The Impact of Adaptive Seating Devices on the Lives of Young Children With Cerebral Palsy and Their Families

F-words e ingredientes das intervenções precoces para crianças com paralisia cerebral não deambuladoras: uma revisão de escopo

Cuidados centrados na família (incluindo coaching e intervenções fornecidas pelo cuidador) e treinamento parental formal são estratégias eficazes para crianças nos níveis IV e V do GMFCS. Os ingredientes de tecnologia assistiva podem promover várias F-words (funcionalidade, saúde, família, diversão, amigos e futuro). O menor nível de evidência foi encontrado para diversão, amigos e futuro. Outros fatores (prestação de serviços, treinamento profissional, dose de terapia, modificações ambientais) são relevantes para crianças pequenas nos níveis IV e V do GMFCS. Esta revisão de escopo identificou os ingredientes de intervenções precoces para crianças com paralisia cerebral em risco de não serem deambuladoras, e os mapeou-os de acordo com a estrutura das F-words. O treinamento formal dos pais e a tecnologia assistiva se destacaram como estratégias para abordar com várias F-words.

F-words and early intervention ingredients for non-ambulant children with cerebral palsy: A scoping review

AIM

To explore the ingredients of early interventions provided to young children with cerebral palsy (CP) who are classified in Gross Motor Function Classification System (GMFCS) levels IV and V, and to identify the 'F-words' addressed by the interventions.

METHOD

Searches were completed in four electronic databases. Inclusion criteria were the original experimental studies that fitted the following PCC components: population, young children (aged 0-5 years, at least 30% of the sample) with CP and significant motor impairment (GMFCS levels IV or V, at least 30% of the sample); concept, non-surgical and non-pharmacological early intervention services measuring outcomes from any of the International Classification of Functioning, Disability and Health domains; and context, studies published from 2001 to 2021, from all settings and not limited to any specific geographical location.

RESULTS

Eighty-seven papers were included for review, with qualitative (n = 3), mixed-methods (n = 4), quantitative descriptive (n = 22), quantitative non-randomized (n = 39), and quantitative randomized (n = 19) designs. Fitness (n = 59), family (n = 46), and functioning (n = 33) ingredients were addressed by most experimental studies, whereas studies on fun (n = 6), friends (n = 5), and future (n = 14) were scarce. Several other factors (n = 55) related to the environment, for example, service provision, professional training, therapy dose, and environmental modifications, were also relevant.

INTERPRETATION

Many studies positively supported formal parent training and use of assistive technology to promote several F-words. A menu of intervention ingredients was provided, with suggestions for future research, to incorporate them into a real context within the family and clinical practice.

WHAT THIS PAPER ADDS

Family-centred care (including coaching and caregiver-delivered interventions) and formal parental training are effective strategies for children in GMFCS levels IV and V. Assistive technology ingredients (power, mobility, supported, sitting, stepping, and standing) may promote several 'F-words' (functioning, fitness, family, fun, friends, and future). The lowest level of evidence was found for fun, friends, and future. Other factors (service provision, professional training, therapy dose, environmental modifications) are relevant for young children in GMFCS levels IV and V.

F-Wörter und Interventionsinhalte in der Frühförderung nicht gehfähiger Kinder mit Cerebralparese: eine umfangreiche Literaturübersicht

Ziel

Untersuchung der Inhalte von Frühfördermaßnahmen für Kleinkinder mit Cerebralparese (CP) mit Gross Motor Function Classification System (GMFCS) Level IV und V und die Identifikation von „F‐Wörtern“, die von den Maßnahmen adressiert werden.

Methode

Recherche in vier elektronischen Datenbanken. Einschlusskriterien: experimentelle Originalstudien, die die folgenden PCC‐Komponenten erfüllten: Population: Kleinkinder (im Alter von 0–5 Jahre, mindestens 30% der Stichprobe) mit CP und erheblicher motorischer Beeinträchtigung (GMFCS‐Levels IV oder V, mindestens 30% der Stichprobe); Konzept: nicht‐chirurgische und nicht‐pharmakologische Leistungen der Frühförderung, die Ergebnisse aus einem der Bereiche der Internationalen Klassifikation der Funktionsfähigkeit, Behinderung und Gesundheit (ICF) messen; und Kontext: Studien, die zwischen 2001 und 2021 veröffentlicht wurden, in allen Konstellationen und nicht auf einen bestimmten geografischen Ort beschränkt.

