Hesperian Health Guides

General Position

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HealthWiki > Disabled Village Children > Chapter 65: Adaptations for Wheelchairs and Other Sitting Aids > General Position


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
Child sitting forward in wooden structure, arrows point to different parts of structure.
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
Child with legs up on wooden structure.

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.
Child sitting up straight, chair inclined backwards. Child sitting on slightly inclined chair and falling forward at the waist. CHild sitting very straight on very backwardly inclined chair. Child sitting very straight on very backwardly inclined chair with wedged headrest.
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.
Young child sitting on straight back inclined seat that pushes head forward. Young child sitting on inclined seat with head aligned with body, resting on headrest behind the backboard. Young child sitting on inclined wheelchair seat with head aligned with body, resting on headrest behind the backboard.

Other ways to help keep hips at a right angle

HIP STRAPS

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.
DVC Ch65 Page 609-1.png
DVC Ch65 Page 609-2.png
WRONG RIGHT

But if the hips tilt forward,
DVC Ch65 Page 609-3.png
A low hip strap will not help much.
DVC Ch65 Page 609-4.png
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.

SPECIAL CUSHIONS

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.

WITH CUSHIONS
shows child using cushions to help sit upright
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.
shows cushion with
sponge rubber padding
block to keep hips from slipping forward
thin wood base
WITHOUT CUSHIONS
shows child sliding off the chair without cushions.
child with spastic cerebral palsy
A footstrap or block that keeps knees bent may help keep the child from straightening stiffly.
shows seat cushion
A padded post may also help to keep hips back and legs apart (see next page).



Keeping the body straight from side to side

DVC Ch65 Page 609-9.png DVC Ch65 Page 609-10.png
hip guides
DVC Ch65 Page 609-11.png DVC Ch65 Page 609-12.png
padded body guide
hip 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.
DVC Ch65 Page 610-1.png DVC Ch65 Page 610-2.png
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.
DVC Ch65 Page 610-3.png DVC Ch65 Page 610-4.png
You can put various holes in the backboard for straps if needed.
body guides
hip guides
DVC Ch65 Page 610-5.png
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.
DVC Ch65 Page 610-6.png DVC Ch65 Page 610-7.png
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.


This page was updated:19 Jan 2018