The host organization identified four local children with CP who attended for assessment and measurement. Participants made the devices and children returned for fitting and necessary adjustment. Completion of post-course forms, action plans, visits after 14 months and contact 3 years later comprised the evaluation.Results: All participants found the course beneficial and valued the networking opportunity provided. They appreciated the practicality and utility of locally manufactured cost effective devices. The trainees planned further implementation to provide assistive devices for children with CP in their localities. Follow-up visits revealed several challenges to local ongoing production.Conclusions: Training people in low-income communities to make bespoke assistive devices for children with CP is straightforward, and the course was positively evaluated. However, maintaining device production is limited without local group support and stable leadership, ideally as part of an existing programme.Implications for rehabilitationAssistive devices are often unobtainable for children with cerebral palsy (CP) in low-income countries.APT is a cost effective way of fulfilling this need and it is relatively straightforward to train people who care for or work with those with CP to make devices using APT.Feedback from APT training suggests participants find the technique a practical way of producing assistive equipment for individuals with CP in their community.Maintaining device production requires support, leadership and increased public awareness of the use of APT at a local level.

Occupational therapy for children with cerebral palsy: a systematic review

Objective: Occupational therapy (OT) for cerebral palsy focuses on the development of skills necessary for the performance of activities of daily living. The aim of this systematic review was to determine whether OT interventions improve outcome for children with cerebral palsy (CP).

Methods: An extensive search in MEDLINE, CINAHL, EMBASE, AMED and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Six intervention categories were distinguished and individually analysed using a best-evidence synthesis. This synthesis is based on the type of design, the methodological quality, the type of outcome measures and the statistical significance of the findings.

Results: Seventeen studies were included in this review, seven of which were randomized controlled trials (RCTs). One RCT had a high methodological quality. The analyses resulted in insufficient evidence of the efficacy of occupational therapy in all intervention categories, due to the low methodological quality of studies presenting statistically nonsignificant results.

Conclusion: Despite the reasonable number of studies identified, the inconclusive findings regarding the efficacy of occupational therapy for children with cerebral palsy may be a reflection of the difficulties in efficacy research in OT for children with CP. Future research should critically reflect on methodological issues.

Adaptive seating systems in children with severe cerebral palsy across International Classification of Functioning, Disability and Health for Children and Youth version domains: a systematic review

AIM

The aim of this study was to systematically review the effect of adaptive seating systems (AdSSs) in young people less than 19 years of age with severe cerebral palsy (CP), with particular focus on child-related outcomes across all components of the functioning and disability domains of the International Classification of Functioning, Disability, and Health for Children and Youth version (ICF-CY).

METHOD

Literature searches of studies published from 1975 to October 2014 were performed. Methodological quality and the risk of bias were analysed using Sackett's level of evidence, the American Academy for Cerebral Palsy and Developmental Medicine guidelines, and Mallen criteria for observational studies.

RESULTS

Nine studies fulfilled the selection criteria. All studies had level IV evidence and were of moderate methodological quality. The results focused on the effects of AdSSs on postural control and on upper extremity function and on additional child-related outcomes. The results suggested that AdSSs that include trunk and hip support devices may improve postural control outcomes, and that special-purpose AdSSs may improve self-care and play behaviour at home.

INTERPRETATION

Because of a low level of evidence and the moderate methodological quality of the studies available, no robust conclusions can be drawn. Nevertheless, the data suggest that AdSSs may be able to improve activity and participation at home among children with severe CP. More studies of high methodological quality addressing the effect of AdSSs on activity and participation are urgently needed. Suggestions for future research are provided.

Peer Interactions among Children with Profound Intellectual and Multiple Disabilities during Group Activities

BACKGROUND

Children with profound intellectual and multiple disabilities (PIMD) meet other children with PIMD in day care centres or schools. This study explores the peer-directed behaviours of children with PIMD, the peer interaction-influencing behaviour of the direct support workers and the children's positioning.

METHOD

Group activities for children with PIMD initiated by a direct support worker were video-recorded. The behaviour and positioning of the children and the behaviour of the direct support workers were coded.

RESULTS

Limited peer-directed behaviour of the children with PIMD and peer interaction-influencing behaviour of the direct support workers are observed. Weak associations were found between the positioning or peer interaction-influencing behaviours and the behaviour of children with PIMD.

CONCLUSIONS

Children with PIMD show social interest in each other during group activities. More knowledge is needed to create an environment which facilitates peer-directed behaviours of persons with PIMD.