Ergebnisse

87 Studien wurden in dieser Literaturübersicht berücksichtigt, mit qualitativen (n = 3), Mixed Methods (n = 4), quantitativ deskriptiven (n = 22), quantitativ nicht‐randomisierten (n = 39) und quantitativ randomisierten (n = 19) Designs. Die meisten experimentellen Studien befassten sich mit Fitness (n = 59), Familie (n = 46) und Funktion (n = 33), während es nur wenige Studien zu den Bereichen Spaß (n = 6), Freunde (n = 5) und Zukunft (n = 14) gab. Verschiedene Umweltfaktoren (n = 55) waren ebenfalls bedeutsam, z. B. das Angebot an Dienstleistungen, Berufsausbildung, Therapiedosis und Umweltanpassungen.

Interpretation

Viele Studien unterstützen Elternschulungen und den Einsatz assistiver Technologien zur Förderung verschiedener F‐Wörter. Ein „Menü“ von Inhalten der Frühförderung wurden ermittelt, mit Vorschlägen für weitere Forschung, um diese in der klinischen Praxis mit Familien umzusetzen.

Was dieser Artikel beiträgt

F-words e ingredientes de las intervenciones tempranas dirigidas a niños no ambulantes con parálisis cerebral: Una revisión exploratoria

La atención centrada en la familia (incluyendo coaching e intervenciones realizadas por los cuidadores) y el entrenamiento formal de los padres son estrategias efectivas para los niños con niveles IV y V de la GMFCS. Los ingredientes de la tecnología de apoyo pueden promover varias "F-words" (funcionamiento, estado físico, familia, diversión, amigos y futuro). Se encontró el nivel más bajo de evidencia para diversión, amigos y futuro. Otros factores (provisión de servicios, formación profesional, dosis de terapia, modificaciones del entorno) son relevantes para los niños pequeños con niveles IV y V de la GMFCS. Ingredientes de la intervención y F-words en intervenciones tempranas dirigidas a niños no ambulantes con parálisis cerebral.

Effect of Adaptive Seating Systems on Postural Control and Activity Performance: A Systematic Review

PURPOSE

To systematically review the effectiveness of adaptive seating systems on sitting posture, postural control, and seated activity performance in children with cerebral palsy (CP).

SUMMARY OF KEY POINTS

From 5 databases, 3 of 21 (14%) articles were of good quality based on the Downs and Black checklist. Commercial modular contoured seating and paper-based low-cost, and contoured foam seating were effective at improving sitting posture, postural control, and seated activity performance. Parents and service providers reported that seating systems reduced stress, burden and psychosocial well-being, and quality of life in children with CP.

CONCLUSION

Limited evidence demonstrated that adaptive seating systems were effective at improving sitting ability and postural control. Randomized controlled trials with objective outcome measures of seating performance in children with CP are needed to evaluate effectiveness.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Adaptive seating devices are preferred by parents and therapists for children with CP; however, objective measures of seating outcomes are needed.

The Experience of Living through the Transition from Adolescence to Adulthood for Young People with Cerebral Palsy

This study explored the lived experience of transition from adolescence to adulthood for young people with cerebral palsy to inform occupational therapy practitioners as to what might promote positive life opportunities. A phenomenological methodology was used with six participants, aged 18 to 25 years with cerebral palsy. The findings are presented in the form of hermeneutic stories and three themes: The storm of uncertainty; time, space and the body, Capsizing in a world of others and, Securing anchorage; being heard and understood. Recommendations include service integration across health, social care and education based on partnership and provision of coordinators.

Opportunities for learning and social interaction in infant sitting: Effects of sitting support, sitting skill, and gross motor delay

The development of independent sitting changes everyday opportunities for learning and has cascading effects on cognitive and language development. Prior to independent sitting, infants experience the sitting position with physical support from caregivers. Why does supported sitting not provide the same input for learning that is experienced in independent sitting? This question is especially relevant for infants with gross motor delay, who require support in sitting for many months after typically developing infants sit independently. We observed infants with typical development (n = 34, ages 4-7 months) and infants with gross motor delay (n = 128, ages 7-16 months) in early stages of sitting development, and their caregivers, in a dyadic play observation. We predicted that infants who required caregiver support for sitting would spend more time facing away from the caregiver and less time contacting objects than infants who could sit independently. We also predicted that caregivers of supported sitters would spend less time contacting objects because their hands would be full supporting their infants. Our first two hypotheses were confirmed; however, caregivers spent surprisingly little time using both hands to provide support, and caregivers of supported sitters spent more time contacting objects than caregivers of independent sitters. Similar patterns were seen in the group of typically developing infants and the infants with motor delay. Our findings suggest that independent sitting and supported sitting provide qualitatively distinct experiences with different implications for social interaction and learning opportunities. HIGHLIGHTS: During seated free play, supported sitters spent more time facing away from their caregivers and less time handling objects than independent sitters. Caregivers who spent more time supporting infants with both hands spent less time handling objects; however, caregivers mostly supported infants with one or no hands. A continuous measure of sitting skill did not uniquely contribute to these behaviors beyond the effect of binary sitting support (supported vs. independent sitter). The pattern of results was similar for typically developing infants and infants with gross motor delay, despite differences in age.

