Adaptive seating systems in children with severe cerebral palsy across International Classification of Functioning, Disability and Health for Children and Youth version domains: a systematic review

Abstract

AIM The aim of this study was to systematically review the effect of adaptive seating systems (AdSSs) in young people less than 19 years of age with severe cerebral palsy (CP), with particular focus on child-related outcomes across all components of the functioning and disability domains of the International Classification of Functioning, Disability, and Health for Children and Youth version (ICF-CY).METHOD Literature searches of studies published from 1975 to October 2014 were performed.Methodological quality and the risk of bias were analysed using Sackett's level of evidence, the American Academy for Cerebral Palsy and Developmental Medicine guidelines, and Mallen criteria for observational studies.RESULTS Nine studies fulfilled the selection criteria. All studies had level IV evidence and were of moderate methodological quality. The results focused on the effects of AdSSs on postural control and on upper extremity function and on additional child-related outcomes. The results suggested that AdSSs that include trunk and hip support devices may improve postural control outcomes, and that special-purpose AdSSs may improve self-care and play behaviour at home. INTERPRETATIONBecause of a low level of evidence and the moderate methodological quality of the studies available, no robust conclusions can be drawn. Nevertheless, the data suggest that AdSSs may be able to improve activity and participation at home among children with severe CP. More studies of high methodological quality addressing the effect of AdSSs on activity and participation are urgently needed. Suggestions for future research are provided.Adaptive seating systems (AdSSs) are part of the postural management programme recommended in multifaceted guidance for children with severe cerebral palsy (CP). 1,2The survey of the Surveillance of Cerebral Palsy in Europe (SCPE) 3 showed that about 40% of children with CP have a severe form of CP, which means that their gross motor function is classified in level IV or V according to the Gross Motor Function Classification System (GMFCS). 4Children with severe forms of CP face serious limitations of functioning, activity, and participation. The functional limitations are apparent from the children's mobility. Children classified in GMFCS level IV usually function in supported sitting with limited self-mobility. They require adaptive seating, which provides support at the level of the pelvis and trunk, and they need physical assistance for most transfers. 4,5 Children functioning in GMFCS level V have severe limitations in pelvis, trunk, and head control.5 They typically require a seating system which provides support for head, trunk, pelvis, and legs, and they depend on adult assistance for mobility and self-care throughout the day. 4,5Their severe postural dysfunction 5 interferes significantly with activities of daily living, such as eating, playing, dressing, and undressing; it also restricts their participation, such as their interaction with friends or family members. 4,6,7 Adaptive seating for children...

Effects of different seating equipment on postural control and upper extremity function in children with cerebral palsy

“…10,18,26 The results of this study showed that there is a very obvious need for postural support for seating in children with CP, since there was a significant difference in most In the present study, GMFCS Level 3, 4, and 5 children were included because the children in these levels require seating systems more, and it has been reported numerous times that as the level increases, their need for seating systems also increases. 11,17 It was surprising (because it contradicts with the literature) to see that there were differences among groups in terms of all SPCM values in both all children ungrouped as well as grouped, and paired comparisons showed no difference between seating groups except in Level 4 children. An analysis of these results showed that the differences in most items of SPCM were between SC and the other applications, and AdSS and CMO yielded similar results.…”

“…5,7,23,24 Adaptive seating systems for the treatment of children with CP have been utilized for the improvement of positioning and functioning and for the prevention of various secondary complications. 11 With additional accessories, adaptive seating equipment is used to activate functionality. Researchers have been working to improve limited postural control, functional potential, and poor sitting balance using appropriate sitting positions.…”

“…Head control 3 (none-good) 4 (poor-good) 4 (fair-good) 0.00* 0.01** 0.00** 0.27 Trunk control 2 (none-good) 3 (none-good) 3.5 (poor-good) 0.00* 0.00** 0.00** 0.13 Foot control 3 (none-good) 4 (poor-good) 4 (poor-good) 0.00* 0.00** 0.00** 0.03 Arm control 2 (none-good) 3 (poor-good) 3 (poor-good) 0.00* 0.00** 0.00** 0.31 Hand control 2 (none-good) 3 (none-good) 3 (none-good) 0.00* 0.00** 0.00** 1 Total 11.5 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) 17 ( …”

“…Most of the previous studies in the literature have investigated the effects of adaptive devices in terms of support for neck, trunk, and hip and pelvis in terms of abductor wedge use for hip abduction, support for knee-joints, and foot/ankle. 11 Although there are several studies in the literature on the topic, to the best of our knowledge, there is no study comparing different adaptive seating systems regarding postural control and upper extremity competencies. Therefore, this study was designed to compare commercially available children's chairs with back support, adjustable seating systems (AdSSs), and custom-made body and pelvis positioning orthoses in terms of postural alignment and related extremity functions observed by the Seated Postural Control Measure (SPCM) and the SAS in a group of children with spastic CP.…”

The management of scoliosis in children with cerebral palsy: a review

“…In non-ambulatory patients, methods of optimizing seating position have been shown to provide increased support and improve functional outcomes (23). Few studies have focused on the effect of seating systems on correction of spinal deformity.…”