Two Seating Systems' Effects on an Adolescent With Cerebral Palsy and Severe Scoliosis

BACKGROUND AND PURPOSE

To compare physiological functioning, communication switch activation, and response accuracy in a 19-year-old young man with quadriplegic cerebral palsy and neurological scoliosis using 2 seating systems within the school setting.

METHODS

Prospective single-subject alternating treatment design with 2 conditions: baseline phase with standard planar inserts (A1), custom-molded back with original seat (B), and return to baseline (A2). Measures included oxygen saturation (SaO2), heart rate (HR), respiration rate (RR), body temperature (BT), processing time to activate switches, and response accuracy.

RESULTS

SaO2 levels increased from "distressed" to "normal"; variability decreased. HR, RR, and BT fluctuations decreased with the custom-molded back. Processing time decreased with increased variability, affected by subject's motivation; accuracy improved slightly. Reported social approachability and student-initiated communication increased.

CONCLUSIONS

SaO2 increased and HR, RR, and BT fluctuations decreased with a custom-molded back. Graphing data may help determine seating effect with complex clients.

Clinical tools that measure sitting posture, seated postural control or functional abilities in children with motor impairments: a systematic review

OBJECTIVE

To identify and critically appraise clinical measurement tools used to assess sitting posture, seated postural control or functional abilities for children with motor impairment who are candidates for seating interventions.

DATA SOURCES

Searches were run in 15 electronic databases along with hand searching. The search included articles published in English to December 2011.

REVIEW METHODS

Key terms included: posture, sitting, sitting posture, seated posture, seated postural control, sitting position, seating, wheelchair(s), outcome and assess(ment). The PRISMA statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, reviewed abstracts and identified full-text articles that met criteria. Data extraction included tool description and clinical utility. Two quality-rating scales were used to evaluate conduct of the studies and psychometric properties of the tools.

RESULTS

Of the 497 titles found in the search, 29 full-text articles met the inclusion criteria and 19 tools were identified. Tools represented all components of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), with emphasis on body structure and function and activity components. Evidence supporting reliability and validity varied, with small sample sizes influencing quality ratings. Evidence of the tools' reliability was more prevalent than evidence of the tools' validity. Only four tools reported on responsiveness, an important consideration for evaluating change. Little information on clinical utility was provided.

CONCLUSION

Although a number of tools are available, evidence supporting their use for seating interventions is limited, as is the evidence supporting the strength of their measurement properties. Few tools address participation, environmental factors or the child's and family's perspective.

Sitting and standing performance in a total population of children with cerebral palsy: a cross-sectional study

Background

Knowledge of sitting and standing performance in a total population of children with cerebral palsy (CP) is of interest for health care planning and for prediction of future ability in the individual child. In 1994, a register and a health care programme for children with CP in southern Sweden was initiated. In the programme information on how the child usually sits, stands, stands up and sits down, together with use of support or assistive devices, is recorded annually.

Methods

A cross-sectional study was performed, analysing the most recent report of all children with CP born 1990-2005 and living in southern Sweden during 2008. All 562 children (326 boys, 236 girls) aged 3-18 years were included in the study. The degree of independence, use of support or assistive devices to sit, stand, stand up and sit down was analysed in relation to the Gross Motor Function Classification System (GMFCS), CP subtype and age.

Result

A majority of the children used standard chairs (57%), could stand independently (62%) and could stand up (62%) and sit down (63%) without external support. Adaptive seating was used by 42%, external support to stand was used by 31%, to stand up by 19%, and to sit down by 18%. The use of adaptive seating and assistive devices increased with GMFCS levels (p < 0.001) and there was a difference between CP subtypes (p < 0.001). The use of support was more frequent in preschool children aged 3-6 (p < 0.001).

Conclusion

About 60% of children with CP, aged 3-18, use standard chairs, stand, stand up, and sit down without external support. Adding those using adaptive seating and external support, 99% of the children could sit, 96% could stand and 81% could stand up from a sitting position and 81% could sit down from a standing position. The GMFCS classification system is a good predictor of sitting and standing performance.

Management of seating posture of children with cerebral palsy by using thoracic-lumbar-sacral orthosis with non-rigid SIDO frame

PURPOSE

To investigate the effects of a special seating device: Thoracic-lumbar-sacral orthosis with non-rigid SIDO frame (TLSO-SIDO) in non-ambulant children with cerebral palsy.

METHOD

A prospective study with matched pairs (the same subject pre- and post-intervention) was carried out. A comparison of the lateral view of thoracic-lumbar spine X-ray before and after TLSO-SIDO application was made. The assessment of changes in daily activities, posture was recorded by questionnaires. A total of 47 children with cerebral palsy at a mean age of 53.2 months +/- 30.1 SD were involved in the study; 15 (35.71%) of the 42 children showed significant problems in feeding at the beginning of the study period, they were identified as a special subgroup with feeding difficulties.