Prevalence of the need for adaptive seating systems among children with cerebral palsy in Egypt

BACKGROUND

An adaptive seating system is a basic rehabilitation need for children and youth with cerebral palsy (CP) as it supports the structure and function of the musculoskeletal system and can positively affect their activities and participation. Despite the importance of adaptive seating systems, there is limited access to such systems in low-income countries.

OBJECTIVES

To determine the percentage of children and youth between 4 and 18 years of age with CP in Egypt whose activity level and sitting ability suggest the need for an adaptive seating system.

STUDY DESIGN

Observational cross-sectional study.

METHODS

One hundred ninety-three participants were included after fulfilling the criteria of the Surveillance of Cerebral Palsy of Europe. Their level of activity was assessed by a physical therapist using the Gross Motor Function Classification System (GMFCS), and their sitting ability was evaluated using the Level of Sitting Scale (LSS). Participants were considered to require an adaptive seating system if they scored GMFCS level IV or V and LSS level 1-5 concurrently.

RESULTS

Approximately 44% of the study participants were classified as GMFCS level IV or V and LSS level 1-5, suggesting that they were in need of an adaptive seating system.

CONCLUSIONS

There is a large percentage of children and youth with CP in Egypt who need an adaptive seating system to be integrated into their rehabilitation.

Thinking outside the cardboard box: insights from a course to train rural Kenyans to make postural support devices from appropriate paper-based technology (APT) for children with cerebral palsy

Purpose: Suitable assistive devices for children with cerebral palsy (CP) in low-income countries are often unavailable. Devices made from APT are in use in several countries but are unevaluated.Materials and methods: A 2-week training course focused on APT principles, measuring children and constructing postural support devices. Twenty-three Kenyans attended the course. The host organization identified four local children with CP who attended for assessment and measurement. Participants made the devices and children returned for fitting and necessary adjustment. Completion of post-course forms, action plans, visits after 14 months and contact 3 years later comprised the evaluation.Results: All participants found the course beneficial and valued the networking opportunity provided. They appreciated the practicality and utility of locally manufactured cost effective devices. The trainees planned further implementation to provide assistive devices for children with CP in their localities. Follow-up visits revealed several challenges to local ongoing production.Conclusions: Training people in low-income communities to make bespoke assistive devices for children with CP is straightforward, and the course was positively evaluated. However, maintaining device production is limited without local group support and stable leadership, ideally as part of an existing programme.Implications for rehabilitationAssistive devices are often unobtainable for children with cerebral palsy (CP) in low-income countries.APT is a cost effective way of fulfilling this need and it is relatively straightforward to train people who care for or work with those with CP to make devices using APT.Feedback from APT training suggests participants find the technique a practical way of producing assistive equipment for individuals with CP in their community.Maintaining device production requires support, leadership and increased public awareness of the use of APT at a local level.

Evaluation of the multidimensional effects of adaptive seating interventions for young children with non-ambulatory cerebral palsy

PURPOSE

To investigate the short-term effectiveness of the first adaptive seating system received by children with non-ambulatory cerebral palsy (CP) who are classified as level IV or V according to the Gross Motor Function Classification System.

MATERIALS AND METHODS

A trained clinical assessor examined 20 children with non-ambulatory CP (mean age: 4.5 years) for their trunk control ability in static, active, and reactive tasks using the Segmental Assessment of Trunk Control. Their primary caregivers were also interviewed about their child's activity and participation using the Paediatric Evaluation of Disability Inventory Computer - Adaptive Test in daily activity and social/cognitive domains and Family Impact of Assistive Technology Scale for Adaptive Seating in child and family functioning domains. Data for each measure were collected 3 times: at baseline (pre-intervention) and then 6 weeks and 3 months after children received their first adaptive seating system.

