Adaptive Seating System Research Articles

Sitting Postural Management to Prevent Migration Percentage Progression in Non-Ambulatory Children with Cerebral Palsy: Randomized Controlled Trial Preliminary Data.

spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV-V, age 1-6 years, migration percentage <41%, and informed consent. contractures affecting the hip, anterior luxation, previous hip surgery, and lumbar scoliosis. The treatment group sat with their hips significantly abducted to reduce the head into the acetabulum in a customized system for at least five hours/day for two years. Controls sat with the pelvis and lower limbs aligned but the hips less abducted in an adaptive seating system. The primary outcome was migration percentage (MP) progression. Health-related quality of life and family satisfaction were among the secondary outcomes. The study was approved by the local ethics board and conducted in accordance with CONSORT reporting guidelines. gov ID: NCT04603625. Overall median MP progression was 1.6 after the first year and 2.5 after the second year. No significant differences were observed between the groups. MP exceeded 40% and 50% in 1.8% and 0% of the experimental group and 5.4% and 3.6% of controls in years 1 and 2, respectively. Both groups expressed satisfaction with the postural system and stable health-related quality of life. Conclusions: MP remained stable over the two-year period in both groups. Considering outliers which progressed over 50%, a more protective trend of the hip-centering sitting approach emerged, but this needs to be confirmed in a final, larger dataset.

IoT-Enabled Adaptive Seating System for Monitoring Vital Signs and Detecting Diabetes in Individuals with Disabilities

The IoT based smart chair for measuring vital parameters and detecting types of diabetes is an innovative solution to monitor the health status of individuals with diabetes. The chair is fitted with detectors to gauge vital signs like blood sugar, levels of oxygen, and your heart rate. Additionally, the chair is capable of detecting the type of diabetes that an individual has by analysing their glucose evels We implemented a prototype of Smart IoT chair combining six custom sensors a PIC, and a chair. In this system RF communication is used for when Person is used the smart chair. If one-time rea the RFID tag then the check the body conditions using health parameters. These collected sensors data fed to microcontroller and can be displayed on LCD display. If any sensor is abnormal means, alarm goes on using buzzer. Then sensors data are updated to IoT using cloud. Acetone sensor is used to sense the exhale air problem of diabetics and update IoT. Finally, UV lamp will be ON for remove the viruses. The smart chair can also be used in hospitals and clinics to monitor patients with diabetes and provide early intervention if necessary. The chair is created to be cosy and simple to operate, with a straightforward layout allowing people to quickly access their important data. In general, the Internet of Things (I smart chair for identifying different types of metabolic disease as recording important indicators has the ability to revolutionise diabetes care by real-time monitoring and feedback to individuals and healthcare professionals.

Seating system for scoliosis in nonambulatory children with cerebral palsy: a randomized controlled trial.

This study aimed to investigate the effect of an adaptive seating system on pelvic obliquity and spinal coronal/sagittal balance in children with nonambulatory cerebral palsy and scoliosis. This was a single-blind, prospective, randomized interventional study. Nonambulatory children aged 6-15 years with cerebral palsy and scoliosis were included. The seating system was used for 4 h/day, and exercises were performed 3 days/week for 12 weeks. The Cobb angle, spinopelvic parameters, pelvic obliquity, Reimer's migration index, and Sitting Assessment Scale were measured before and after treatments. A total of 29 participants were randomized into two groups, namely, the seating system+exercise group (SSE-group; n=15) and the exercise group (E-group; n=14). There was no significant change in Cobb angle and Reimer's migration index for both hips in SSE-group, but there was a significant increase in E-group (p=0.002, 0.049, and 0.003, respectively). The sagittal vertical axis, pelvic incidence, and pelvic obliquity decreased in SSE-group. However, there was no difference in the other sagittal parameters and Sitting Assessment Scale-total scores among groups. The adaptive seating system was found to be superior in reducing the progression of Cobb angle and hip subluxation/dislocation, decreasing pelvic obliquity, and improving the sagittal balance of the spine/pelvis compared with exercise therapy.

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

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. 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. Observational cross-sectional study. 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. 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. 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.

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 CP IMPLICATIONS FOR REHABILITATION The 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.

