Hesperian Health Guides
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We have talked about this a lot, but it is worth repeating:
|Most children who require special seating sit best with their hips, knees, and ankles at right angles.||USUALLY RIGHT
right angle 90°
right angle 90°
right angle 90°
|A chair shaped like this may cause a child with spasticity to stiffen and straighten, or cause a severely paralyzed child to slip forward and slump.||USUALLY WRONG
ANGLE OF BODY AND HEAD
|A slight backward tilt helps most children sit in a better, more relaxed position.||If the child still falls or stiffens forward, it may help to tip the chair back even more.||However, this may cause his head to lean back so his eyes look upward.||A head pad may help position him to look forward, and may decrease some spasticity. It can also reduce spasticity in the eye muscles.|
|The heads of babies and small children may be so big that the headrest tilts them forward so their eyes look down.||Putting the headrest behind the level of the backboard lets the child hold her head in a better position.||REMEMBER: All the seating ideas shown on these pages apply to wheelchairs, and also to special seats without wheels.|
Other ways to help keep hips at a right angle
|If the hips tilt back, like this||A high hip strap will not help much.||A low hip strap helps keep the hips at a good angle.|
|But if the hips tilt forward,|
|A low hip strap will not help much.||A high hip strap helps keep the hips at a better angle.|
Notice that in both of these children with cerebral palsy, supporting the hips in a better position helps the whole body take a more normal position.
Good cushions sometimes make straps unnecessary.
For the child whose hips tilt back, or whose upper body is ‘floppy’, a padded support across the lower part of the back may help her keep a good position.
Lower back padded support
This cushion helps keep the hips from coming forward
Pad toe rest to prevent cuts and sores caused by spastic push.
sponge rubber padding
block to keep hips from slipping forward
thin wood base
child with spastic cerebral palsy
A footstrap or block that keeps knees bent may help keep the child from straightening stiffly.
A padded post may also help to keep hips back and legs apart (see next page).
Note: See cushion designs for spinal cord injury .
Keeping the body straight from side to side
padded body guide
|Even with a firm board seat, this boy’s body sags to one side. This can lead to increasing curve of the spine (scoliosis).||Hip guides may help him sit straighter.||Sometimes, hip guides alone are not enough.||He may also need carefully placed body guides, to help keep his body in a straighter position.|
Deciding where to place body guides
|1. Look carefully at how the child sits.||2. Draw a sketch of how he sits. Then draw arrows where you would need to push to help him sit straighter.|
|3. While someone holds the child in his best position, mark where you think the guides should be placed.||4. First, build in the guides in a temporary way.|
You can put various holes in the backboard for straps if needed.
The guides under the child’s arms should be thin. To hold their position you can use angle irons.
|5. See how well the child sits in the adapted seat. When you cannot improve it more, fasten the guides firmly and pad them so they do not hurt him.|
An ‘H’ harness, with straps that pass through slots in the backboard, is another way to help hold steady the body of a severely disabled child.