RESULTS AND CONCLUSION

The static and active trunk control scores between baseline and 6 weeks, and baseline and 3 months significantly improved. Daily activity scaled scores significantly improved between baseline and 3 months, and 6 weeks and 3 months. Significant, large gains in child and family functioning overall were detected between baseline and 6 weeks, and baseline and 3 months. These findings provide emerging evidence of multidimensional effects associated with the introduction of a first adaptive seating system into the lives of young children with non-ambulatory CPIMPLICATIONS FOR REHABILITATIONThe introduction of an adaptive seating system into the wheelchair of children with non-ambulatory cerebral palsy may be associated with short-term gains in body function, activities, participation and aspects of the child's environment.

Effects of adjustments to wheelchair seat to back support angle on head, neck, and shoulder postures in subjects with cerebral palsy

A wheelchair is usually a source of mobility for people with moderate to severe cerebral palsy, who are unable to walk. They spend long periods of time sitting in their wheelchair, which can affect their head and neck alignment. Opening the seat to back support angle of the wheelchair can modify realignment of body segments and improve posture. Aims: To examine the effect of seat to back support angle adjustments on head, neck, and shoulder postural alignment in people with cerebral palsy. Methods: Nine participants with cerebral palsy who use a wheelchair for mobility sat in a research wheelchair. Sagittal head angle (SHA), cervical angle (CVA), and shoulder angle (SA) from photographs were examined using the Coach's Eye device during three different seat to back support angles of the wheelchair (90°, 100°, 110°). Results: There were significant differences in mean SHA and CVA among the different seat to back support angles (p < .001). However, there was no significant difference in mean SA. Conclusion: Head (SHA) and (CVA) alignment was closest to neutral posture with seat to back support angles set at 110°. Thus, adjusting the wheelchair back support to a 110º would provide the most appropriate sagittal head and cervical angle for this population.

Design and development of the first exoskeletal garment to enhance arm mobility for children with movement impairments

Children with a variety of diagnoses have impairments that limit their arm function. Despite the fact that arm function is important for early learning and activities of daily living, there are few tools to assist movement for these children, and existing devices have challenges related to cost, accessibility, comfort, and aesthetics. In this article, we describe the design process and development of the first garment-based exoskeleton to assist arm movement in young children with movement impairments: the Playskin Lift^TM. We outline our design process, which contrasts with the traditional medical model in that it is interdisciplinary, user-centered, and addresses the broad needs of users, rather than device function alone. Then we report the results of field-testing with the initial prototype with respect to our design metrics on a toddler with significant bilateral arm movement impairments. Finally, we summarize our ongoing development aimed at increasing comfort, aesthetics, and accessibility of the garment. The interdisciplinary, user-centered approach to assistive technology design presented here can result in innovative and impactful design solutions that translate to the real world.

Effects of different seating equipment on postural control and upper extremity function in children with cerebral palsy

BACKGROUND

Adaptive seating supports for cerebral palsy are recommended to develop and maintain optimum posture, and functional use of upper extremities.

OBJECTIVES

To compare the effectiveness of different seating adaptations regarding postural alignment and related functions and to investigate the effects of these seating adaptations on different motor levels.

STUDY DESIGN

Prospective study.

METHODS

A total of 20 children with spastic cerebral palsy (Gross Motor Function Classification System 3-5) were included. Postural control and function (Seated Postural Control Measure, Sitting Assessment Scale) were measured in three different systems: standard chair, adjustable seating system and custom-made orthosis.

RESULTS

In results of all participants ungrouped, there was a significant difference in most parameters of both measurement tools in favor of custom-made orthosis and adjustable seating system when compared to standard chair ( p < 0.0017). There was a difference among interventions in most of the Seated Postural Control Measure results in Level 4 when subjects were grouped according to Gross Motor Function Classification System levels. A difference was observed between standard chair and adjustable seating system in foot control, arm control, and total Sitting Assessment Scale scores; and between standard chair and custom-made orthosis in trunk control, arm control, and total Sitting Assessment Scale score in Level 4. There was no difference in adjustable seating system and custom-made orthosis in Sitting Assessment Scale in this group of children ( p < 0.017).

CONCLUSION

Although custom-made orthosis fabrication is time consuming, it is still recommended since it is custom made, easy to use, and low-cost. On the other hand, the adjustable seating system can be modified according to a patient's height and weight. Clinical relevance It was found that Gross Motor Function Classification System Level 4 children benefitted most from the seating support systems. It was presented that standard chair is sufficient in providing postural alignment. Both custom-made orthosis and adjustable seating system have pros and cons and the best solution for each will be dependent on a number of factors.

