Michelle: Thank you Fawn, and thanks everyone for joining us here for this webinar today. I do hope that it is helpful to you and to the clients that you serve. We are going to be talking about wheelchair seating, specifically with a pediatric population, and emphasizing what is different between providing pediatric seating versus seating to an adult population.
What We Will Be Covering
- Pediatric Seating
- Dependent upon mobility base
- Size range
- Growth
- Accommodating changes to medical condition
- Seating categories
- General seating principles
- Increased muscle tone
- Muscle weakness/paralysis
- Case Studies throughout
Wheelchair seating is a subject in and of its own. There are quite a bit of resources out there to discuss the topic of wheelchair seating; many courses within OccupationalTherapy.com that address wheelchair seating. Today, we are going to be really stressing what is different between general wheelchair seating and specifically looking at wheelchair seating for our younger clients.
Pediatric Seating
In general, kids are smaller, so we need bases that can accommodate very small sizes. Kids grow so those same bases not only need to accommodate smaller body dimensions, but also be able to accommodate growth, sometimes in fairly quick spurts. Kids are really likely to change, more so than the adult population, because they are also changing developmentally in stature, growth, mind, and in their environmental requirements. Keeping up with those changes can be difficult.
Kids are more likely to be in a dependent mobility base as compared to adults. A child may not yet be ready for independent mobility, or if the child has independent mobility, such as in a power chair, they might only be in that power chair a portion of their day. They might spend a longer period of time in a dependent base. This changes the seating requirements.
Kids also do not tend to sit in any particular wheelchair seating system for as long a period of time. Children are still small, and it is a lot easier to pop them in and out of their chair and put them into other positions, such as a side-lyer, a stander, or a gait-trainer. Thus, kids tend to be moved around more than adults, so that is another requirement that we have to keep in mind.
Finally, kids, fortunately, are less likely to develop pressure injuries than adults. There are a number of reasons for that, and if we have time, we can get into that in a little more detail.
Pediatric Seating-Unique Considerations
There are some unique considerations to keep in mind when we are providing seating to this population. First, the seating system tends to be very dependent upon the mobility base. Whereas with adults, if we are providing a fairly standard manual wheelchair through the range of more complex rehab manual chairs that are out there, seating is not quite as dependent on the base. Other unique considerations are the size range of both the seating system and the mobility base, each of those providing adequate growth. Finally, we need to accommodate ongoing changes within this little person, and those changes can impact seating.
Seating is Dependent on the Mobility Base
Again, seating is very dependent upon the mobility base. Mobility bases can include adaptive strollers; manual wheelchairs that are designed for dependent mobility, meaning that the client is not propelling these on their own; manual wheelchairs designed for independent propulsion; and power wheelchairs.
Strollers
We often work with very young children who use adaptive strollers. These are not strollers that you buy at Toys"R"Us; these are special rehab strollers designed to meet special positioning and other needs. The advantage of strollers is that the size range can start as young as infancy, because we might be recommending this equipment for a child as young as a child who has just reached term and has been discharged from the neonatal intensive care unit.
Families sometimes will accept strollers more readily than a wheelchair, because they look more age-appropriate and "typical" to them. Strollers often are light weight and are easier to fold. This can be important for a young family who has never had the need for an accessible vehicle or home before. They might also have other children riding in their vehicle. Children under 40 pounds, regardless of their age, should be in a standard infant car seat. They should not be yet riding within their mobility base. These are kids that are getting transferred out of their mobility base, into a car seat, and the mobility base needs a place in the vehicle. A light weight, easy to fold piece of equipment can be very important for these reasons.
Some of these strollers have tilt and recline and the option to support medical equipment. This is particularly important for those kids who may be discharged from the neonatal intensive care unit needing equipment such as oxygen, a ventilator, or a suction machines. Some of the strollers also offer a hi-low base option where the seat pops off that stroller and goes onto a different base that allows someone to put that child at a very low level, say during circle time at preschool, and then raised up for feeding. There are also tandem options, in case this child is a twin. For these to be covered, both of the twins have to require adaptive seating. Despite all the advantages of these adaptive strollers, there are some drawbacks for some of our clients too. Oftentimes, the seating options that are available on these strollers are fairly minimal. There is not a lot of postural support or stability that is available. Additionally, some strollers, like the one pictured in Figure 1, tend to place the child in a fixed posterior tilt.
Figure 1. Stroller with fixed posterior pelvic tilt.
