Page 15 - Mobility Management, April 2019

the 2008 book Spina Bifida: Management and Outcome, hydro- cephalus will develop in 80 to 90 percent of children with myelomeningocele.
Meningocele is similar to myelomeningocele in that both result in the formation of a sac through a spinal opening. But with menin- gocele, the nerves and spinal cord do not fill the sac, leaving little to no nerve damage and usually resulting in minor disabilities.
Because spina bifida can present in different ways depending
on the type, impairments to mobility can vary among children. Sally Mallory, PT, ATP, CPST, education manager for Convaid|R82, explained, “There is a huge variance because it has to do with the level of the lesion on the spine, at what vertebral level that occurs. The higher the level, obviously, the more involved the client is going to be from a physical standpoint in terms of muscle function, but also possible range of motion limitations.”
For instance, a child with spina bifida occulta might not expe- rience any mobility impairments, whereas a child with myelome- ningocele could experience muscle weakness or paralysis below the chest. With the more severe forms of spina bifida, seating and mobility interventions may be necessary.
“Sit Up Straight!”
Spina bifida is a degenerative disability, and for that reason, introducing children with spina bifida to seating and positioning interventions early is necessary to reduce the severity of the disability in adolescence and adulthood. “Obviously, the disability is degenerative, so it will worsen throughout time regardless of what we do. But we can dramatically slow that down by correctly supporting a child from a very young age,” explained Ross Andrews, International Business Manager and Seating Specialist with Specialised Orthotic Services (SOS) by Drive.
Andrews recommended starting at 6 months. “Start at 6 months old, and they will generally be seated from that age upwards until they reach adulthood and full growth. The benefit at 6 months is that they are more malleable,” he said. As a result of spina bifida, children may develop scoliosis, kyphosis or lordosis, but Andrews explained that by seating these children properly starting at 6 months, such conditions are marginally correctable.
If a client does not have any current scoliosis or other spinal positioning issues, Andrews said it is still important to provide specialized seating for them starting at 6 months. “We can put them in a position that is better for them in the long run in terms of functionality and stopping anything occurring down the line.”
If spinal positioning problems are allowed to set in prior to intervention, treating and correcting them can become much more difficult. “You will see a lot of children with spina bifida, if they are seated at a later age, who will generally be sat in their seat leaned over to the right, could be the left depending on which way the scoliosis has gone, and they will be propped on the right elbow,” Andrews said. “They’re all in poor position because the client is just going to compound the issue of what he’s already got. It’s very hard once the client has been seated in that position for a couple of
years to try to explain that we need to seat him in [a] new position with back support. Early intervention is absolutely key in that because at 6 months, they’ve not yet experienced anything else. If we can get clients seated, that will become the norm.”
In addition to preventing and correcting positioning issues, seating and positioning also facilitates interaction with one’s environment. In a 2005 study from the University of Ulster in Northern Ireland titled “The Fundamental Principles of Seating and Positioning in Children and Young People with Physical Disabilities,” researchers found that appropriate seating and positioning can aid in a child’s engagement with the world around them.
Andrews’ work with clients bears this out. By giving seating balance and support to strengthen muscle tone and engage the trunk, Andrews said that children are much more capable and ready to interact with their environment. “What we generally see is clients who have very low tone or a very weak trunk and poor motor control. They’ll be fighting to maintain balance. What we look to do in seating is balance and symmetry.”
Andrews drew a comparison to able-bodied adults to illus- trate his point. “It’s very easy for us to sit in a position and change and move to another position and to balance ourselves and perch on the edge of a desk or chair. You can maintain the ability to balance yourself. But with the clients and the children that we see, they have a very low tone. Generally, if we put them in a seat that isn’t correct for them or doesn’t give the correct amount of support, they’ll fatigue at a quicker rate throughout the day because self consciously they’re having to concentrate more on correcting the balance, the pelvis and the core, and that, in turn, will take away from them being able to use that energy to balance their head.”
It’s imperative that we give kids access to independent mobility at the same as their peers are starting to experience independent mobility, and that happens very young —
Amy Morgan
Constantly focusing to keep balance diverts children’s atten- tion and energy away from outward engagement. But when that distraction is taken away by proper seating, Andrews said that children are ready to engage. “By correctly supporting someone from the pelvis up to the shoulders with good support in the trunk, you’ve given back control over fine motor function and
the ability to interact and play,” he said. “They can use the hands, the arms, and better control the head position, which in turn will usually help with speech, feeding, and them being able to just see and look around.”
MobilityMgmt.com
MOBILITY MANAGEMENT | APRIL 2019 13