Adaptive Seating Devices for Children with CP
By Casey Daniel
Technically speaking, adaptive seating is defined as “modifications to seating devices to improve sitting posture and/or postural control in mobility-impaired individuals.” In layman’s terms, this means your child may use a special desk or wheelchair that has been personalized to meet their needs. This chair may involve features like external supports, “saddle seating,” adjustable seat depth, and so forth. There are several different types of adaptive seating devices.
Common Types of Adaptive Seating Devices
Saddle Seats (Bolster Chairs)
These narrow seats allow your child to sit in “saddle position.” Recommended for children with spastic or athetoid CP who experience stiffness in their legs, saddle seats help maintain hip flexion. Bolster chairs are considered a safer seating alternative for kids who sit on the floor with their legs beneath them (“W-sitting”), which can cause muscle contractures and skeletal deformities.
In bolster chairs, pelvic and foot supports maintain bodily alignment, freeing the hands for activities – and preventing loss of posture when the child moves. The adjustable foot supports keep the hips and knees at right angles, so the child is always centered over the base of support.
Seat inserts range from elaborate biofeedback devices to simple contoured foam pieces. Contoured foam seating (CFS) is a popular option because it is affordable, easy to transport, and simple to modify.
Built with an eye for skeletal alignment, CFS inserts hold the pelvis in a neutral position. These inserts are thought to increase postural stability and sharpen somatosensory feedback – meaning the child’s perception of bodily sensations (like pressure and warmth) becomes clearer.
There are a variety of external support features on special needs chairs for children, but the most common is the corner chair. Corner chairs assist with visual scanning, breathing, eating, and development of arm mobility; they are ideal for children who lack postural control of the head, neck, or trunk.
The back of the chair is V-shaped rather than straight, and the seat can be lifted or lowered. A raised seat promotes thigh alignment, reducing both tightness in the hamstrings and spasticity in spinal and pelvic alignment. A lowered seat allows the child to relax with legs extended.
Corner chairs often come with abductors, or rectangular cushions that are placed between the distal femurs to ensure hip alignment. The abductor, in conjunction with the seatbelt, helps prevent the child from sliding or pushing out of their chair.
Some adaptive chairs are similar to corner chairs, but with one key difference: they have a straight back, rather than a V-shaped back. These seats are ideal for children who struggle less with head and neck control, but more with hip adduction. Straight-backed adaptive chairs are often recommended for kids who experience undue rotation stress on their femoral heads.
Some adaptive chairs offer a pelvic femoral stabilizer – a vertical, padded board that extends across the front of the knees, keeping the child positioned firmly on the seat.
Benefits of Adaptive Seating Devices
Adaptive seating devices are believed to provide skeletal stability, thus improving postural control. Postural control allows children to develop heightened functional ability – particularly mobility of the arms, grasping, visual scanning and tracking, and especially self-feeding. These devices are particularly useful in the development of self-feeding skills because they hold the pelvis in a neutral position, providing a secure foundation for the rest of the spine. Altogether, this promotes trunk alignment, which both frees the child’s hands and allows for proper digestion.
Adaptive seating is also associated with decreased risk of spinal deformity. In some cases, these devices can promote the correction of existing scoliosis in children with CP.
Researchers commonly observe that individuals who use adaptive seating devices often experience increases in social interaction, occupational satisfaction, and performance of the activities of daily living (ADL). Many of these improvements persist even after the device is removed.
One study suggested that regular use of adaptive seating devices can “prevent deterioration of [an individual’s] measured skill set over a period of five years.” This means that, in addition to increasing function and posture during use, these devices can help “lock in” existing abilities and result in cumulative improvement over time.
Studies About the Benefits of Adaptive Seating Devices
Dozens of studies about the benefits of adaptive seating devices have been conducted since the 1980s, but their findings have varied widely. At the end of 2008, the American Physical Therapy Association (APTA) oversaw a comprehensive review of these studies’ methods and results, which was published in their pediatric journal.
APTA concluded that the devices seem to help manage impairments associated with CP and can improve overall function. They noted that quality research on whether these devices truly improve postural control is limited, and the results of this research have been mixed.
Research into the benefits of saddle seats yielded mixed results – some children experienced improved mobility and posture, while others did not. Seat inserts, external supports, and modular seating systems produced more uniformly positive findings, with the majority of children demonstrating improvements. All devices – especially saddle seats and seat inserts – seemed to bolster social skills and ADL performance to some degree.
Nearly all adaptive seating devices showed positive results moreover, APTA concluded – but the improvements were rarely drastic. Anecdotal evidence for the benefits of these devices, however, is strong; an overwhelming majority of families report substantial improvements in their child’s performance when the child is using an adaptive seating device.
For more information about the implications of various seat inclinations, see Proper Positioning for Children with CP.