Guidance on Assessment and Provision of Specialised Seating for children and young people

1. Guidance on Assessment and Provision of Specialised Seating for children and young people

2. 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

3. 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.

4. 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.

5. 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.

6. 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

7. 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

8. Assessing the Child • How do you currently assess a child for seating?

9. 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.

10. Four Parts to Assessment: • General Observation & Information gathering. • Assessment in supine • Assessment in unsupported sitting • Measurement

11. General Observations • What are some of the things you will be looking for when first meeting a child for a seating assessment?

12. General Observations • Note what position the child is in on your arrival. • What is the child’s current level of mobility • Ask the parent what the child’s preferred position is for play • Ask about medical history & future planned surgery • Feeding

13. 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.

14. 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, windswept, scissor or frog

15. Assessment in Supine Cont. • Pelvis – Feel the pelvis. Does it move freely under your hands or is it fixed? What happens to the legs when you do this? • Bend the knee into flexion – is it easy or difficult (what is the influence of tone)?

16. 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 with 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).

17. 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, forward flexion, scoliosis (which side) • Can the child sit with hands free • Head position

18. 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

19. Now it’s your turn! Group Session

20. 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

21. Features of Supportive Chairs Specialist chairs have a range of accessories to support different parts of the body including: • Pelvis • Legs • Trunk & Shoulders • Head

22. Pelvis • What is needed to achieve an optimum sitting position?

23. Pelvis • Key point of control: It’s the first part of the body to secure. • Lap straps (pelvic harness): - Two point - Four point - Pelvic Cradles • Pelvis right back in seat well, harness secured firmly

25. Legs • Scissor gait: Leg gutters or pommel • Windsweep: 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

27. Trunk & Shoulders • Trunk should be in contact with back of the seat. Top of the seat level with 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

29. 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 & well supported • Range of head rests available depending on level of support required.

31. Questions?

32. Case Study • You are now going to look at several case studies. For each case consider the seating needs of the child and what type of features the child may need on his/her chair.