Sitting is a place crucial for day by day actions. Through the day we sit to eat, work or loosen up. Sitting functionally for these varied actions appears easy however is advanced beneath the floor, involving interplay of postural and trunk muscle mass. That is necessary for a therapist to know when instructing kids with disabilities who spend a lot of their day in a seated place. The variations in passive and lively sitting postures have an effect on the general perform of youngsters with disabilities.

Passive Sitting and Well being Concerns

Sitting in a resting place is named passive sitting. When enjoyable in a reclined place similar to one offered by a solar porch lounge or a comfortable lounge sofa, the higher physique and head are leaning again and the toes are supported. On this posture, muscle mass are at relaxation and gravity relaxes the physique into the seat. For kids with vital bodily disabilities who spend lengthy hours in a wheelchair or stroller, extended passive sitting could cause issues. Within the reclined place, kids have little alternative for impartial motion as a result of they don’t have the power to beat gravity. Because of this, a toddler might sit with their head tilted again or flopped ahead. This doesn’t essentially imply they’re drained or bored; quite the opposite, it might consequence from low muscle tone and the necessity for higher positioning.

Extended passive positioning contributes to a number of points, together with decreased eye contact and social interplay – think about staring on the ground or ceiling all day. Moreover, the head-down place ends in rounded again and shoulders, limiting lung enlargement and making respiration and talking troublesome.¹ Consuming and swallowing capability can also be adversely affected by poor trunk and head positioning.¹ Furthermore, flexion contractures can emerge over time as a consequence of extended sitting, and lack of bodily exercise and enough time in an upright posture.

Many wheelchairs and strollers place kids in a passive sitting place, which can be crucial for transport. It’s critical, nonetheless, to acknowledge the disadvantages of extended time spent in these gadgets. A baby will steadily slide ahead with their pelvis in a sacral sitting place, even after simply thirty minutes in a wheelchair.² One other disadvantage of most wheelchairs is that they don’t seem to be useful for day by day actions.³ They’re troublesome to maneuver across the residence to entry a sink for hand-washing or tooth-brushing, and to convey to a desk for household meals or companionship throughout homework time. The seat is simply too excessive for enjoyable instances on the carpet with household or pets. Being at eye stage with friends is important for social growth and psychological well-being.⁴

Step-by-Step Lively Sitting for Operate

A baby’s long-term well being and social future may be fortified by alternatives for lively sitting; adaptive seating gear can change the image. It’s widely known that guided postural positioning in an adaptive chair produces excellent outcomes for perform and well being. Your bodily therapist, occupational therapist, or speech therapist are greatest outfitted to supply this recommendation on a private stage, however listed below are some fundamental positioning suggestions.

1. Alter the seat depth to completely assist the underside of the kid’s thighs, leaving area of about an inch behind the knees to keep away from rubbing.
2. Place the kid’s hips (pelvis) in a barely forward-angled (anteriorly tilted) place and use a seatbelt or pelvic harness to safe the hips in place in the back of the chair seat.
3. Encourage hip abduction with knees aside.⁵
4. Present assist beneath the toes. When the toes are firmly planted, the physique may be stabilized and balanced.⁶ Adjusting the peak and angle of the footboard could make a distinction in offering enough foot contact.
5. Inserting the kid’s forearms on a tray or desk floor permits the arms to help with weight-bearing and may set up higher postural management of the higher physique, neck and head.^{7, 8, 9}
6. Trial the place of the seat, experimenting between a horizontal and a barely forward-tilted place of the seat floor. Observe your youngster’s head management and his/her capability to succeed in, and resolve which seat angle place is greatest for the actual exercise you might be doing.

View this video for an illustration of adjusting the Exercise Chair for an lively, useful sitting place:

Well being Advantages of Lively Sitting

Doing all the above helps to supply a secure base of assist that can promote higher postural management of the trunk, arms and head.^{10, 11, 12} Additionally, you will see enhancements in respiration; respiration and coughing will turn into simpler.^{13, 14, 15} You could even discover will increase in drooling and coughing up of mucous and fluids when a toddler is first positioned in a useful, forward-leaning place, exhibiting how this new posture assists clearing of the lungs. Begin with quick periods and regularly enhance time because the lungs start to clear and the postural muscle mass turn into stronger.⁸

With an lively sitting place, communication improves as nicely. Many kids are non-verbal, and this lively sitting aids their physique language and facial expressions. For the kid, a greater visible subject not solely improves their high quality of life however in some circumstances presents the potential of improved eye-gaze communication.¹ As a result of lively sitting, via higher alignment of the shoulders relative to the hips, promotes hand performance, eye-hand coordination and activation of the postural muscle mass, it may well additionally end in simpler use of communication gadgets.¹⁶

Good sitting posture and head alignment additionally enhance consuming and ingesting considerably. Liquid and meals may be retained within the mouth extra successfully, and swallowing is less complicated. Kids might even progress from bottle to cup ingesting and from consuming blended to chopped or cut-up meals.¹⁷ Secure swallowing includes a sure sample of closing the lips, the motion of the tongue, and shutting of the airway because the meals is moved from the mouth, down the throat to the abdomen. A very good head and trunk place can scale back the kid’s danger of aspiration and associated well being points similar to pneumonia.

Postural management has a giant affect on arm perform.^{17, 18} In an adaptive chair, the angle of the seat itself can affect using the arms. It’s best to evaluate every youngster individually to find out whether or not they do higher with the seat floor flat or tilted barely ahead.²⁰ In some circumstances, a ahead tilt of the seat floor can enhance the kid’s arm motion management.²¹ For instance, kids with spastic hemiplegia (just one aspect is affected) exhibit improved reaching capability when the seat is tilted ahead. Alternatively, kids with bilateral spastic CP (each legs affected) do higher with the seat left horizontal.^{22, 23}

Sit-to-Stand Transfers from the Lively Sitting Place

The lively, useful sitting place may be step one towards sit-to-stand transfers. Deliberately positioning the chair seat larger and tilted ahead helps the kid transfer extra simply from sitting to standing as they switch out of the chair. Kids who exhibit the flexibility to carry out this lively sit-to-stand switch shall be extra prone to be impartial in strolling someday. ²⁴

Introducing Weight-Bearing within the Lively Sitting Place

Kids who don’t have any weight-bearing capability via their legs can be helped. Their toes needs to be firmly planted on the ground or footboard of the chair. The seat needs to be angled right into a ahead tilt, bringing the kid’s middle of gravity ahead. The physique will reply naturally by urgent down via the toes to maneuver the hips and pelvis to the again of the chair seat and to straighten the backbone.

Some kids might solely tolerate this place for brief segments at first – maybe solely fifteen seconds. However with persistent follow, weight-bearing capability improves. A tray or desk in entrance of the chair might assist with the gradual introduction of weight-bearing as nicely. Place this floor shut sufficient so the kid can relaxation their arms on it to stabilize their trunk for an upright place. As a result of this place is safe, the butterfly harness or chest strap could also be cautiously (briefly) eliminated to permit the kid to realize consciousness of their physique and their capabilities to actively have interaction their arms and core muscle mass to take care of this place. In time, improved head management emerges, and you will notice your youngster holding this posture for longer durations.⁶

It’s thrilling to comprehend that via introducing lively seating and postural adjustments, a toddler can turn into rather more useful and lively. It’s value discovering even one second throughout a toddler’s day if you can provide them this follow alternative. Seeing the gradual positive factors your youngster will obtain over time will make an effort value it.

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