Hesperian Health Guides
General Position
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
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
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Contents
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
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. | |
WRONG | RIGHT |
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 healthier 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.
WITHOUT CUSHIONS
child with spastic cerebral palsy
A footstrap or block that keeps knees bent may help keep the child from straightening stiffly. |
WITH CUSHIONS
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 |
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
hip guides |
padded body guide
hip guide |
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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.
body guides
hip guides |
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 child with severe disabilities. |