Seating System to Improve Postural Control in Children with Scoliosis

Children with cerebral palsy (CP) who are wheelchair bound are at high risk of developing scoliosis, a spinal deformity caused by their neuromuscular disorder. Scoliosis is the lateral curvature of the spine along with rotation of the vertebral bodies, this can impair movement and function, in severe cases lung and heart function is restricted, reducing the individual’s life expectancy and quality of life.

In Britain the standard conservative treatment for non-ambulant children with scoliosis is using customised support systems along with physiotherapy. Support systems vary between standing, sleeping and seated supports. Seated supports are built to accommodate the patient’s size and shape and position them into as ‘healthy’ a position as possible while maintaining comfort. Although the position a child is held is crucial to minimise the development of scoliosis and other muscular skeletal problems, currently this process solely relies on the skill and subjective judgement of seating staff.

The aim for this PhD is to develop an objective measure to aid in the prescription of seating to non-ambulant, CP children with scoliosis. Funding for this project is provided by the British Scoliosis Research Foundation. Using a user centred design approach an in-depth device specification has been created, involving stakeholders in each stage of the design process including clinicians, seating staff, carers, patients, parents and many more. The community Paediatricians in Leeds General Infirmary have worked very closely with the project aiding and co-managing clinical trails.

Preliminarily work is concerned with assessing the suitability of two spinal measurement systems, the Quantec scanner and the gold standard for spinal assessment, the X-ray. A feasibility study to discover if the Quantec scanner is suitable as a spinal assessment tool for patients whilst seated. A secondary aim is to assess the suitability of a specialised support system built to the device specification, and to discover the range of support positions and forces applied to the user group.

Future work will look to compare how differing seating techniques can improve outcome measures. Stakeholder feedback suggests the fundamental outcome measures to include pelvic obliquity, scoliosis, loading at the interface between the patient and the supports, clinical imbalance, seating stability, trunk orientation, upper limb function and patient comfort.

Image 1: Leatherman K.D., Dickson R.A., "The Management of Spinal Deformities." Butterworth-Heinemann,1988

Collaborators
British Scoliosis Society
Community Paediatricians in Leeds General Infirmary

Research Team
Prof. Richard Hall
Prof. Martin Levesley
Prof. Bipinchandra Bhakta
Mr. Carwyn Jones

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