Michelle L. Lange, OTR/L, ABDA, ATP/SMS and Greg Peek, President, Seating Dynamics
I mainly work in pediatrics and so growth is always a concern. When recommending equipment, whether it be a bath seat or a wheelchair frame, I need to know how much growth is available in order to ensure the item will continue to meet a child’s needs for as long as possible. After all, this complex rehab equipment is expensive, and funding is often a challenge.
When I recommend a wheelchair frame, I am also recommending other components including the seating system, secondary supports, i.e. a pelvic positioning belt, a tray … and often dynamic seating. So, will the dynamic seating components continue to meet the child’s needs as they are growing up in a wheelchair?
Here we discuss the many ways changes may be made for growth when needed. Before we start please note that we consider it best to use a wheelchair which has adjustable seat depth when dealing with a child who will be growing. It is also a good idea to have the chair setup when new, in the shortest seat depth possible or practical, again to allow for growth.
Dynamic Rocker Back interface (DRBi)
- Seat Depth
- The back assembly, DRBi and back canes are moved rearward on the frame, increasing seat depth to accommodate growth.
- Back Height
- The DRBi will allow the back height to be raised.
- The DRBi may limit how low the back is initially mounted on the canes but has no impact on how high the back can be mounted.
- Some things to consider are:
- Initial back height,
- Back cane height,
- Fixed height or height adjustable back canes,
- Position of the back mounting hardware on the cane, and
- Any additional equipment which needs to be installed on the back canes.
- Taller back canes and/or new backs may be added to the existing wheelchair frame and DRBi to accommodate the child’s growth.
- Seat Width
- The DRBi is independent of chair width so growth in width has no impact other than potentially the need for a firmer elastomer.
- Leg Length
- Kids mostly grow in height. Growth affects footrest leg length, seat depth and seat to floor height. Anticipated growth needs to be considered in configuring a new wheelchair. As the lower leg length increases, the Seating Dynamics Dynamic Footrests have up to 2.5” of length adjustment.
- Depending on the Seating Dynamics footrest style, the mechanism protrudes 1.5” to 2” below the top of the footplate which could be an issue with ground clearance. If the footplates are too close to the floor after lengthening, there are three possible ways to address ground clearance:
- The seat to floor height may need to be increased,
- The angle of the Dynamic Footrests at the knee may be increased (if this does not create a stretch to the hamstrings) or,
- The chair may need to be set at a slight posterior tilt, raising the front of the seat.
- If a high pivot hanger is used to accommodate a very short lower leg length, 4.5” of adjustment is available (2” at the knee and 2.5” at the lower extension). If the child exceeds the available growth adjustment, this hanger may be changed to the low pivot hanger, lowering the footplate by 4.5”. Alternatively, ordering a longer lower extension may work.
- Finally, if a new wheelchair frame is ordered and it is a different make or model form the original, the Seating Dynamic Footrests may still be used on the new chair by changing to the appropriate adapter / receiver. Changes in chair styles and cushions may impact the fit and require different parts. Just contact us to ensure compatibility.
- Seat Width
- If the wheelchair frame is widened, it will not impact the Dynamic Footrests, however, larger footplates may be needed.
Dynamic Head Support Hardware
This hardware attaches to the back of the seating system. As the child grows and the back height increases, the Seating Dynamics Head Support Hardware will move with the back or can be attached to a new back at the necessary height. The universal mounting hardware works with a variety of back styles.
By planning for growth and having accurate measurements today, our dynamic seating components can meet the needs of a growing child into the future!
Remember to inspect the movement of all dynamic components every month or so to ensure that they are still working as they did when new. It is also a good idea to inspect and replace elastomers annually to keep things working like new as they are subject to a lot of wear and tear as well as potential environmentally caused deterioration.
Please see our related Blog, Dynamic Seating: A Cost Benefit Analysis.