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Sitting in Motion - An Active Sitting Concept for Children with Special Needs - featured August 27, 2010

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Sitting in Motion, An Active Sitting Concept for Children with Special Needs

Reprinted with the expressed consent and approval of ExoMotion and Exceptional Parent Magazine

By: Kathrin Brinks, OT

For children, the urge to move is a basic need. Movement is essential for the development of physical and mental abilities. Quite often, other considerations receive priority over movement in seats for children already distracted by their fixed seating system. The result is an even greater reduction of their freedom to move. With help from technology like the micro stimulation system, more freedom of movement is provided. The end result is better body awareness and perception.

Many of us can recall from our own childhood being told “sit still for once” or “you can not sit still for even a minute.” The tale of Fidgety Philip has been told for more than 150 years. Even then, the energy of children and their urge to move was something people talked about. In the first sentence of the story, the parents wonder: Is Philip going to sit still at the table today?

Nowadays, we recognize that the urge to move is natural and a basic need for children. Many of today`s “Philips” do not want to sit still at a table. The ability to move is an intrinsic condition of a child’s physical and mental development.

When dealing with children who are not challenged with disabilities, using movement to encourage development has met with resounding success in recent years. In primary schools, sitting balls are used instead of rigid wooden chairs, and awareness for the need of active breaks for children has grown significantly. For children with intellectual and physical disabilities who require special supportive seating, quite often other considerations receive priority, and their natural urge to move is nipped in the bud.

This article is meant to raise awareness that an “active sitting concept” with better body cognition is possible and to encourage people to strike a new path.

The Difficulty of Combining Stability and Flexibility
Everyone involved in the provision of therapeutic seating for a child with physical disabilities faces a very complex problem. The orthopedic conditions, such as skeletal deformities and dysfunction of the muscles, must be considered while at the same time determining what the child needs for daily use and independent function. For example, what type of mobility equipment sub frame is needed, and does the child require secondary positioning for postural support? Finally, the child’s needs are the focal point and should surround all other aspects of choosing equipment.

When talking about giving children more movement and flexibility in a seating system, justified doubts lurk in the minds of parents and professionals: children with physical disabilities need stability and support. But it is not about choosing either one or the other but more about combining both aspects. In fact, many children with median brain damage in the thorax area also have very low muscle activity. Micro stimulation is especially helpful for these children.

After brain damage, there is often very low muscle tone in the trunk area. At the same time, the muscle fibers in the extremities can build up too much tension. An example of this condition is a child with cerebral palsy who gives the impression of a slumped down body. The spine is kyphotic (or hunched), and the child tends to tilt to one favorite side with the upper part of the body. Avoiding later scoliosis or kyphosis is one of the main tasks of the prescribed seating system. Besides this long term preventative aim, there is often also the short term aim to give the child more stability. This enables better function of the hands or improved posture of the head.

All these aspects underline the need for more stability in the seat unit. The question remains in how to achieve this stability and whether a fixed posture in the upright position fulfills the requirements the child has for reaching his or her functional potential.

Micro Stimulation When Sitting Down

A micro stimulation system aims to fill exactly this gap between stability and flexibility. These systems also create more body cognition and play a greater roll than in conventional seating concepts.

For most healthy people, it is natural to move about slightly when sitting down. Involuntarily, we regularly change our sitting position—lean more to the right, shift the weight onto our left thigh, slump down on the chair only to then straighten up again. Children who are dependent on support while sitting are quite often forced into one position for a long period of time. Additionally, they are often belted up to further hold their position. Thigh, bottom, and back are imbedded into a rigid seat system. As soon as the person is not given the chance to move on the hard or soft surfaces, the body ceases to receive any information at all. This process to “blend out” constant stimulation is called habituation. It can be compared to wearing a watch. In the morning, just after putting it on, we still perceive it. After just a short period of time, we do not feel the watch any more.

This process was created by the body in order to protect us from over stimulation during the day, but when sitting in a fixed position, there is a negative effect as well. The body only acknowledges stimulations that change, and these changes activate a person. To feel yourself and to feel parts of your body is a main condition of movement. Body parts that we do not perceive and that we “blend out” are also moved less.

The back muscles are particularly needed for self-straightening when sitting. In order to activate the back, we need to be aware of it as a part of the body, and we need to feel it. This shows how important it is to provide children with supportive seats that also help them with the self-straightening process. When all these factors are working together, the child has improved body cognition, and independent activity is encouraged.

How Does the Micro Stimulation System Work?

Micro stimulation systems always consist of flexible mounted fibreglass slats onto which the moveable wing springs are assembled. This slightly dynamic mounting ensures that the system gives constant, very gentle feedback to the slightest movements of the body. It nestles up against these movements and, at the same time, transfers sensory impulses to the child’s body using the wing springs.

It is also part of the basic concept that the pelvis and the feet are positioned onto a solid, fixed base. The pelvis is positioned firmly on a solid seating surface. The child experiences freedom of movement and sensory stimulation exclusively from the micro stimulation in the back. The lateral slats in the back area are designed to adjust in order to compensate for rotational movements of the upper body and to slightly give in. A slight resistance ensures that the child always returns to a symmetrical starting position.

Summary of Micro Stimulation in Special Seating
Micro stimulation is an exciting, new offering in the area of seating and mobility equipment and has the potential to greatly improve the lives and functional potential of those challenged with disabilities. Hopefully, this article will encourage parents and professionals to look for new approaches when it comes to a child’s seating, posture, and movement needs, and micro stimulation is certainly a new technology to research in doing so.

It should be stated that not all children can necessarily benefit from this type of seating. Some children with extreme hypertony in the acormus area, severe scoliosis, or similar problems have to be positioned firmly and fixed. At the same time, there are many children who, because of the need for intense care, are put into a fixed seating position too early and the potential for and benefits of movement overlooked. With micro stimulation, an inactive, atonic child might create more natural activity if given the freedom and space to do so.

The message is not to say that all children with disabilities benefit from freedom of movement in the same way children who are not challenged with physical disabilities are. It is time, however, to think about how children with physical disabilities can be given more quality of life. Even if the main focus for the individual child is not on activation and movement, everyone involved in the provision of support aids should focus on the child’s comfort and well-being. Micro stimulation can increase the child’s chance for independent movement, creating a better platform for physical and mental development.

Featured Authors and Organization: Exosystems

We thank ExoMotion for allowing PediaStaff to reprint their article as published in Exceptional Parent Magazine

ExoMotion is a resource for special needs seating, mobility, and sleep systems for children, adults and elders. We focus on innovative, quality products, designed and tested for use in every day life. Our guiding principle is simple. Parents and Caregivers are the center of decisions for their children and family members.

Kathrin Brinks, OT is a leading specialist for children’s rehabilitation in the area of the IGAP Scale. She works at the Institute for Innovation in the Health Sectorand Applied Care Science in Bremervörde, Germany.

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Tags: PT Assistive Technology Article Newsletter 27 August 2010