The psychosocial impact of assistive device scale: Italian validation in a cohort of nonambulant people with neuromotor disorders

ABSTRACTThe importance of adaptive seating system on body structure and function is widely accepted, but its impact on psychosocial aspects needs more consideration by health professionals. This article describes the Italian validation of the Psychosocial Impact of Assistive Device Scale (IT-PIADS) for non-ambulant people with neuromotor disorders.Once agreement has been given by the original authors, the scale was translated and adapted to the Italian culture. The IT-PIADS was administered to different wheelchairs users with heterogeneous diagnosis. The internal consistency and test–retest reliability were examined. Its concurrent validity was evaluated with the Italian version of the WheelCon-M-SF.The IT-PIADS was administered to 87 subjects. Cronbach’s α was 0.92 (p < 0.05), and the test–retest reliability (ICC) for competence, adaptability and self-esteem subscales were 0.96, 0.90, 0.93, respectively. The Pearson correlation coefficient of the IT-PIADS with the WheelCon-M-I-SF scores showed significant data for competence and adaptability subscales.Psychosocial perception on assistive devices can be reliably measure. The IT-PIADS showed good psychometric properties and it is possible to confirm its validity for clinical and research purposes. Nevertheless, before using this measure with greater confidence, further psychometric properties tests of the IT-PIADS are recommended.

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 RehabilitationAssistive 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 comparison of flat and ramped, contoured cushions as adaptive seating interventions for children with neurological disorders

This study is a part of an ongoing effort to address the lack of rigorous, scientific evidence to inform the prescription of adaptive seating interventions for children with neurological disorders. The aim is to investigate one aspect of the seat – the cushion, at the same time as developing a battery of tests which are objective, easy to implement and reliable with which adaptive seating interventions can be measured. Method: A total of 35 school-aged children with neurological disorders were assessed in a bespoke adaptive seating system to compare the use of a flat and a ramped, contoured cushion. The measures used were an accelerometer to measure stability, two actigraphs to measure activity, a pressure mapping system to measure weight distribution, goniometry to measure posture and activities to measure functional ability. Results: The results generally support the use of ramped, contoured cushions over flat cushions. The accelerometer and pressure mapping system show particular promise in future research. The actigraphs were unreliable, although other models may prove more suitable. The goniometry produced the best results, although it was the least reliable to implement and the seated functional activities need further work. Interpretation: The methodology showed in a number of ways that ramped contoured cushions were more effective than flat seat cushions for a heterogeneous population of children. Accelerometry and pressure mapping showed particular promise for advancing research and practice in the area of adaptive seating, with further work required in other areas. In particular, it is recommended that future efforts pursue the use of more reliable electronic measurement.

Functional Outcomes Associated With Adaptive Seating Interventions in Children and Youth With Wheeled Mobility Needs

ObjectiveTo determine the parent-reported functional outcomes associated with adaptive seating devices for wheeled mobility devices used by young people aged 1 to 17 years. DesignLongitudinal case series. SettingHomes of participating parents. ParticipantsParents (N=70, 63 mothers, 6 fathers, 1 grandmother) who had children with adaptive seating needs. InterventionAdaptive seating system for wheeled mobility devices. Main Outcome MeasureFamily Impact of Assistive Technology Scale for Adaptive Seating (FIATS-AS). ResultsAll parents completed the FIATS-AS 4 times—2 times before and 2 times after their child received a new adaptive seating system. Mixed-design analysis of variance did not detect significant mean differences among the FIATS-AS scores measured at baseline and 2 and 8 months after receiving the seating system (F2,134=.22, P=.81). However, the FIATS-AS detected a significant interaction between age cohort and interview time (F4,134=4.5, P<.001, partial η2=.16). Post hoc testing confirmed that 8 months after receiving the seating system was associated with a large improvement in child and family functioning for children <4 years, maintenance of functioning for children between 4 and 12 years, and a moderate decline in functioning for youth between 13 and 17 years. ConclusionsAdaptive seating interventions for wheeled mobility devices are associated with functional changes in the lives of children and their families that interact inversely with age. Future controlled longitudinal studies could provide further empirical evidence of functional changes in the lives of children and their families after the introduction and long-term use of specific adaptive seating interventions.

A novelty universal adaptive seating system for dragon boating

Dragon boating is a non-weight-bearing sport that requires strenuous and repetitive upper body movements. Athletes with lower limb and trunk weakness are unable to participate due to insufficient seating balance and are at an increased risk of injury. This technical note presents an innovative and successful design of an adaptive seating system for dragon boating. The adaptive seating system provided an optimal trunk support and required stability through an adjustable upholder and angled seat. It also facilitated the athletes to maximize their upper limb function. Specific design for safety measures and quick installation were also highlighted. The adaptive seating system is functional, safe, and a universal design for physically disabled athletes with lower limb and trunk weakness in dragon boating.