Family adaptation to cerebral palsy in adolescents: A European multicenter study

BACKGROUND AND AIM

Factors promoting family adaptation to child's disability are poorly studied together. The aim of the study was to describe the family adaptation to disability and to identify determinants associated with using a global theoretical model.

MATERIALS AND METHODS

286 families of teenagers [13-17 years] with cerebral palsy (CP) from 4 European disability registers were included and visited at home. Face to face interviews were performed in order to measure parental distress, perceived impact in various dimensions of family life, family resources and stressors. Relationships were modelled with structural equations.

RESULTS

31.8% of parents living with an adolescent with CP showed clinically significant high stress requiring professional assistance. The main stressors were the level of motor impairment and behavioural disorders in adolescent. A good family functioning was the best protective factor. Respite in care and a parents' positive attitude were significantly related to less parental distress. Material support, socioeconomical level, marital status or parental qualifications did not appear to be significant protector factors.

CONCLUSIONS

Particular attention must be paid not only on physical condition but also on adolescent psychological problems to improve family adaptation. Families at risk of experiencing severe distress should be targeted early and proactive caregiver interventions on the whole family should be performed.

WHAT THIS PAPER ADDS

Family is a dynamic system: facing disability, it tries to recover its balance with available resources and its perception of the situation. Literature highlights potential stressors and protecting factors that could affect the disabled child's family adaptation but few papers study a global model including most of these factors. This study validated a global theoretical model of family adaptation to disability at adolescence. It identified behaviour disorders and motor impairment level as main stressors, family functioning as the largest protecting factors, and equipment and financial support as non significant protective factors.

An Exploration of Comfort and Discomfort Amongst Children and Young People with Intellectual Disabilities Who Depend on Postural Management Equipment

BACKGROUND

The natural response to the intrusive bodily sensation is positional change. This study explored how children and young people (CYP) with intellectual disabilities had their comfort needs met when using adaptive positioning equipment.

METHODS

Thirteen qualitative case studies were undertaken. A parent, a teacher/key worker and a therapist for each CYP were interviewed, and daily routines were observed, with selective video recording. Single case and cross case analyses were undertaken.

RESULTS

Attentive caregivers read the behavioural expressions of the CYP and responded reassuringly, safeguarding them from discomforting experiences. Threats to comfort include the restrictive nature of some equipment accessories, positioning errors and procedural stretching.

CONCLUSIONS

The same item of equipment can be both comfortable and uncomfortable. Given the social and interactional world in which the CYP live and learn, it is others who must accept responsibility for ensuring their optimal level of comfort.

Exploring the functional impact of adaptive seating on the lives of individual children and their families: a collective case study

PURPOSE

This study examined parent-reported change in the functional performance of four school-aged children with wheeled mobility needs who had used a new adaptive seating system for 6 weeks.

METHODS

The collective case study involved four mothers whose children, ages 6-9 years, received a new adaptive seating system for a manual wheelchair or stroller. Mothers completed the Family Impact of Assistive Technology Scale for Adaptive Seating (FIATS-AS) at the time their child received a new seating system, and then after 6 weeks of daily use. Other questionnaires, health records, and semi-structured interviews provided additional data about the seating interventions and their functional effects on individual children and their families.

RESULTS

The FIATS-AS detected overall functional gain in one family, and both gains and losses in 2-7 dimensions for all families. Functional status and change scores showed consistency with measures of seating intervention satisfaction, global functional change, and home participation. Interview themes also suggested consistency with change scores, but provided a deeper understanding of important factors that influenced adaptive seating outcomes.

CONCLUSION

This study supports the need to explore further the complexity, temporality and meaningfulness of adaptive seating outcomes in individual children and their families. Implications for Rehabilitation Assistive technology practitioners need to adopt practical measurement strategies that consider the complexity, temporality, and meaningfulness of outcomes to make evidence-informed decisions about how to improve adaptive seating services and interventions. Health measurement scales that measure adaptive seating outcomes for service applications must have adequate levels of reliability and validity, as well as demonstrate responsive to important change over time for individual children and their families. Needs-specific measurement scales provide a promising avenue for understanding functional outcomes for individual children and youth who use adaptive seating systems.

