Modular seating for paralytic scoliosis: design and initial experience

The clinical effectiveness of custom-contoured seating for wheelchair users with neuromuscular disorders: a scoping review

Despite its widespread use, the clinical effectiveness of custom-contoured wheelchair seating for individuals with neuromuscular disorders remains unclear. A scoping review was conducted using PubMed, Scopus, and Web of Knowledge databases in November 2021 and updated April 2022. A total of 17 full text articles were included. Discussion themes were grouped based on three outcomes of interest: (1) posture and musculoskeletal deformity, (2) quantitative measures of body structures and functions, and (3) qualitative perceptions, opinions, and quality of life indicators. This review highlighted the lack of literature exploring the impact of custom-contoured seating on cardiopulmonary function, pressure injury management, and upper limb function; although, there was no indication that risk is increased compared to alternative seating and it performed well in terms of perceived user satisfaction, comfort, and function. The findings also demonstrated immediate benefits to postural alignment, although, the longitudinal effect on progression of musculoskeletal deformity compared to alternative seating is more ambiguous. This review aimed to scope the evidence-base for custom-contoured seating for wheelchair users with neuromuscular disorders to synthesize information from the existing literature, inform current practice, and identify knowledge gaps for further experimental investigation.

Pressure relief characteristics in alternating pressure air cushions

In this study a computerised system was used which continuously measured air pressure, interface pressure and pressure-time cycle characteristics of an alternating pressure air cushion (APAC), and calculated the time the interface pressure remained below three chosen thresholds of 20, 40 and 60 mm Hg. Ten healthy volunteers were used to evaluate the pressure relieving characteristics of four APACs. Results indicated significant differences between products when the threshold periods were analysed, showing some devices were not capable of relieving interface pressures below 20 mm Hg. Though deflation pressure decreased to nearer zero, interface pressure did not follow suit.

The influence of scoliosis brace treatment on function in children with myelomeningocele

The influence of Boston brace treatment on the functional and motor ability of children with scoliosis secondary to myelomeningocele was studied in a consecutive series of 20 children of 5-19 years of age. Motor activity, ADL function and ambulation ability were assessed before brace treatment and then annually during the treatment period, which lasted an average of 2.7 years (range 0.6-8.7 years). Thirteen children were followed-up one year after braces were removed. The effect of brace treatment on the scoliosis was favourable as is reported elsewhere. The children's motor activity and ADL function remained unchanged during brace treatment, but brace wearing was accompanied by a decreased ambulatory skill. This may partly be explained by a slight increase of flexion contractures of the hips during treatment. Patients with useful ambulation ability kept this ability up even during brace treatment. Considering the favourable effect of brace treatment on the scoliosis curve and the few complications encountered, we recommend brace treatment for scoliosis in patients with myelomeningocele.

Lumbar extension in Duchenne muscular dystrophy: effect on lateral curvature

The purpose of this study was to investigate the hypothesis that a lumbar pad producing extension of the lumbar spine is of value in posture support seats for children with Duchenne muscular dystrophy. Our method was to establish whether or not an increase in lumbar lordosis produced any increase in resistance to static lateral curvature of the supine lumbar spine. Nine boys with Duchenne muscular dystrophy were studied at an age when they were about to go into a wheelchair or had recently become wheelchair mobile. In each case the child lay supine on low-friction material on an x-ray table while the spine was flexed first to the right and then to the left, with and without a lumbar pad, by a predetermined force. The degree of lateral curvature was measured from anteroposterior radiographs. While lateral forces were applied when the boys were supine rather than seated, the results failed to show a difference in curvature with or without the lumbar pad.

Experience of a seating clinic

Patients who cannot walk, particularly those with orthopaedic deformities, need more than a simple wheelchair; they require a special seating system. Since the early 1970's many different systems have been introduced to the field of orthotics and prescribed through "Seating Clinics" in many centres in North America and around the world. Our experience in the Seating Clinic at the University of Kansas Medical centre is presented. Most patients were children (70%) with 69% male and 31% female. Various seating systems were prescribed, including the Safety Travel Chair, the Moulded Plastic Insert, the Orthopaedic Body Support (foam on plywood), the Spinal Support System, the Moulded Seat Total Contact Shell (sitting support orthosis) and the DESEMO support system. The majority of patients had cerebral palsy (58%) and muscular dystrophy (33%). Other conditions included spinal cord injury, spina bifida and multiple orthopaedic deformities. Sixty five percent of the custom made seating systems prescribed were the Orthopaedic Body Support. Unilateral dislocation of the hip presents a major problem in seating because of pelvic obliquity.