The development of alternative seating and mobility systems

A Qualitative Study Comparing the Experiences of Tilt-in-Space Wheelchair Use and Conventional Wheelchair Use by Clients Severely Disabled with Multiple Sclerosis

The aim of this study was to explore and compare the experiences of tilt-in-space wheelchair use and conventional wheelchair use in severely disabled clients with multiple sclerosis and significant spasticity.

The research design was a descriptive qualitative approach, using in-depth audio-taped interviews in clients' homes carried out over a 9-month period. A total of 23 clients (7 tilt-in-space wheelchair users and 16 conventional wheelchair users) were recruited from three adjacent district wheelchair services in South-East England. The criteria for recruitment were that the clients were severely disabled with multiple sclerosis, had significant spasticity and were full-time wheelchair users, usually requiring hoisting. Their carers were also interviewed.

The majority of tilt-in-space wheelchair users (6 out of 7) reported that their chairs were comfortable compared with only half of those in conventional wheelchairs (8 out of 16). The positive aspects of tilt-in-space wheelchair provision included comfort, improved postural support, enhanced seating stability, relief of pressure and being able to rest sitting out of bed for prolonged periods, often for more than 6 hours a day. One person reported improved catheter drainage and another reported reduced spasms. The negative aspects of tilt-in-space wheelchairs included their bulky size and lack of manoeuvrability compared with conventional wheelchairs. All the wheelchair users had experienced difficulty with transport and many had relied on family and friends to help with the purchase of expensive adapted vehicles. In conclusion, the majority of the tilt-in-space users were satisfied with their wheelchair, particularly in terms of comfort.

Multi-adjustable chairs for children with disabilities

There is a growing demand that severely disabled children should be offered a normal-looking, comfortable alternative to highly supportive wheelchair seating to facilitate relaxation and social integration. An evaluation of five chairs, funded by Medical Devices Agency, an executive agency of the Department of Health, was undertaken with potential and actual users of these chairs to investigate the chairs' function with respect to the child's posture, and what features were effective. Twenty-nine children tried five chairs for up to 30 min in each; and a postal survey received 100 responses. The chairs seem to meet many users' postural needs (78% of postal survey; 31-72% of short-term evaluation depending on chair); the chairs' adjustability and availability of special features are important in meeting the needs of this user group; evidence of poor design and its implications are discussed.

Postural control in sitting the SAM system: evaluation of use over three years

The most appropriate posture in which to support the person with severe disability and diverse symptoms as a result of complex pathology remains more a matter of opinion than the result of research. This work reviews some of the studies which have attempted to identify definitive criteria for seating in such cases. Factors relating to measurement and conditions which threaten to invalidate the results of research in this field are highlighted. A description of the Seating and Mobility (SAM) system is given, together with a report of the monitoring of nine children with cerebral palsy using the system for a period of three years. The difficulties inherent in this work are noted and questions for future considerations are raised.

Some aspects of modern orthotics

Orthotics is changing more rapidly than ever before, largely resulting from improved understanding of the human requirements and the current state of technological abilities. Walking is always seen as a basic requirement for normal activity and as such it is in this area that most research and development effort is expended. This paper outlines some of the current developments in this interesting topic and includes seating and posture as these are often viewed as precursors to successful standing and then, possibly, gait.

Development of sitting ability, assessment of children with a motor handicap and prescription of appropriate seating systems

The prescription of appropriate seating for children and young adults with a motor handicap is a complex issue requiring a clear identification of the child's physical ability in all postures. Recent work by Pountney et al. (1990) has shown how the development of lying ability is linked to sitting ability. This emphasises the importance of the total approach to assessment and prescription of seating systems and of not isolating seating needs from other postural considerations. This article summarises the work undertaken in recent years at Chailey Heritage to improve knowledge about prescriptive, adaptive seating for children with a motor handicap. The results are being increasingly applied throughout the United Kingdom.