A Perceptual Motor Intervention Improves Play Behavior in Children with Moderate to Severe Cerebral Palsy

For children with moderate or severe cerebral palsy (CP), a foundational early goal is independent sitting. Sitting offers additional opportunities for object exploration, play and social engagement. The achievement of sitting coincides with important milestones in other developmental areas, such as social engagement with others, understanding of spatial relationships, and the use of both hands to explore objects. These milestones are essential skills necessary for play behavior. However, little is known about how sitting and play behavior might be affected by a physical therapy intervention in children with moderate or severe CP. Therefore, our overall purpose in this study was to determine if sitting skill could be advanced in children with moderate to severe CP using a perceptual motor intervention, and if play skills would change significantly as sitting advanced. Thirty children between the ages of 18 months and 6 years who were able to hold prop sitting for at least 10 s were recruited for this study. Outcome measures were the sitting subsection of the Gross Motor Function Measure (GMFM), and the Play Assessment of Children with Motor Impairment play assessment scale, which is a modified version of the Play in Early Childhood Evaluation System. Significant improvements in GMFM sitting scores (p < 0.001) and marginally significant improvement in play assessment scores (p = 0.067) were found from pre- to post-intervention. Sitting change explained a significant portion of the variance in play change for children over the age of 3 years, who were more severely affected by CP. The results of this study indicate that advances in sitting skill may be a factor in supporting improvements in functional play, along with age and severity of physical impairment.

Lessons learned from studying the functional impact of adaptive seating interventions for children with cerebral palsy

Little empirical evidence exists about the effectiveness of assistive technology interventions for children with cerebral palsy (CP) to inform clinical practice. This article reviews what we know about the functional impact of adaptive seating interventions - a common assistive technology type recommended for children with CP. A contemporary assistive technology outcomes framework is considered as a way to model the temporality and measure the effects of seating interventions and moderating cofactors. Three research studies are profiled to illustrate different research methods, measurement approaches, and follow-up periods to learn about adaptive seating outcomes. Recommendations for future research include the adoption of common measurement indicators, consideration of quality assessment criteria, and the use of varied methodologies to generate new knowledge about functional outcomes. It is suggested that the proposed strategies will lead to new understandings, clinical applications, and ultimately improvements in the everyday lives of children with CP and their families.

Adaptive seating systems in children with severe cerebral palsy across International Classification of Functioning, Disability and Health for Children and Youth version domains: a systematic review

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.

INTERPRETATION

Because 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.

Effects of seat surface inclination on respiration and speech production in children with spastic cerebral palsy

Background

Respiratory and speech problems are commonly observed in children with cerebral palsy (CP). The purpose of this study was to identify if inclination of seat surface could influence respiratory ability and speech production in children with spastic diplegic CP.

Methods

Sixteen children with spastic diplegic CP, ages 6 to 12 years old, participated in this study. The subjects’ respiratory ability (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), peak expiratory flow (PEF), and maximum phonation time (MPT)) were measured in three sitting conditions: a seat surface inclined 0°, anterior 15°, and posterior 15°.

Results

FVC was significantly different across three inclinations of seat surface, F(2, 45) = 3.81, P = 0.03. In particular, the subjects’ FVC at a seat surface inclined anterior 15° was significantly greater than at a seat surface inclined posterior 15° (P < 0.05). However, FEV1, PEF, and MPT were not significantly affected by seat surface inclination (P > 0.05).

Conclusions

The results suggest that anterior inclination of seat surface may provide a positive effect on respiratory function in children with spastic diplegic CP.

Two Seating Systems' Effects on an Adolescent With Cerebral Palsy and Severe Scoliosis

BACKGROUND AND PURPOSE

To compare physiological functioning, communication switch activation, and response accuracy in a 19-year-old young man with quadriplegic cerebral palsy and neurological scoliosis using 2 seating systems within the school setting.

METHODS

Prospective single-subject alternating treatment design with 2 conditions: baseline phase with standard planar inserts (A1), custom-molded back with original seat (B), and return to baseline (A2). Measures included oxygen saturation (SaO2), heart rate (HR), respiration rate (RR), body temperature (BT), processing time to activate switches, and response accuracy.

RESULTS

SaO2 levels increased from "distressed" to "normal"; variability decreased. HR, RR, and BT fluctuations decreased with the custom-molded back. Processing time decreased with increased variability, affected by subject's motivation; accuracy improved slightly. Reported social approachability and student-initiated communication increased.

CONCLUSIONS

SaO2 increased and HR, RR, and BT fluctuations decreased with a custom-molded back. Graphing data may help determine seating effect with complex clients.

