This review analyzed research literature concerning pulmonary function and positioning of persons with cerebral palsy (CP) who lack trunk control. The search reviewed literature published from 1966 through March 2003. Twenty-eight references located by electronic database search were analyzed using Moody's Research Analysis Tool. All reflected either a physiologic or therapy-based model involving function in activities of daily living, but no health outcomes. One reference applied a nursing model to care of developmentally disabled persons, including those with CP. Existing research gaps include the need for human subjects, larger sample sizes, measurement of influence of gravity on body position, greater precision in describing independent variables of positioning, and participation by children with disabilities. This paper proposes a conceptual model using Orem's self-care theory upon which to base nursing interventions, including therapeutic positioning of persons with CP who lack trunk control. Future nursing research should explore health outcomes of various properties of wheelchair positioning.

In children with cerebral palsy (CP), poor trunk control can lead to spinal deformity, pulmonary compromise (Canet, Praud, & Bureau, 1998), and increased health risks and costs of long-term care (Braddock, 2002). Evidence links posture and pulmonary function, but the influence of wheelchair components on pulmonary function is unknown. This article reports on a study evaluating pulmonary measurement in wheelchairs and how it affected children with CP. The objectives of the study were to (a) describe recruitment and retention of school-aged children with CP and (b) discuss participants'response to the protocol. Using a wheelchair simulator, participants experienced five seating parameters while pulmonary mechanics measures were recorded. A process log captured participant recruitment and retention challenges and response to the protocol. Recruitment was challenging; retention was 50%. The protocol was feasible for 50% of participants, none of whom could participate in conventional pulmonary function testing. Among the study's participants, facemask and seating simulator acceptability were 75%, improving with participants'increased verbal communication abilities (verbal children tolerated the procedure best). The facemask was vulnerable to tilt; 75% of participants experienced fatigue.