Michelle L. Lange, OTR/L, ABDA, ATP/SMS
When I first began working with clients more than 30 years ago (yikes!), I saw many children with the diagnosis of cerebral palsy. Cerebral palsy is an umbrella diagnosis with many other diagnoses residing underneath. As the practice of medicine has progressed, many children have more specific diagnoses thanks to more advanced diagnostic technologies, such as MRIs.
Common specific diagnoses that are under the general cerebral palsy diagnosis include:
- Periventricular Leukomalacia (PVL) – damage to the white matter of the brain
- Cerebral dysgenesis – abnormal brain development
- Absence of the corpus collosum
- Fetal stroke (intracranial hemorrhage)
- Asphyxia – lack of oxygen in the brain, including hypoxic-ischemic encephalopathy
- Certain genetic disorders
- Certain metabolic disorders
- Maternal infection
- Exposure to toxins
- Post Natal Causes
- Traumatic brain injury occurring shortly after birth (some physicians will diagnosis a child with cerebral palsy even up to age 24 months)
When it comes to need for Dynamic Seating interventions, it is not so much the ‘label’ as the clinical presentation. Many clients who fall under the umbrella of cerebral palsy exhibit increased muscle tone, uncontrolled or extraneous movement, or seek out movement. Dynamic seating moves in response to client movement, diffusing increased muscle tone and reducing overall tonal patterns as well as reducing forces which can lead to client injury or damage to the wheelchair seating system and frame. Extraneous movement patterns, commonly seen in clients with cerebral palsy, can be frequent and quite strong. Dynamic seating can absorb forces from these movements, often increasing sitting tolerance for the client. Finally, many clients with cerebral palsy seek out movement and tend to fight against static surfaces, displaying increased tone when encountering non-yielding surfaces. As Dynamic seating moves, these clients now have the ability to move within the wheelchair, rather than fight against it.
Are you working with clients using Dynamic Seating? What client diagnoses are you working with? We would love to hear from you in the comments below!