Page 20 - Mobility Management, September 2019

Pediatric Series
I Can Push Myself!
it means fitting the chair to each individual child, rather than just building in, for instance, a generic amount of growth.
“Somewhere in PT school,” Rosen said, “in the 15 minutes
of training we got, we were told to make a chair 2" wider than the person. You have to plan some growth, but if you look at these kids, you can see how they’re going to grow. You see their parents, you see their family. A lot of these kids are skinny. They’re going to grow a lot in height, but they’re not going to grow in width.”
What’s the harm of making a wheelchair that’s wider than necessary?
“They can’t reach to push correctly,” Rosen said. “They also don’t feel stable in the chair. The wider the chair is relative to you, the more your hips can shift. We build the chair too wide, so then we put big, heavy hip guides on it to hold your hips.”
They think about their chair the same way a kid gets up in the morning and puts his shoes on — Lauren Rosen
Which once again creates a chair that isn’t fun or easy to push.
Rosen acknowledged that reaching a handrim is always tough for the littlest wheelchair users: “If I’m putting a 12-month-old in a chair, I can’t get him to his handrims no matter what I do. He’s going to push on the tire, and that’s fine. But at least he can get to that tire, and he’s in a good position getting to that tire. He’s not significantly abducted.
“I feel like people automatically say, ‘You’re 13" wide right now. We need to go to at least 15" if not 16" because you’re going to grow.’ They grow taller, not necessarily wider. There are growth curves on kids with different disabilities [see sidebar], and the growth curves show that these kids don’t grow in weight, height and size like their age-matched peers. If you have a 6-year-old user and you know what a [typically developing] 10-year-old looks like, if you’re planning on that 6-year-old looking like that typically developing 10-year-old, it’s not going to happen. There are specific growth curves for different disability groups because these kids don’t grow like typically developing kids.”
Age-Appropriate Answers
Other ways that Rosen tries to make pediatric chairs as inviting and efficient as possible include camber.
“I usually put 4° or so of camber for my little ones, because their chairs are so small I don’t have to worry about doorway access,” she explained. “Putting the camber there makes the chair turn better and moves that wheel a little closer to them. I like to give anybody some camber when I can, but if you’re much larger, I can’t because then you can’t get through any door.”
She also likes to build in some seat slope: “I see a lot of kids
come into my office with no seat slope. You try sitting in a chair with no seat slope! If you look at office chairs, the butt is lower than the knees. When you sit flat, you feel like you’re going to fall out of that chair.”
Rosen doesn’t worry much about propulsion styles with
her youngest users, who wouldn’t listen anyway: “I just say go atit.Butifyoucometomeat7or8,andyou’realreadyina chair, then I will get in a chair next to you and I will show you how much easier pushing is if you use a semi-circular pattern versus that arc [see sidebar]. I know that my kids who are afraid of their chairs and don’t use their chairs much are ‘arc’ kids. Because they’re not comfortable in the chair. Either somebody made it too tippy initially so they’ve learned to take short little strokes so the chair doesn’t flip, or when the wheel’s too far back, all they can access is the top of the rim. So they’ve devel- oped that arc pattern because that’s the only thing that works.
“I will try to take slightly older kids out of the arc only because I think that’s not as functional over time. What I find is most kids, like a 12-month-old when they first get into a chair, they will arc just at the very beginning. Then as soon as they get comfortable, if they’ve got trunk [control], they’re leaning forward and pushing because they realize, ‘This thing gets me somewhere fast, I want to get there fast, and this is the most functional way to do it.’”
Rosen added that she educates families early: “Sometimes I can’t get the wheel position to exactly where I want it, because maybe it’ll be too tippy for a new user. But I always inform the family: ‘In six months, call the supplier, have them come out. Move those wheels where we want them, because she’ll be a better user then.’ Or ‘We had to put [anti-tip] wheelie bars on there for right now. But down the road, I would like to lose those wheelie bars.’”
The ultimate reward of starting a very young child on indepen- dent mobility is seeing how far they can go.
“I think the younger you put them into it, the less stigma that’s attached to it from the kid’s side,” she said. “It’s just empowering. They think about their chair the same way a kid gets up in the morning and puts his shoes on. The younger you put them into the chair and the more functional you make them, the less they see it as a limitation. They’re thinking, ‘Why don’t these other kids have wheels? I’m faster than they are. Every kid should have wheels.’”
Rosen remembered putting a toddler in his first chair the same weekend that elite wheelchair racers happened to be in town for a competition. Upon seeing the athletes at the mall, the child was inspired.
“He went over to them,” Rosen said, “and he said, ‘Let’s race!’ He’s challenging some of the top wheelchair racers in the world because he could. Because he didn’t see himself as being any different than these other people who had these chairs with wheels. And that was awesome.” m
20 SEPTEMBER 2019 | MOBILITY MANAGEMENT
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