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Alternative Positions Outside of the Wheelchair for Children

Michelle Lange, OTR/L, ABDA, ATP/SMS

April 15, 2023

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Question

What are the importance, goals, and disadvantages of alternative positions for pediatric wheelchair users?  

Answer

Most kids, especially those with complex needs, have more than one seating system and mobility base. They might have a lot of positioning equipment, filling up their home and garage. It is very important to look at a child's positioning 24 hours a day when evaluating him or her. I might work hard to develop the best seating system I can, along with a team for an individual child, but they might only be in it two or three hours a day. There are a lot of other hours that they could be in a very destructive posture. We don't want that to happen. So I need to go through all the equipment they have to make sure it's appropriate and that they're in a good position for most of their day and night.

So when working with young students, children may spend time outside of the wheelchair in other positions. This could be at home but also in the classroom. The classroom might have some of this equipment, but it's most likely generic because it's used with multiple children.

The goals of taking a child out of their primary seating system are to

  • Provide an alternative position to the wheelchair seating system to prevent range of motion losses from those sustained seated positions
  • Provide a position that perhaps places a child at a height for peer activities (with our younger kids, that's a lower height than their stroller or than their manual or power wheelchair)
  • Provide a "more comfortable" position. This is important because some alternative positions aren't that different than the wheelchair seating system. So if somebody's in an alternative seat, it might be an alternative to the wheelchair seat, but if the hips and knees are still flexed, it's not an alternative position, and that's not going to prevent range losses that are so common in the hips and knees. Unfortunately, many wheelchair users begin to look more and more and more like their wheelchair, like a seated position, and lose hip mobility into extension.

Disadvantages of alternative positioning systems include

  • No generic positioning system will provide as much support as a custom-made seating system to meet an individual's specific needs. 
  • An alternative seating system will not prevent range losses seen from prolonged seating in the wheelchair seating system.
  • Less support can mean less function for a client, and less support may mean less postural support to keep someone aligned, which can lead to someone assuming and maintaining more destructive postures.

It is important to analyze if the alternative position is doing more harm than good. Remember, the student may not be able to function / access as well in the alternative system. It may be best to use this during more passive activities. Optimal position is key to limiting loss of range of motion, orthopedic changes, facilitating function, and access to assistive tech optimizing vision, breathing, and swallowing. 

This Ask the Expert is an edited excerpt from the course 4670 Wheelchair Seating For The Pediatric Population by Michelle Lange, OTR/L, ABDA, ATP/SMS

 


michelle lange

Michelle Lange, OTR/L, ABDA, ATP/SMS

Michelle Lange is an occupational therapist with over 35 years of experience and has been in private practice, at Access to Independence for over 15 years. She is a well-respected lecturer, both nationally and internationally, and has authored numerous texts, chapters, and articles. She is the co-editor of Seating and Wheeled Mobility: a clinical resource guide. She is the former NRRTS Continuing Education Curriculum Coordinator and Clinical Editor of NRRTS Directions magazine. Michelle is a RESNA Fellow and member of the Clinician Task Force. Michelle is a RESNA certified ATP and SMS.


Related Courses

Supporting Respiratory Equipment on Wheelchair Bases
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Recorded Webinar

Presenter

Michelle Lange, OTR/L, ABDA, ATP/SMS
Course: #4894Level: Introductory1 Hour
Many people who require respiratory equipment, such as oxygen and ventilators, use a wheeled mobility base. This course will address how to support respiratory equipment on an adaptive stroller, manual wheelchair, or power wheelchair safely and as a part of a team.

Wheelchair Seating For The Pediatric Population
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Recorded Webinar

Presenter

Michelle Lange, OTR/L, ABDA, ATP/SMS
Course: #4669Level: Advanced2 Hours
  'The pressure by teachers/staff/parents to seat student's in generic seating systems vs their customized wheelchairs is high'   Read Reviews
Pediatric seating and mobility equipment are not simply smaller than equipment designed for adults. This course will present the importance of pediatric positioning, clinical considerations, how to determine if a child is positioned adequately, as well as alternative positioning. A detailed case study will pull all the information together in a practical way.

Secondary Supports: It’s All In The Angles!
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Recorded Webinar

Presenter

Michelle Lange, OTR/L, ABDA, ATP/SMS
Course: #4808Level: Intermediate1 Hour
  'Appreciated the reviews and questions that tested my understanding'   Read Reviews
Wheelchair seating systems often include secondary supports including pelvic belts, anterior trunk supports, and ankle straps. This course will explore secondary supports and appropriate clinical applications, as well as what to do when secondary supports are required, and team members have restraint concerns. Case studies will be included.

Matching Products to Seating Needs
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Recorded Webinar

Presenter

Michelle Lange, OTR/L, ABDA, ATP/SMS
Course: #4099Level: Introductory1 Hour
  'excellent slides'   Read Reviews
Once the wheelchair seating assessment has been completed and seating interventions considered, it is time to match specific client needs to product interventions. This course presents various categories of seating systems. Seating systems, whether linear, contoured, or molded, are comprised of primary support surfaces, secondary support components, and materials. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

Dependent Mobility Intervention
Presented by Michelle Lange, OTR/L, ABDA, ATP/SMS
Recorded Webinar

Presenter

Michelle Lange, OTR/L, ABDA, ATP/SMS
Course: #4102Level: Introductory1 Hour
  'Great course and well presented'   Read Reviews
Dependent mobility devices are not designed for self-propulsion. These include adaptive strollers, transport chairs, tilt-in space manual wheelchairs, reclining manual wheelchairs, and standard manual wheelchairs. For very small children, adaptive strollers are often required to meet positional and dependent mobility needs. Other dependent mobility bases, such as transport chairs and standard wheelchairs, are used for quick trips or for temporary use. Clients may also use a dependent mobility base as a backup to a power wheelchair. This course is directly related to the practice of physical therapy and is therefore appropriate for the PT/PTA.

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