The seating clinic

Abstract

Provision of an appropriate seat for a child with poor postural control or deformity not only improves function by ensuring he feels secure and comfortable, but also forms an important part of his programme of postural management. Children with severe physical disability often spend the majority of their day sitting or lying down and receive comparatively short periods of therapy. Long periods of immobility, particularly in an asymmetric posture, are a recognised cause of deformity. 1 If special seating, together with devices to develop postural control in other positions such as lying and standing reflect and reinforce therapy aims, the child will be encouraged to develop and improve his postural control and the risks of deformity are reduced. A special seating clinic for children and teenagers was set up in Reading 9 years ago, as there were many young people with severe seating problems. At that time the wheelchair service was provided by the Artificial Limb and Appliance Centre and focused on mobility. The majority of patients seen were adults, frequently in the geriatric age group, and the needs of children were often poorly understood. Special seating depended on referral to the Regional Rehabilitation Service and this was usually not considered until deformity precluded use of a standard wheelchair. In 1991 the NHS took over the management of the Wheelchair Service. Their brief is now wider and includes consideration of their patients’ comfort, function, posture, pressure relief and changing needs as well as mobility. Seating advice for complex cases is available at supradistrict or regional level but dedicated children’s services are not available in all regions. This is disappointing as prescriptive seating has been developed for children with motor handicaps, combining bio-mechanical principles with therapy aims, so as to promote maturation of sitting posture and control deforming forces.