Dynamic Seating: What Does the Research Say? Part 3

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Our last two blogs explored some of the published research that has been done on Dynamic Seating, demonstrating the effectiveness of this intervention for many of the clients using wheelchair technologies. This blog will review some additional research that has been presented at Wheeled Seating and Mobility conferences such as the International Seating Symposium, but has not been published. Although this information is not in the literature, it can still be helpful in directing our interventions.

  1. Adlam, T. and Gimeno, H. (2018). A Feasibility Trial of a Whole Body Dynamic Seating System for Preschool Children with Dystonia: Aims, Methods and Measures. International Seating Symposium, Vancouver, BC. Proceedings, pgs. 111-114.
    http://www.seatingsymposium.com/images/pdf/ISS2018_Syllabus_eVersion.pdf

Seating Dynamics - Dynamics Research - International Seating Symposium

This session presented a current feasibility trial to guide and inform the design of a full scale trial to assess acceptability and efficacy of whole-body dynamic seating on activity, participation, and quality of life in preschool children with dystonic cerebral palsy, using mixed qualitative and quantitative methods.

Tim Adlam and his group have been working hard on this project and have presented two other times on their progress (see #2 and #4 below).

  1. Adlam, T., Morris, C., McFadden, H., Dutton, A. (2016). Designing for Dystonia: Begin at the Beginning with Children, Parents and Therapists. International Seating Symposium, Vancouver. Proceedings, pgs. 64-68.
    http://www.seatingsymposium.com/images/pdf/2016Syllabus.pdf

At the time of this presentation, this group was designing a seating system for children ages two to five years with whole body dystonia. They were also determining the feasibility of evaluating the impact of the seat with functional outcome measures suitable for use with this group, as preparation for a subsequent trial with a group of six children. Item #1 on this list presents their progress.

  1. Crane, B. (2015). Effects of Dynamic Wheelchair Seating on Pressure, Motion, and Propulsion. International Seating Symposium, Nashville, TN. Proceedings, p. 159.
    http://www.iss.pitt.edu/ISS_Pre/Iss_Pre_Doc/ISS_2015.pdf

This session presented research that was on-going and stated that long-term testing was underway. The study was testing whether the KiSS dynamic seating system impacted body motion or seat interface pressure.

Results:
Preliminary testing did not show a significant effect.

  1. Adlam T (Designability), Orpwood R (University of B), Wisbeach A (Great OSH), Alger H (Great OSH), Johnson E (Great OSH). (2014). Whole Body Dynamic Seating for Children with Extensor Spasms. In: Cooper D, Story M, editors. 30th International Seating Symposium. Vancouver: Interprofessional Continuing Education, University of British Columbia. pp. 182–185.
    http://seatingsymposium.com/images/pdf/2014Syllabus.pdf

This session describes the development of a novel dynamic seating system. Initial prototypes were evaluated by two children. The final prototype was then used in further studies (see items #1 and #2 above).

Results:
The following outcomes were noted: increased vocalization, increased movement, one child was able to access a switch in the dynamic seat (and unable to in their static seating), reduced spasm intensity, increased symmetry in posture, increased head control, and the onset of movement (of the dynamic seat) reduced the rate of increase of spasm. The client also expressed preference for the dynamic option.

  1. Dalton (2014). An Evaluation of a Simulated Dynamic Foot Support. International Seating Symposium, Vancouver, BC. Proceedings, pgs. 64-67.
    http://seatingsymposium.com/images/pdf/2014Syllabus.pdf

This session described an evaluation of the impact of a simulated dynamic foot support on an adult with Dystonic cerebral palsy who experiences whole body extensor spasms. This study was designed to optimize the mechanical design of the foot support to then use in a pilot study scheduled for February 2014. It is unknown if this study occurred.

Results:
Use of the simulated foot support increased head and arm control and the client reported that it was easier to drink and swallow. It should be noted that the simulated support was provided only by the clinician’s hands.

  1. Samaneein, K., Greene, P., Lees, K., and Riches, P. (2013). Comparison of Imparted Forces between Rigid and Dynamic Seating Systems during Activities of Daily Living by Children with Cerebral Palsy. Congress of the International Society of Biomechanics, Brazil.

A mobile strain gauge data acquisition system was developed to capture the forces and moments in wheelchair components in a rigid and dynamic seating system. The research team determined the magnitude of the contact force on the backrest, footrests and center of pressure (COP) on the seat during ADLs (Activities of Daily Living). Footrest forces and moments varied, but back support interface forces remained the same for each system (static and dynamic). Average force on the backrest was 60-70% BW (Body Weight) and 20% BW on each footrest. Peak forces (during extension) were 200% BW on backrest and 600% BW on footrests.

Results:
Clients are able to exert up to 200% of their body weight against the backrest and 600% of their body weight against the footrests during extension. Dynamic seating can be used to diffuse these forces.

I am not a researcher myself. I’m a clinician and educator. However, I do appreciate all the hard work of research and how this, in turn, informs my clinical decisions. While we do need more research in Dynamic Seating, we can take note of the studies which have been conducted and take note of the results.

If you are aware of further research, please let us know! It helps all of us to share this valuable information!

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