SUMMARY The most appropriate posture in which to support the person with severe disability and diverse symptoms as a result of complex pathology remains more a matter of opinion than the result of research. This work reviews some of the studies which have attempted to identify definitive criteria for seating in such cases. Factors relating to measurement and conditions which threaten to invalidate the results of research in this field are highlighted. A description of the Seating and Mobility (SAM) system is given, together with a report of the monitoring of nine children with cerebral palsy using the system for a period of three years. The difficulties inherent in this work are noted and questions for future considerations are raised. RÉSUMÉ Asseoir les personnes présentant des incapacités graves. Le système SAM de mise en position assise: utilisation durant trois ans La posture la plus appropriée pour supporter une personne présentant des incapacités sévères et divers symptômes résultant ďune pathologie complexe relève plus ďune opinion a priori que du résultat ďune recherche. Ce travail revoit quelques unes des études qui ont tenté ďidentifier les critères définitifs pour permettre la position assise dans ces cas. Les facteurs liés à la mesure et aux conditions qui menacent ďinvalider les résultats des recherches en ce domaine ont été soulignes. Une description du système Mise assis et mobilité (SAM) est donnée, ainsi que le suivi de neuf enfants IMC ayant utilisé le système durant trois ans. Les difficultés inhérentes à ce genre de travail sont soulignées et des questions sont posées pour des investigations ultérieures. ZUSAMMENFASSUNG Sitzposition bei schwer behinderten Personen. Das SAM Seating System: drei Jahre in der Erprobung Es ist mehr.eine Ansichtssache als das Ergebnis von Untersuchungen in welcher Haltung ein Patient mit schweren Behinderungen und verschiedenen pathologischen Symptomen gelagert werden sollte. Diese Arbeit gibt eine Überblick über einige Studien, die versucht haben, genaue Kriterien für die Lagerung in solchen Fällen herauszufinden. Faktoren bezüglich Messung und Bedingungen, die die Untersuchungsergebnisse in Frage zu stellen scheinen, werden hervorgehoben. Das Seating und Mobility (SAM) System wird beschrieben und es werden die Ergebnisse der Überwachung von neun Kindern mit Cerebralparese, die dieses System drei Jahre benutzt haben, dargestellt. Die Schwierigkeiten, die in dieser Arbeit stecken, werden aufgezeigt und es werden Fragen für zukünftige Erwägungen aufgeworfen. RESUMEN La sedestación de las personas con grave incapacidad. El sistema sedestación SAM: la evaluatión del empleo durante tres años La postura más apropiada para el soporte de una persona con una grave incapacidad y con diversos sintomas como resultado de una patología compleja, es más una cuestion de opinión que el resultados de una investigación. El presente trabajo revisa algunos de los estudios que han tratado de identificar criterios definitivos para la sedestación en estos casos. Los factores en relatión ...
Contractures are a common complication of advanced multiple sclerosis. In consequence the care load is increased. Sitting in the wheelchair becomes difficult if not impossible and there is a high risk of pressure sores due to inadequate weight distribution. The greatest impedance to care and maintenance was thought to be the bilateral knee flexion contractures and unilateral hip adduction contracture frequently found in the severely paralysed MS patient. It was postulated that release of contracture would ease the care load and management. Comfort and quality of life would improve as a result. Surgery to release the bilateral knee flexion contracture was combined with passive stretching to associated contractures in an attempt to improve the physical condition. A routine regimen of maintenance was introduced postoperatively and continued indefinitely. A comparison of postoperative method to increase range using continuous passive motion (CPM) and plaster of Paris (POP) serial splinting was carried out. The results of the six reported cases show a markedly increased range of movement at the knee, a reduction in care load and an improved sitting posture postoperatively which was maintained when reassessed at nine months. Little difference between the postoperative regimens of CPM and POP fixation was found.
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