Ease of Caregiving for Children: a measure of parent perceptions of the physical demands of caregiving for young children with cerebral palsy

The Ease of Caregiving for Children is a parent-completed measure of how difficult it is for them to safely help their children participate in activities of daily living. The objectives of this study were to determine the internal consistency, test–retest reliability, and construct validity (known groups methods) of the Ease of Caregiving for Children and create an interval-level scale. Participants included 429 parents of children with cerebral palsy (CP) and 110 parents of children without motor delay. Children ranged in age from 18 to 60 months. Parents completed the Ease of Caregiving for Children and therapists assessed children's gross motor function. The Rasch model of item response analysis was used to create an interval-level scale. Results indicated high internal consistency and acceptable test-retest reliability. Ease of caregiving varied by children's ages for parents of children without motor delay, however there was no significant difference by age for parents of children with CP. Parents of children with less gross motor ability reported more difficulty in caregiving than parents of children with higher gross motor ability. Rasch analysis for children with CP resulted in a hierarchical ordering of items by difficulty with good fit and logical ordering. Findings support the Ease of Caregiving for Children as a reliable and valid measure of parents' perceptions of their difficulty to safely assist their children to perform activities of daily living. The measure should enable health care providers to assess and provide interventions that address families' needs in caring for their children with CP.

Early diagnosis and early intervention in cerebral palsy

This paper reviews the opportunities and challenges for early diagnosis and early intervention in cerebral palsy (CP). CP describes a group of disorders of the development of movement and posture, causing activity limitation that is attributed to disturbances that occurred in the fetal or infant brain. Therefore, the paper starts with a summary of relevant information from developmental neuroscience. Most lesions underlying CP occur in the second half of gestation, when developmental activity in the brain reaches its summit. Variations in timing of the damage not only result in different lesions but also in different neuroplastic reactions and different associated neuropathologies. This turns CP into a heterogeneous entity. This may mean that the best early diagnostics and the best intervention methods may differ for various subgroups of children with CP. Next, the paper addresses possibilities for early diagnosis. It discusses the predictive value of neuromotor and neurological exams, neuroimaging techniques, and neurophysiological assessments. Prediction is best when complementary techniques are used in longitudinal series. Possibilities for early prediction of CP differ for infants admitted to neonatal intensive care and other infants. In the former group, best prediction is achieved with the combination of neuroimaging and the assessment of general movements, in the latter group, best prediction is based on carefully documented milestones and neurological assessment. The last part reviews early intervention in infants developing CP. Most knowledge on early intervention is based on studies in high-risk infants without CP. In these infants, early intervention programs promote cognitive development until preschool age; motor development profits less. The few studies on early intervention in infants developing CP suggest that programs that stimulate all aspects of infant development by means of family coaching are most promising. More research is urgently needed.

Avaliação da capacidade funcional de crianças com paralisia cerebral

Objetivo descrever a capacidade funcional de crianças com paralisia cerebral que realizavam atendimentos de Fisioterapia e Fisioterapia e Fonoaudiologia. Métodos estudo descritivo, de caráter transversal, composto por 14 crianças com PC do tipo quadriplegia espástica (6 realizavam Fisioterapia e 8 Fisioterapia e Fonoaudiologia). Foram utilizados para avaliação o Inventário de Avaliação Pediátrica de Incapacidade (PEDI) e o Sistema de Classificação da Função Motora Grossa (GMFCS). As associações entre as variáveis categóricas foram analisadas por meio do teste exato de Fisher. Comparações entre médias foram realizadas utilizando-se o teste t de Student. Resultados não se obteve melhora estatisticamente significante nas áreas de autocuidado, mobilidade e função social entre os dois grupos nos domínios de habilidade funcional e assistência ao cuidador. Conclusão as crianças do grupo Fisioterapia tiveram escores funcionais mais elevados que as do grupo Fisioterapia associado à Fonoaudiologia, mas não houve diferença estatisticamente significante entre os grupos. Isso se deu, provavelmente, devido ao reduzido número de participantes, à diversidade de quadros clínicos que a patologia pode apresentar e a possíveis diferenças na intervenção fisioterapêutica realizada nos dois estados, que possuem situações socioeconômicas bem diversas.

Family impact of assistive technology scale: development of a measurement scale for parents of children with complex communication needs

Young people use augmentative and alternative communication (AAC) systems to meet their everyday communication needs. However, the successful integration of an AAC system into a child's life requires strong commitment and continuous support from parents and other family members. This article describes the development and evaluation of the Family Impact of Assistive Technology Scale for AAC Systems - a parent-report questionnaire intended to detect the impact of AAC systems on the lives of children with complex communication needs and their families. The study involved 179 parents and clinical experts to test the content and face validities of the questionnaire, demonstrate its internal reliability and stability over time, and estimate its convergent construct validity when compared to a standardized measure of family impact.

