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Seating and Support One of
most critical decisions regarding chair options, and one for which professional input is most crucial, is
choice of a seating cushion.
"The basis for good seating posture starts in
pelvis," Seiberlich says. "We're looking to distribute
weight over as big an area as possible, for support, for comfort and to prevent skin breakdown."
She notes that pressure sores, or decubitis, are a critical concern with prolonged seating. For those who aren't in
wheelchair for many hours at a time, a flat seat may be appropriate. For more prolonged use, or when stability in
chair becomes an issue, a high-quality foam cushion becomes preferable. Other alternatives include air-filled or gel-filled cushions.
"Children with scoliosis (curvature of
spine), whether or not it has been stabilized with spinal fusion, may have some left-right tilt in
pelvis," Seiberlich says. "In such cases, we can use
seating system to minimize
effects of
tilt. Some of
kids are still flexible, so by raising
lower side, we may be able to level out
pelvis. On
other hand, if
tilt is fixed, we'll support
higher side, so it takes up some of
weight. Distributing that weight is
key."
Scoliosis also figures into
choice of
back. "We can't always use a standard flat back or sling back. We may need a molded back to match up to
spinal curvature. Again, we're trying to get more surface contact to lessen pressure," Seiberlich says.
Lateral supports may be an important element as well. "If
child does not have
trunk strength to maintain their upright posture, we need to do it with laterals. Even with spinal fusion, they may need them to help prevent tipping."
Becerril notes that a "tilt-in-space" chair may be appropriate for someone with very little trunk strength. This type of chair maintains
sitting posture, but tilts back to relieve some of
anti-gravity work for a while, combating fatigue. Recliner chairs, which allow a prone position, are used more often for those unable to tolerate
normal angles of seated posture.
Final Fitting Once
chair has been ordered, Becerril says, expect a couple months delay before it arrives. "Authorization takes time, and typically we're dealing with several different companies, and it's a custom product. Nothing related to wheelchairs ever happens quickly."
Once
chair arrives,
hands-on fitting process may take two to three hours, Becerril explains. "Things come up you can't foresee. Also, we want to show parents
signs of an improper fit. It's not something you do once and it's done: Kids grow fast, and their condition can change fast, so you need to monitor
fit constantly."
Seiberlich adds, "We always want parents to be checking for redness, because this indicates too much pressure. They need to check
buttocks,
back,
feet, and
back of
legs. Anywhere
chair is making contact, there's
potential for too much pressure."
She offers an important rule of thumb: "There should be no more than three fingers worth of space between
front of
seat and
back of
legs. With any more than this,
seat is not providing enough thigh support, and
chair may dig into
legs. It also makes sitting more difficult, as you don't get
same amount of surface holding you up. Also, you need to make sure that
footrests are low enough to get full contact for
whole thigh." There should be at least half an inch between
hips and
side of
chair. The laterals shouldn't be too tight, and shouldn't dig into
armpits.
"Parents can make these adjustments, if they know what to look for," Seiberlich says. "But we like to see
child in his chair at least once a year, especially if he's still growing. And anytime they think there's a problem they can't fix, we want them to come in."
Maintenance In addition to monitoring
fit of
chair, Seiberlich stresses
importance of regular maintenance. "The chair should be washed regularly, using a spray cleaner. Most cushions are washable, or have washable covers. A thorough inspection of
whole chair once a week is a good idea: Check
brakes, look for loose hardware, and check
tires and seat."
Becerril points out that change in temperature can change
inflation pressure of tires and air-filled or gel-filled seats. Simple problems can easily be fixed at home. More involved ones can be taken care of by
vendor, who will almost always do maintenance for free.
Finally, Seiberlich returns to
transportation issue to stress an important safety rule.
"Chairs are generally not crash-tested, and
pelvic strap that keeps you in
seat is not as strong as a seat belt. We recommend that a child be on
car seat, strapped in using
car's seat and shoulder belts." If needed for lateral support, a chest harness can be used as well.

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