Page 14 - Mobility Management, January/February 2020

Pediatric Series
GROWING PAINS Adding the Right Amount of Growth Into Pediatric Wheelchairs
By Laurie Watanabe
One of the big challenges of working with little wheelchair users is building those wheelchairs to work today and fit tomorrow.
From a funding standpoint, payors want wheelchairs that capably endure not just the rigors of playgrounds and siblings, but also kids getting taller and heavier. From a clinical perspective, clinicians and ATPs want wheelchairs that support optimal positioning and func- tion, including self propulsion for children in independent manual mobility devices. And from an aesthetic and emotional viewpoint, parents can be more willing to consider a wheelchair if its size isn’t overwhelming compared to the child using it.
Given all those demands that need to come together, here are 7 factors to consider when building growth into a kid’s wheelchair, manual or power.
1. How Old Is the Child?
Kids grow at different rates during childhood (see sidebar), so knowing if a growth spurt is imminent (or if your client is in the middle of one) can be helpful.
Angie Kiger, M.Ed., CTRS, ATP/SMS, is the Clinical Strategy & Education Manager for Sunrise Medical. Asked what she thinks about when building growth into a pediatric system, Kiger asked, “What age group are you talking about? The primary growth spurts when you’re [age] 0-3 are in depth, not width.”
Terri Witten, RN, ATP, Account Manager for Sunrise Medical,
agreed: “Seat depth seems to be a bigger deal than width. [Depth is] where they grow the fastest.”
2. Don’t Overdo the Width
While increasing seat width might sound like great insurance against growth spurts, a chair that’s too big can cause other problems.
Lauren Rosen, PT, MPT, MSMS, ATP/SMS, is the Motion Analysis Center Program Coordinator at St. Joseph’s Children’s Hospital in Tampa, Fla.
“It’s more limiting than enabling,” Rosen said of building in too much growth. For that reason, if the child’s history and Rosen’s observations support it, she prefers to be more conservative on seat width: “This chair fits this kid, width wise. It’s fine. He’s got half an inch on either side, and the chair’s not old enough to be redone anyway, but the chair is not too narrow. But somewhere in PT school, we were told that you 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.”
In those cases, if you add too much width to a self-propelled chair, “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
12 JANUARY/FEBRUARY2020|MOBILITYMANAGEMENT
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