RESULTS

The mean pre-TLSO-SIDO thoracic kyphosis was 53.7 +/- 16.2 in Cobb angle, while the post-TLSO-SIDO thoracic kyphosis was 47.2 +/- 12.1. The lumbar lordosis was 21.3 +/- 13 and in the TLSO-SIDO 17.8 +/- 11.9. The majority of the children have shown improvement in the feeding items and in posture (trunk, head and extremities). The overall satisfaction of the parents with the TLSO-SIDO was very good, namely 3.972 +/- 0.796 on the 5-point analogue scale. We did not find a direct correlation with the improvement in the separate items and the overall satisfaction.

CONCLUSION

It is extremely difficult to measure the effect of the postural management on the development of children with cerebral palsy. According to the results of the study, regular application of the TLSO-SIDO in children with spastic cerebral palsy had a beneficial effect on feeding problems and on posture.

A method to measure reaching capacity of children with neuromuscular disorders

PROBLEM

The measurement of quantitative changes in upper-extremity skills has been limited by the lack of objective standardized measures and, therefore, reaching tasks have been subjectively defined.

SOLUTION

A frame made from PVC tubing was constructed to assist in measuring the parameters of vertical, horizontal, and cross midline functional reach of children with neuromuscular disorders, and a measurement protocol was adopted for obtaining the measures of reach.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Suggestions for assuring consistency in measurements and further exploration of the number of sessions required to determine a child's best reaching effort are put forth.

Review of the efficacy and effectiveness of adaptive seating for children with cerebral palsy

The purpose of this article is to review the published research evidence for the efficacy and effectiveness of adaptive seating in the management of children with cerebral palsy. This review is undertaken to determine whether adaptive seating outcomes proposed in the clinical literature have been substantiated. The literature search was confined to English-language publications between 1982 and 1994. Thirty-seven research studies were identified through: 1) on-line search of Index Medicus, Cumulative Index to Nursing and Allied Health Literature, and Psychological Abstracts; 2) scanning conference proceedings and article reference lists; and, 3) tracking of author citations through the Science Citations Index. Eight studies met the selection criteria of using subjects who were children with cerebral palsy, including adaptive seating as an independent variable, and including an unsupported sitting comparison condition. Study quality was evaluated using an adaptation of Sackett's validity criteria. Sackett's classification system was utilized to identify levels of evidence and to grade recommendations. Grade A, B, and C recommendations were generated from Level I to Level V evidence for some of the clinically proposed seating outcomes. Additional seating research is required to strengthen the recommendations and investigate unexplored outcomes. Limitations of the review are potential reviewer and publication bias.

Rehabilitation service evaluation: a follow-up of the extent of use of technical aids for disabled children

The increased awareness of the benefits of rehabilitation technology will lead to an increased demand for services and may lead to discrepancies between needs and resources available. The present study was a regional follow-up of the use of 1278 technical aids. In this study the satisfaction with aids was high and quite near the optimum, but unsatisfactory areas were also identified. A better follow-up of the use of technical aids should be part of rehabilitation practice. Careful assessment of functional and psychosocial needs, goal attainment and environmental factors, and a good system of selection with available alternatives and proper instructions are the basic considerations for satisfactory technical aids.

Technical aids for daily activities: a regional survey of 204 disabled children

Home-care of even severely disabled children is strongly favoured today. However, the role of technical aids for daily activities has not been emphasised in the assessment of the needs of families with disabled children. This study evaluated the extent of help needed for daily living among 204 disabled children and the uses and role of and need for technical aids for eating, dressing, toileting and bathing. The children needed much help. Severely disabled children and their parents benefited most from the use of aids. The structured interview unexpectedly revealed many problems, including a considerable need for extra aids for dressing, bathing and toileting. The parents were ready to accept technical aids, but needed more information on their possibilities, benefits and therapeutic aspects. The authors conclude that the need for technical aids for daily activities is not readily recognised during outpatient or hospital visits.

A regional survey of technical aids used by handicapped children in day care and at school

Normalization, which underlines mainstreaming, is widely accepted in paediatric rehabilitation, but its success depends on the availability of special services, including proper technical aids for day care and school. This study aimed to evaluate the need for and use of technical aids in various forms of day care and education. Handicapped children used basic technical aids. In day care children needed more technical aids to promote independent mobility and playing, and in school they needed more computers and adaptations and software for these computers. The arrangement of technical aids for handicapped children requires good cooperation between the children's parents and various professionals.