The trunk/spine complex and wheelchair seating for children: A literature review

Abstract

Wheelchair seating should provide children with disabilities with an external support system from which to gain postural and movement control. The importance of correct pelvic positioning has been extensively discussed in the literature in relation to maintaining correct spinal curvature and muscle balance, and providing a stable base of support for the trunk and upper body. The effects of positioning on the trunk/spine complex has been quantitatively investigated in relation to non‐disabled adults, but little literature is available in relation to children. Of significance to occupational therapists is the effect of trunk/spine positioning on the developing child with a disability. This paper reviews the quantitative literature on seating and assesses the application of research on adults with and without a disability to the child with a disability. Awareness of potential physical stress areas —muscles, ligaments and joints, enables informed practice by occupational therapists. However, it is evident that there are constraints in relating information from research with adults to children with disabilities.

Clinical tools that measure sitting posture, seated postural control or functional abilities in children with motor impairments: a systematic review

“…30,31,51,53,56,57,58,59,61,63–66,69,71,73,74,78 Because our review focused on evaluating the tools used and not the specific intervention outcomes of the study, readers are referred to other reviews of paediatric seating interventions for an evaluation of the quality of evidence provided in these intervention studies. 1,7–9,16–20 Three reviews 9,19,20 highlighted psychometric properties of tools used to evaluate seating interventions: the Sitting Ability Scale, 30 the Modified Schober Measurement of Spinal Extension (referred to simply as Schober for the remainder of this article), 61,62 and Hulme’s assessment instrument. 56,57…”

“…12–14 Well-developed tools assure confidence that the tools measure what they are supposed to measure consistently, are responsive to change, and have clinical meaning interpretable by the user. 12,15 Reviews on the effectiveness of seating interventions have been published for children with different diagnoses, 1,4,8,16–18 with few touching on the measurement tools used in the studies. 9,19,20 A systematic review summarizing the range of tools available would be useful for clinicians with limited time and resources.…”

Occupational therapists as object users: A critique of Australian practice 1954–1995

“…By the 1990s, occupational therapists' thinking had focused on even more specific aspects of human function. For example, Burgman (1994), in discussing spinal mechanisms, stated that 'in terms of flexed posture, effects are noted as compression stress on the anterior annulus with concomitant tensile stress of the posterior annulus fibres, and increased nucleus pulposus pressure' (p. 125). This trend is consistent with adoption of an increasingly reductionist scientific basis to practice, which Kielhofner (1992) describes.…”