Hesperian Health Guides

Carefully Evaluate What Kinds of Support Each Child Needs

Maria’s legs straighten, press together, and turn inward. Her whole body position is affected.

A hip strap holds her hips back some but does not help her overall position much.
Girl slumping in wheel chair strapped at the hips.
However, a backboard that bends her hips more, plus a knee post, help improve her whole body position —without straps!
Child sitting straight in wheelchair with back support and knee post.

Pedro is a heavy child whose body stiffens and his knees push open.

A combination of a backboard with guides, a special cushion and a knee block does not help him.
Boy sitting in wheelchair with guides and body sliding forward.
However, a hip strap together with blocks outside his knees gives him a much better position. (He may also need foot straps.) Larger boy sitting up straight in wheelchair with hipstrap and rectangular supports outside his legs that keep them straight.


Pablito’s spastic muscles pull his shoulders back and make it hard for him to bring his hands together in front of him. The village team had an idea. Boy sitting in chair with arms open.
Back of chair with triangle supports and angled wood on seat to keep legs in.
They put ‘wings’ behind his shoulder blades, like this, to help keep his shoulders forward. boy with triangular wedge behind shoulder
Now Pablito can bring his hands together and play more easily.


These can be made from thin wood, plywood, or fiberboard. They should be easy to take off, but grip firmly when in place.

You can make a simple instrument out of cardboard or stiff paper to measure the child’s body for cutting out the lap board.
3 strips of paper connected to form an upside down U
Child sitting under lap board with raised edges.
Extra holes for changing peg position.
Raised edges help keep toys from falling.
Two pegs to hold onto may help him sit, or move into a better position. They also help him develop hand control (games with rings, etc.)
A lap board can help keep shoulders, arms, and body in a better position, especially if it has a part cut out measured to fit around the child. Lap board with arrows.
Velcro (stick-to-itself tape) can be used to fix the board to the chair for easy removal — and to adjust it forward or backward.
Height of the lapboard is usually the same as for armrests. Experiment to find out what works best.
Child sitting with arms back and hands on lap board.
Child sitting with hands on lap board, with supports for arms.
If needed, arm guides can be used with a lap board to keep a child’s shoulders forward and his arms in a better position to use his hands.
Be sure to put the softer part of the Velcro on the chair arms. The rough parts could scratch the child when the board is not used. DVC Ch65 Page 611-11.png


This insert, from Positioning the Client with Central Nervous System Deficits, provides a lot of control, and is especially useful for some children with spasticity. Although it was designed as an insert for a wheelchair, you can use it as the frame of a wooden wheelchair, or chair without wheels built for a specific child.

DVC Ch65 Page 612-1.png
adjustable shoulder blade wings
hip guide
removable knee and foot separator (wider at front so that child’s knees do not slip forward)
long, thin holes for adjusting back pieces
small-of-back support
hip strap
fasten these joints together with angle irons
wide lip fits firmly against the front side supports of the wheelchair

Measurements are given in centimeters (cm.). To change to inches, divide by 2.5.

DVC Ch65 Page 612-2.png
measurements of an insert to fit a standard ‘junior growing wheelchair’
the height and depth measurements must be adapted to the individual child

(mostly for very young children)

shows two boards forming a seat with
shoulder blade wings
hip guide
straps for holding legs apart
DVC Ch65 Page 612-4.png
To seat the child, the frame can be put on the ground, a table, a chair, or into a wheelchair.


Use the same suggestions for supports, guides, and straps.

straight leg sitting frame with supports as a wheeled cart DVC Ch65 Page 612-6.png

Note: The child’s weight is over the large wheels. He can rock from one caster to the other. For travel over rough ground, he will learn to balance on the center wheel and barely touch down with the others.

CAUTION! Be sure to add cushions or adequate padding to all seating designs. Children whose bodies push in uncontrolled ways can very easily develop pressure sores (see Chapter 24).

This page was updated:27 May 2020