An investigation of teaching staff members' and parents' views on the current state of adaptive seating technology and provision

Purpose. It is recognized that for children with poor postural control, a comfortable adaptive seating system which provides them with the support needed to maintain a sitting position can be essential for raising their overall level of well being. The purpose of this study was to investigate the views of teaching staff members at special needs schools and of the parents of children who attended these schools on the provision and current technology of seating systems.Method. Two similar questionnaires intended to elicit the views of teaching staff and the parents of children attending these schools were designed and distributed to these groups.Results. Dissatisfaction exists with reliability of these systems and the time it takes for replacement systems to be issued. The perceived importance of adaptive seating role in the user being accepted by peers was found to be statistically different between the two groups. Time spent per day transferring the child to and from seating systems was found to be greater than 1 h for both groups.Conclusion. Scope remains for improvements to be made in adaptive seating provision and technology. Although mainly descriptive, these results could be of use when developing newer systems and improving services.

The Development of a Novel Adaptive Seating System for Children with Neuromuscular Disorders

Adaptive seating has been defined as the customized prescription and application of sitting support devices based on therapeutic principles. It is recognized that for children with neuromuscular disorders that result in poor postural control, a comfortable adaptive seating system that provides them with the support needed to maintain a sitting position can be essential for raising their overall level of well being. These systems are also used to try and prevent or to slow the progression of skeletal deformities. However, problems with current adaptive seating systems do exist. After extensive research into these problems we developed a novel adaptive seating system which aims to improve on current designs. It includes a number of innovative features including • Active dynamic supports: The backrest and headrest are mounted on gas springs, allowing them to move in order to accommodate the user's task induced movement or abnormal muscle tone. The forces applied to and the position of the supports are monitored and used to control motors attached to the gas springs. This means that the user can, when required, be returned to their original position in a controlled but still dynamic manner. The “floating” nature of these supports, especially the backrest, is also intended to allow for some growth of the user. • Novel backrest shape: In an attempt to positively influence abnormal hip extensor tone, the user's trunk is given a predominantly lateral rather than posterior type of support. Preliminary results suggest that this approach could have some beneficial effects in terms of reducing abnormal hip extensor tone. • Multi-planar tilting seat base: Tilting of the base in the saggital and coronal planes can be actuated manually or pre-programmed to do so automatically at set intervals. This aims to improve user comfort and prevent the development of pressure sores and could also be used to accommodate deformities such as pelvic obliquities. Through these features the novel system has the potential to provide improved comfort, support and functionality for the users and to reduce the burden place on those who care for them.

A comparative exploration of the thoughts of parents and therapists regarding seating equipment for children with multiple and complex needs

Purpose. We investigated the opinions of parents and therapists of children using adaptive seating systems in order to understand their common areas of interest or disagreement.Method. Parents and therapists participated in answering a questionnaire regarding their child's response to, and comfort in their individual adaptive seating system. The children all had a motor disorder involving all four limbs and did not have verbal communication skills. Questionnaire was analysed using non-parametric statistics for quantitative questions and by keyword analysis of qualitative questions. The results were then further categorized into the domains of the International Classification of Functioning, Disability and Health (ICF).Results. Parents and therapists showed differences in key areas: Parents concentrated on personal and environmental factors to explain their satisfaction or otherwise of the chair, whereas therapists concentrated on body function and structures; to the exclusion of all other domains of seated function.Conclusions. Based on these findings, we suggest further investigation of these seating systems, concentrating on the activity and participation of the children themselves, although considering all domains of functioning.

Community-Based Performance of a Pelvic Stabilization Device for Children With Spasticity

We developed a new type of pelvic stabilization device designed to help children be better positioned in their wheelchairs. The device replaces a wheelchair lap belt by providing firm anterior pelvic support for the seated user. We developed, tested, and evaluated instructions for installing, fitting, and using the device to study its performance in “typical” community settings in Toronto, Canada. Each of four therapists worked with a local rehabilitation technology supplier to install and fit the device onto an adaptive wheelchair seating system for a young child between 5 and 10 years of age. Therapists assessed the system's positioning effects, and children used the system for 12–14 days. Following the trials, therapists, parents, and children reported their levels of satisfaction with the performance of the device as compared with the children's existing lap belts. Participating therapists confirmed that the device provided better anterior pelvic stability for their clients. Parents felt that their children were generally better positioned in their seats and thought that the device was easy to use. Children had similar perspectives. Suppliers were confident that they could readily install the devices following the instructions provided. Based on the opinions of participants and our inspection of the installed devices, we proposed that minor modifications be made to the product design and instructions for installation, fitting, and use.

