Vince is a young adult with the diagnosis of cerebral palsy. He had significant muscle tone throughout his body and frequently extends in his current wheelchair seating system. We were anxious to explore dynamic seating options to diffuse some of this extensor tone. However, Vince had very little hip flexion or extension beyond his current seated position and, as a result, he could not benefit from a dynamic back which allows movement past this point. He had no knee extension past 90 degrees and his range limitations prevented him using even the telescoping feature of a dynamic footrest. We were unsure if we could provide any dynamic intervention when Vince broke yet another head support.
The Dynamic Head Support Solution
We decided to try a dynamic head support hardware. With the addition of this dynamic component, we found that Vince’s head was in an aligned position most of the time, rather than his typical hyper-extended position. He experienced less force through the cervical area, as well, which we hoped would protect his neck from injury and increase his comfort. His overall extensor tone and posturing improved when force was diffused at his neck. Finally, Vince has yet to break his head support hardware since “going dynamic”!
Using Combination Dynamic Seating Components
If Vince had adequate range of motion, we would have also recommended a Dynamic Rocker Back and Dynamic Footrests due to his extreme tone. In combination with Dynamic Head Support Hardware, this would have provided a very effective solution. Due to range limitations, Vince could only use the Dynamic Head Support Hardware. Even this lone dynamic component diffused forces, reduced overall tone and posturing, and improved head position.
On St. Patrick’s Day, we had the opportunity to participate in the Salisbury, MD Numotion NuFair. Approximately 45 therapists from the surrounding areas attended 3 CEU courses and the extensive exhibits.
Michelle Lange presented on Dynamic Seating and Seating Dynamics exhibited. The attendees were great and enjoyed learning more about this practice area!
This is our third and last blog summing up a wonderful 2017 International Seating Symposium in Nashville. I had the privilege of presenting a workshop on the topic of “Positioning the Head.” A great group gathered in the ballroom in search of answers for those clients who persist with less than desirable head positions despite our best efforts.
Now, I tend to throw chocolate in my sessions, and I have a pretty good arm, but I could only throw about a third of the length of this room, so I encouraged folks to move up for chocolate – and to see the screen! Continue reading →
President and Principal Designer, Seating Dynamics
Having attended all but five of the International Seating Symposiums since 1987, I can say that it has always been the greatest place on earth to learn about wheelchair seating, simple as that. The opportunity that I have had as a designer to meet and listen to people about the problems that they face on a daily basis is unbeatable. Those of you who know me undoubtedly know that I love a challenge and when someone explains a problem that has no solution, I don’t see it as a problem, but as an opportunity. Often I say, “I can fix that”! Continue reading →
The Seating Dynamics van made the trek from Denver to Nashville in time to exhibit at the International Seating Symposium or ISS. Over 2000 people attended this event from all over the world! ISS offers great educational courses, an enormous exhibit hall, and wonderful networking. A good time was had by all! Continue reading →
In our last blog, we discussed clinical indicators and contra-indicators to allowing movement into neck extension using a dynamic head support. Dynamic movement in this area can protect the head support hardware from damage, limit client injury, and reduce overall extensor tone. How does design facilitate these goals? Continue reading →
In previous blogs, we have discussed clinical indicators for providing dynamic movement at the hips and knees. Another location dynamic movement can be provided is at the neck through Dynamic head support mounting hardware. Most dynamic options allow movement into neck extension and then facilitate return to an upright and aligned posture. So when is a dynamic head support clinically indicated? Continue reading →
Daniel is a teenage boy with the diagnoses of cerebral palsy and seizures. He has significantly high muscle tone and has had varied success with tone management over the years. If his feet are not strapped to the footplates, he extends at his knees and his feet are then hanging far in front of the footplates. This increases the turning radius of the wheelchair, places his lower legs at risk of injury, and leads to a loss of position of his pelvis. As a result, his feet have been strapped into shoeholders for most of his life. This positioning has kept his feet on the footplates, but has created other issues. Continue reading →
Allowing movement at the knee is more complicated than it sounds. When a client extends at the knee, this movement is not just in one plane. In other words, the foot doesn’t simply slide forward. The foot follows an arc, forward and upward.
Wheelchair footrest hangers are generally static. If the client is able to extend at the knees, the feet move forward off the footplates. This is fine for clients who can easily move their foot back onto the footplate. If the client’s feet tend to leave the footplates and the client cannot return to this starting position, we often add in foot straps and/or shoeholders to maintain this position.