By Lee Vander Loop
CP Family Network Editor

About a third of children with cerebral palsy are non-ambulatory and will require the use of a wheelchair for transportation outside, indoors, or both. Getting the right wheelchair at an early age helps a child gain independence and all the confidence that can inspire.

When a child reaches a size where they can’t be carried safely, around 3 years old, it’s time to get a wheelchair. If you’re new to this need, it is easy to get overwhelmed by all of the choices. But as a parent who has dealt with this issue for many years, there are really only four basic considerations:

• Is it comfortable?
• Is it reasonably adaptable?
• Does it provide the needed support and alignment?
• Is it easy to transport?

That said, there’s an amazing array of wheelchairs and associated technology available today that didn’t exist even 10 years ago. Lightweight, ultra-light, electric, “smart,” sports, all-terrain and customized seating are just some of the wheelchair options for non-ambulatory children and adults in today’s world. There are even wheelchairs that incorporate gyroscopic technology and four-wheel drive.

Selecting a Wheelchair Seating System

Most hospitals and all rehabilitation centers offer “seating clinics.” This is where physical and occupational therapists evaluate a child’s needs and make recommendations for a wheelchair, a.k.a. seating system. Be aware that these clinics may deal with only certain manufacturers and therefore won’t be showing you what other options may be available.

A main consideration of therapists is to choose a seating system that distributes a user’s weight away from areas of the body that are most at risk for pressure sores. For someone who spends hours of their day in the sitting position, the parts of the body that are the most at risk for tissue breakdown include the ischial tuberosities, coccyx, sacrum and greater trochanters. The seating system also must provide stability, comfort, shock absorption and aid in seating posture.

Custom seating systems can be created for individuals with scoliosis or other complex muscular skeletal conditions when it’s obvious that standard seating systems aren’t suitable. United Spinal Association offers an impressive list of manufacturers of custom and molded wheelchair seating systems.

Questions to Ask

You should ask these questions of whatever seating system your child’s therapists recommend:

• How and why did the therapists select the style, options or seating system they are presenting?
• Can the chair/seating system be adjusted for future growth, changes in posture, or function?
• Can the wheelchair or seating system be folded or converted for easy transport?
• Can the chair be used in a vehicle tie down system (if you will be using a tie down system)? If so, what adaptions need to be made?
• What additional accessories are available, such as seating trays, clamps to attach switches or alternative communication devices?
• What adaptations are being added and do they facilitate your child’s needs?
• What type of headrest is being used and what parameters are being used in assessing the best headrest for your child?
• What type of harness system will be used with your child’s new wheelchair or seating system and what is its crash-test rating? A five-point restraint harness is recommended for children.

What about a Powered Wheelchair?

A Swedish study of wheelchair use among children with cerebral palsy found, not surprisingly, that children using powered wheelchairs experienced much greater independence than those that required adult pushing. Therefore, the researchers suggested that children be introduced to a powered wheelchair as soon as they can safely begin to use one.