This month, I would like to focus on early intervention devices – also known as adaptive strollers. We will look at what makes adaptive strollers different from mainstream, commercial strollers and why early intervention devices may be prescribed.
Before we focus on early intervention devices, let’s discuss why seating and mobility is provided in general. Seating and mobility is provided to support postural alignment. The stability provided through the base of support enables balance for function. Support for optimal postural alignment for an individual can slow down or correct a flexible postural deformity or accommodate a fixed deformity. As I have said in the workshops I facilitate, just because a postural deformity is fixed, it does not mean that it will not worsen, which is one of the reasons why positioning is so important. Positioning also can optimize functional tone and inhibit non-functional tone. In addition, seating and mobility is provided to protect skin integrity. (Past articles on skin protection can be accessed by clicking on "skin protection" in the tag cloud to the right.) Seating and mobility also may be provided to increase sitting tolerance, not only by increasing comfort but also by taking the “work” out of sitting by providing proper postural support so that a person does not have to expend inordinate energy to remain upright. Last, but certainly not least, seating and mobility is provided to facilitate function – whether it is physiological function, such as respiration and digestion through optimal positioning, or activity-related function, such as fine motor skills, which may be enhanced by providing proximal stability for distal function.
What makes an adaptive stroller different than a commercially available stroller? A mainstream stroller will have only standard seating options available. Some brands will have only limited recline available. An adaptive stroller will have numerous seating and positioning options available, including tilt (anterior and posterior degrees) and recline. Adaptive strollers allow for growth and adjustability – the seat depth can be increased, the back height can be raised, and trunk and pelvic lateral supports can be widened as the infant or toddler grows. This is important to promote proper positioning of the pelvis, trunk, head and extremities as the child grows and continues to use the stroller. Adaptive strollers also have storage and accessories to allow for medical equipment mounting, such as for a ventilator or oxygen tank. In some models, the entire seating system of an adaptive stroller can be removed from the stroller base. This allows for easy folding of the stroller base. In addition, the seating system can be mounted to a height-adjustable booster base, which enables positioning while eating, for example. An adaptive stroller may have a transit option available that, if transit approved, allows the child to remain seated in the stroller while the stroller is secured to the vehicle through the transit tie-downs. This is an important feature if the child does not have the postural control to sit in an infant car seat.
The features of an adaptive stroller help us to see why an early intervention device might be prescribed for an infant or toddler with special needs. Early intervention devices enable positioning and accommodate for growth, allow for equipment mounting, and provide transportation options. Positioning is important as it enables function. For example, the proximal stability obtained through the seating of the early intervention device may facilitate upper extremity function for a child. It is important that children are provided with opportunities that help them to meet developmental milestones, such as reaching for objects, even through modified means.
As always, please provide your comments, questions and suggestions regarding Clinical Corner on my blog. I look forward to hearing from you!
Sheilagh Sherman, BA, BHScOT, OT Reg. (Ont.)
Sunrise Medical Canada
Note: The content of this article is not meant to be prescriptive; rather, it is meant as a general resource for clinicians to then use clinical reasoning skills to determine optimal seating and mobility solutions for individual clients. Sheilagh is unable to answer questions from members of the general public. Members of the general public are directed to their own therapists or other health care professionals to ask questions regarding seating and mobility needs.
This article is © Sunrise Medical, Inc., 2013 and cannot be copied, distributed, or otherwise reproduced in whole or in part without the express written permission of Sunrise Medical Canada.