The International Classification of Functioning, Disability and Health provides a Model for Adaptive Seating Interventions for Children with Cerebral Palsy

Children with severe types of cerebral palsy use adaptive seating systems to encourage function and assist in delaying the development of deformity. These systems are often assessed for and provided by occupational therapists. However, there has been no unifying policy or theoretical basis on which these systems are provided and research evidence is lacking, with studies tending to be small and non-controlled.The International Classification of Functioning, Disability and Health (World Health Organisation 2001a,b) aims to establish a common language for clinical practice as well as research, while bringing together the opposing social and medical models of health care delivery. This paper suggests that the ICF model is an ideal theoretical basis for adaptive seating system assessment and provision, given that these systems often conflict between the medical model of reducing or delaying impairment of body functions and structures and the social model of children and families accessing life and environmental situations through mobility and seating equipment.The paper considers all the domains of the ICF with regard to the current literature. It concludes that using the model in the context of providing adaptive seating gives occupational therapists both a powerful tool for communicating with children and families as well as managers and a basis for evaluating practice.

Revolutionary Advances in Adaptive Seating Systems for the Elderly and Persons with Disabilities that Assist Sit-to-Stand Transfers

The independence of elderly and arthritic patients as well as persons with disabilities is influenced considerably by their ability to stand from a chair. The presence of pain, reduced joint range of motion, stiffness, and muscle weakness often limit the ability to achieve a sit-to-stand position (STS). Realizing the enormous implications of STS performance, physicians, scientists, and industry have joined together to design and manufacture a wide variety of adaptive seating systems that facilitate therising process. These systems can be divided into three groups: those without mechanical devices, those with mechanical lifts, and those that can lift, tilt in space, recline, or rock. The design of mechanical seating systems without mechanical assists have been influenced by several factors, including chair height, armrest height, and foot position of the occupant. The evaluation of STS performance involves a variety of measurements to include joint angles and moments, speed of time to rise, functional reach and sway, and perception of patient stability (or perceived safety) in rising from a chair. These studies reported that chair seat height, use of armrest, and foot position had a major influence on the ability to do a STS movement. The use of higher chair seats resulted in lower moments at the knee and hip level. Investigators reported that lowering the chair height increased the need for momentum generation or repositioning of the feet to lower the needed moments. They found that the use of an armrest reduced the moments needed at the hip without altering the range of motion of the joints. These investigators found that repositioning of the feet influenced the strategy of STS movement, allowing lower mean extension moments at the hipwhen the foot position changed from anterior to posterior. Adaptive seating systems with lifts include the spring-booster chair spring-loaded flap seat, and ejector chair. Innovative investigators reported that increased seat height complemented by the mechanical lift enhanced STS transfers by persons with disabilities. The investigators noted that it was easier to perform STS transfer when using a mechanical lift than when rising unassisted or from a raised seat height. The latest adaptive seating system, the elevator chair, has the unique ability to assist the occupant to the STS position. The rear section of this chair remains in a fixed position to support the buttocks of the user during the mechanical lift. The front portion of the seat folds down incrementally as the chair rises to allow the feet of the user to be positioned firmly on the floor. Using an elevator chair, the height that the chair rises will vary with the length of the occupant's legs. When the user reaches a point when his/her legs are comfortably straight and the body is in an erect position, the occupant will walk unassisted from the chair. This elevator chair will soon be available with a tilt-in-space capability as well as a gently rocking motion. The elevator chairs are ideally suited for offices, waiting rooms, hospitals, long-term care facilities, and homes. While persons with disabilities appreciate the benefits of these adaptive seating systems, which allow them to achieve a STS position without assistance, healthcare personnel also value the benefits of these adaptive seating systems because they eliminate their need to lift the occupant to a standing position--an invitation for a potentially serious back injury.

Adaptive seating and pulmonary function in adults with muscular disease

Pulmonary infections, possibly due to poor pulmonary functions, are common in individuals with muscular dystrophy. In order to evaluate the relative effects of seating devices on pulmonary function the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and forced expiratory time (FET) in eight adults aged between 12 and 21 years with Duchenne Muscular Dystrophy was measured while seated in an adaptive and a nonadaptive seating device. The results showed a 28.0% increase in FVC, a 14.5% increase in FEV1, and a 17.3% increase in FET in the adaptive seating system compared to the nonadaptive system. This result emphasizes the need for proper seating as an important way of maximising pulmonary function and minimizing pulmonary complications in this population.

Effect of adaptive seating on pulmonary function of children with cerebral palsy.

The vital capacity (VC), forced expiratory volume in one second (FEV1) and expiratory time (ET) of eight cerebral-palsied children aged between five and 12 years was measured, when seated in a regular sling-type wheelchair and in an adaptive seating system. The results showed a 57.7 per cent increase in VC, a 51.6 per cent increase in FEV1 as a percentage of VC, and a 55 per cent increase in ET in the adaptive seating system compared with the standard wheelchair. These results have important implications for speech, sitting for prolonged periods and prevention of hypoxia and pulmonary hypertension.