AIM The aim of this study was to systematically review the effect of adaptive seating systems (AdSSs) in young people less than 19 years of age with severe cerebral palsy (CP), with particular focus on child-related outcomes across all components of the functioning and disability domains of the International Classification of Functioning, Disability, and Health for Children and Youth version (ICF-CY).METHOD Literature searches of studies published from 1975 to October 2014 were performed.Methodological quality and the risk of bias were analysed using Sackett's level of evidence, the American Academy for Cerebral Palsy and Developmental Medicine guidelines, and Mallen criteria for observational studies.RESULTS Nine studies fulfilled the selection criteria. All studies had level IV evidence and were of moderate methodological quality. The results focused on the effects of AdSSs on postural control and on upper extremity function and on additional child-related outcomes. The results suggested that AdSSs that include trunk and hip support devices may improve postural control outcomes, and that special-purpose AdSSs may improve self-care and play behaviour at home. INTERPRETATIONBecause of a low level of evidence and the moderate methodological quality of the studies available, no robust conclusions can be drawn. Nevertheless, the data suggest that AdSSs may be able to improve activity and participation at home among children with severe CP. More studies of high methodological quality addressing the effect of AdSSs on activity and participation are urgently needed. Suggestions for future research are provided.Adaptive seating systems (AdSSs) are part of the postural management programme recommended in multifaceted guidance for children with severe cerebral palsy (CP). 1,2The survey of the Surveillance of Cerebral Palsy in Europe (SCPE) 3 showed that about 40% of children with CP have a severe form of CP, which means that their gross motor function is classified in level IV or V according to the Gross Motor Function Classification System (GMFCS). 4Children with severe forms of CP face serious limitations of functioning, activity, and participation. The functional limitations are apparent from the children's mobility. Children classified in GMFCS level IV usually function in supported sitting with limited self-mobility. They require adaptive seating, which provides support at the level of the pelvis and trunk, and they need physical assistance for most transfers. 4,5 Children functioning in GMFCS level V have severe limitations in pelvis, trunk, and head control.5 They typically require a seating system which provides support for head, trunk, pelvis, and legs, and they depend on adult assistance for mobility and self-care throughout the day. 4,5Their severe postural dysfunction 5 interferes significantly with activities of daily living, such as eating, playing, dressing, and undressing; it also restricts their participation, such as their interaction with friends or family members. 4,6,7 Adaptive seating for children...

The feasibility of the complex protocol was established. The data suggested that a 6-week TDAR intervention may improve gross motor function and may reduce stereotyped postural adjustments in children with CP. The limited results warrant replication in a well-powered randomized controlled trial.

No abstract