Functional outcomes associated with adaptive seating interventions in children and youth with wheeled mobility needs.

OBJECTIVE: To determine the parent-reported functional outcomes associated with adaptive seating devices for wheeled mobility devices used by young people aged 1 to 17 years. DESIGN: Longitudinal case series. SETTING: Homes of participating parents. PARTICIPANTS: Parents (N=70, 63 mothers, 6 fathers, 1 grandmother) who had children with adaptive seating needs. INTERVENTION: Adaptive seating system for wheeled mobility devices. MAIN OUTCOME MEASURE: Family Impact of Assistive Technology Scale for Adaptive Seating (FIATS-AS). RESULTS: All parents completed the FIATS-AS 4 times-2 times before and 2 times after their child received a new adaptive seating system. Mixed-design analysis of variance did not detect significant mean differences among the FIATS-AS scores measured at baseline and 2 and 8 months after receiving the seating system (F2,134=.22, P=.81). However, the FIATS-AS detected a significant interaction between age cohort and interview time (F4,134=4.5, P<.001, partial η(2)=.16). Post hoc testing confirmed that 8 months after receiving the seating system was associated with a large improvement in child and family functioning for children <4 years, maintenance of functioning for children between 4 and 12 years, and a moderate decline in functioning for youth between 13 and 17 years. CONCLUSIONS: Adaptive seating interventions for wheeled mobility devices are associated with functional changes in the lives of children and their families that interact inversely with age. Future controlled longitudinal studies could provide further empirical evidence of functional changes in the lives of children and their families after the introduction and long-term use of specific adaptive seating interventions.

Randomised controlled trial comparing two school furniture configurations in the printing performance of young children with cerebral palsy.

AIM: This randomised controlled trial compared the same-session effects of two different school furniture configurations on printing legibility. METHODS: A total of 30 school-age children with ambulatory cerebral palsy participated in this study. Each child provided one near-point printing sample of up to 34 letters while positioned on Mandal-type specialty school furniture and on standard school furniture. An assessor who was unaware of the intervention assignment scored printing errors. RESULTS: No significant difference in legibility score mean values between the interventions was detected and the effect size was small. CONCLUSIONS: Compared with standard school furniture, the use of specialty school furniture did not lead to immediate gains in printing legibility and other printing performance areas for children with cerebral palsy. Further study of the influence of functional abilities, other contextual factors and the longer-term use of school furniture on handwriting performance is recommended.

Effect of adaptive seating devices on the activity performance of children with cerebral palsy.

OBJECTIVE: To evaluate the short-term impact of 2 adaptive seating devices on the activity performance and satisfaction with performance of children with cerebral palsy (CP), as observed by their parents. DESIGN: Baseline-intervention-baseline study. SETTING: Homes of participating families. PARTICIPANTS: Parents and their children (N=30), mean age of 4 years 6 months, with Gross Motor Function Classification System levels III and IV CP participated. INTERVENTIONS: Two special purpose seating devices: one for sitting support on the floor or on a chair, the other for postural control on a toilet. MAIN OUTCOME MEASURES: Changes in activity performance and satisfaction were measured through parent ratings on the Canadian Occupational Performance Measure. We interviewed parents biweekly using the Home Activity Log to describe and explain their child's activity performance during the 3 study phases. RESULTS: Parents identified 139 activity performance issues (4.6 a child): 58.3% in self-care, 34.5% in play, and 7.2% in socialization and quiet recreation. We used paired t tests to demonstrate significantly improved performance and satisfaction with self-care and play activities when the children used the adaptive seating devices during the 6-week intervention phase. Three themes arose from the analysis of comments made by parents during Home Activity Log interviews: adaptive seating can have an enabling influence on the child, caregivers and family find adaptive seating useful, and the adaptive seating devices did not meet every family's needs. CONCLUSIONS: Parents reported that their young children with CP were more able to engage in self-care and play activities when using specific adaptive seating devices in their home. Parents indicated that their child's activity performance decreased after the seating devices were removed from their homes.

The impact of adaptive seating devices on the lives of young children with cerebral palsy and their families.

OBJECTIVE: To determine the parent-perceived effect of adaptive seating devices on the lives of young children with cerebral palsy (CP) (aged 2-7y) and their families. DESIGN: Baseline-intervention-baseline study. SETTING: Homes of participating families. PARTICIPANTS: Thirty parents and their children with Gross Motor Function Classification System level III or IV CP. INTERVENTIONS: Two special-purpose seating devices: 1 for sitting support on the floor or on a chair and the other for postural control on a toilet. MAIN OUTCOME MEASURES: Family Impact of Assistive Technology Scale (FIATS) and Impact on Family Scale (IFS). RESULTS: Thirty parents (29 mothers, 1 father) and their children with CP participated. Repeated-measures analysis of variance detected significant mean differences among the FIATS scores (F(1.4,40.6)=19.25, P<.001). Post hoc testing confirmed significant mean differences in overall FIATS scores between baseline and intervention and intervention and postintervention phases. The test of within-subject effects did not detect a significant change among IFS mean scores. CONCLUSIONS: The introduction of adaptive seating devices for young children who need support to sit had a meaningful, positive impact on child and family life. Removal of the study devices showed a concomitant negative impact on key aspects of child and family life. Environmental resources, such as seating and other assistive technology devices, may have an important role to play in the lives of young children with physical disabilities and their families.

Reliability of the family impact of assistive technology scale for families of young children with cerebral palsy.

OBJECTIVE: To examine the internal consistency and test-retest reliability of the Family Impact of Assistive Technology Scale (FIATS) when used to measure the perceptions of parents about important aspects of family life that may be influenced by their children's use of assistive devices. DESIGN: Repeated measure. SETTING: Homes of 50 participating families. PARTICIPANTS: Parents of young children with cerebral palsy. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The FIATS. RESULTS: Through an a priori item-reduction process, we reduced the length of the FIATS from 89 to 64 items. We retained 8 of the 9 original subscales. The 8 subscales included the following: autonomy, caregiver relief, contentment, doing activities, effort, family and social interaction, caregiver supervision, and safety. Remaining items of the removed subscale (technology acceptance) correlated well with the subscale total, but did not relate well to the FIATS total score. This construct was retained as a separate but noncontributing scale within the FIATS. The overall FIATS and its 8 contributing subscales had acceptable internal consistencies and test-retest reliabilities. CONCLUSIONS: The FIATS shows promise as a homogeneous and reproducible multidimensional measure of dimensions of child and family life. We plan further testing to examine the sensitivity and clinical meaningfulness of change scores on the FIATS.