The effect of flat vs. contoured seat cushions on movement, stability and function for children with neuromuscular conditions

Abstract

Adaptive seating devices are often placed within wheelchairs of children with neurological disorders who cannot walk independently. They are used in an attempt to (a) improve children's postural alignment or symmetry and thereby reduce the development of fixed deformity, (b) improve children's seated stability in order to increase function, and (c) improve children's comfort. These devices can be difficult for families to use and costly to provide and maintain. Although limited evidence exists that breathing may be improved with upright sitting compared with lying, no scientific evidence exists on the efficacy of these devices in relation to postural management and control, enhancement of function, or comfort. In order to provide an evidence base for this clinical work, we have prioritised four domains of seated behaviour to investigate : function, comfort, stability and postural alignment . For each of these domains we have identified potential outcome measurement tools, such as manual and electric goniometry, modified pain scales, seated functional activities accelerometry, actigraphy and pressure mapping. We are using these tools to compare a ramped contoured seat cushion with a flat seat cushion to explore the differences in seated behaviour in the domains of seated stability, comfort in a seated position, seated function and postural alignment. Theoretically, in a ramped, contoured seat cushion, we would expect an improvement in stability, functional movement, postural alignment and comfort than a standard flat seat cushion. This paper presentation reports the results of a controlled research trial comparing the two seated surfaces for 31 children with complex difficulties, illustrating and quantifying the differences between flat and ramped contoured cushions