“How should I apply this information?”
Adolescent students with severe scoliosis and cerebral palsy (CP), Gross Motor Function Classification System (GMFCS) levels IV to V, who rely on seating systems to provide alignment and stability for learning, pose challenges to pediatric therapists intent on supporting students' body structures/functions, activities, and participation. Inappropriate and outdated seating systems may contribute to cardiopulmonary compromise and decreased activity and participation, particularly in older students with multiple disabilities and fixed bony deformities. The authors reported on the physiological and performance changes of a 19-year-old man with severe scoliosis and CP, GMFCS level V, in 2 seating systems. When sitting, researchers reported that the student's SaO2 levels increased, and heart rate, respiratory rate, and body temperature fluctuations decreased in custom seating compared with standard seating. Furthermore, student processing time decreased and accuracy of answering 5 questions improved slightly in the custom seating. School staff reported increased social approachability and student-initiated conversation, and researchers reported student refusal to use the standard seating system after using the custom seating system. These reports suggest the importance of individualized intervention and data collection and careful analysis beyond body structures, activities, and participation, to include environmental and personal factors, such as context, behavior, and student preference.
“What should I be mindful about when applying this information?”
Although the researchers found significance in SaO2, only decreasing trends were discovered in other physiological measures, and no significance was identified in processing time or accuracy of response. Although single-subject design research adds knowledge to a topic of interest, as only 1 individual was studied, the information cannot be generalized to all adolescent students with CP and scoliosis. Further research is needed on more single subject and group samples to provide more evidence of the efficacy of custom seating related to body structures/functions, activity, and participation.
Sandra Arnold, PT, PhD
University of Oklahoma Health Sciences Center
Oklahoma City, Oklahoma
Danielle Morris, PT, MS, PCS
Our Lady of the Lake Regional Medical Center
Baton Rouge, Louisiana