Validation of the relation between the type and amount of seating support provided and Level of Sitting Scale (LSS) scores for children with neuromotor disorders

OBJECTIVES

To assess the construct validity of the Level of Sitting Scale (LSS) by examining the relationship between LSS scores and the type and amount of seating supports.

METHODS

Secondary analysis of the data for 114 children ≤18 years, with neuromotor disorders who participated in a responsiveness study of the Seated Postural Control Measure.

RESULTS

A significant inverse relationship (Spearman rho = -0.42, p < 0.05) was found between LSS scores and amount of seating support provided. Statistically significant differences were also revealed between LSS levels of sitting ability (p < 0.004) and pelvic, thigh, trunk and head seating components and type of seating system, using Kruskal-Wallis test.

CONCLUSION

This study provides evidence of construct validity for the LSS in use as a discriminative measure of sitting ability in children with neuromotor disorders. Further validation is justified. Clinically intuitive associations between sitting ability and seating interventions were confirmed.

Impact of assistive technology on family caregivers of children with physical disabilities: a systematic review

PURPOSE

To systematically review the literature on the effects of assistive technology (AT) on family caregivers of children with physical disabilities.

METHOD

Electronic searches of Medline, CINAHL Plus, PubMed, and PsychInfo were conducted. The main search terms were AT, caregiver, physical disability, cerebral palsy and quality of life. Studies were included if they related to the impact of AT on the family caregiver of children with physical impairment. Data extraction and quality assessments were conducted by three reviewers.

RESULTS

Five articles were eligible for inclusion. Two studies rated weak quality of evidence (level 5), two studies rated moderate quality of evidence (level 3), and one article was a systematic review, rating high level of quality (level 1). A paucity of literature, small sample sizes, descriptive study designs and weak methodological quality meant a narrative review was possible. Three articles reported that AT lightened caregiver assistance in the areas of mobility, self- care and social function.

CONCLUSIONS

Evidence suggests that AT has a positive impact on children with physical impairments and their caregivers. Future studies in this area could include valid and reliable outcome measures of AT use and the psychological impacts of AT on caring for a child with physical impairments.

Functional Seating for School-Age Children With Cerebral Palsy: An Evidence-Based Tutorial

Purpose

This tutorial is designed to teach speech-language pathologists (SLPs) best practices to support functional seating of children with cerebral palsy (CP) in the classroom and in school-based therapy sessions. This tutorial teaches SLPs to (a) recognize the positive effects of seating intervention, (b) identify the characteristics of functional seating that may produce these positive effects, and (c) realize their role in supporting functional seating for school-age children with CP.

Method

The research reporting positive effects of seating intervention for school-age children with CP is presented according to the International Classification of Functioning, Disability and Health (World Health Organization, 2001). Recommended guidelines for functional seating for school-age children with CP are gleaned from the research evidence. The specific role of the SLP in providing functional seating for children with CP is then discussed.

Conclusion

Seating intervention may produce positive body structure and function, activities, and participation effects for school-age children with CP when appropriate equipment is provided for weight bearing, the pelvis is positioned for stability and mobility, and the body is properly aligned. SLPs can support functional seating for school-age children with CP by communicating with professionals with seating expertise and by invoking and monitoring recommended guidelines for children with basic and complex seating needs, respectively.

Injury risk compensation in children with disabilities: could assistive technology devices have a dark side?

PURPOSE

This review article investigates the role of assistive technology (AT) devices and other contextual aspects as unintentional injury risk factors in children with disabilities.

METHOD

A literature review was conducted to identify and review empirical studies that examined the role of AT devices, protective equipment (PE), and other consumer products in the risk-taking behaviors of children and their parents.

RESULTS

Nine original empirical studies and one systematic review examining changes in the risk-taking behaviors or injury levels associated with children's PE and other products were identified and critically reviewed. None of the articles specifically addressed the compensatory effect of AT devices. Since evidence of changes in the risk tolerance of children and their parents after the introduction of PE and other products for children exists, it is conceivable under certain conditions that AT devices could interact with other known risk factors to promote injury risk-taking behaviors in children and their parents.

CONCLUSIONS

Outcomes of this review and current thinking about the interaction of health conditions and contextual factors provide a theoretical underpinning to explore the causal association among unintentional injury risk factors and AT device use by children with disabilities.