Leckey

Alice’s Squiggles Seat helps her develop fine motor skills and participate in family life

Alice lives with her older brother and adoring parents. She has cerebral palsy. Her muscle tone fluctuates between low and high, and her body goes into hyperextension when she is excited - see the picture on the left taken when Alice was 18 months old. Alice has a gastrostomy tube to meet 100% of her nutritional needs.

Initial assessment at 7 months

• Alice showed delays in gross and fine motor skills, as well as visual, feeding and communication skills.
• Alice needed help to roll, and she had strong extensor tone in her trunk and neck.
• Alice was able to sit when fully supported, but she was unable to reach for or grasp a toy.
• She also had delays in self-help skills, especially nursing and bottle feeding during which she had difficulty co-ordinating sucking, swallowing and breathing. The photograph shows Alice feeding at 7 months.

Clinical Assessment

Alice requires fully supportive special seating to manage her posture for oral motor therapy and gastostromy feeds, therapies to develop motor and cognitive skills, and to provide opportunities for face-to-face interaction. Furthermore, experiencing stable and proper posture provides Alice with an awareness of the postural set necessary to develop gross motor skills.

Approach

Alice first started using her Squiggles Seat at 9 months old. She required hip supports and four-point pelvic harness, lateral trunk supports, pommel, foot rest, head support with lateral guides, and tray with horizontal toy bar. Initially Alice was placed in her Squiggles seat 10-12 times per day in a supported and reclined (25 degrees approx) position for:

• Feeding and administration of medication through G-tube
• Reduction of reflux

In a more vertical position, the Squiggles seat was used to:

•  Increase play skills, in particular fine motor skills and cognitive capacity
•  Improve face-to-face social interaction with her family

Outcome

OutcomeO

Alice benefited from the postural support her Squiggles seat gave her in developing her motor skills. Some of the optional features were used regularly in her therapeutic work. Using the tray adjusted to the correct height  was helpful in developing fine motor and play skills. She hand-painted this Christmas card with her  mother when she was 17 months old. 

Early in Alice's therapies, the horizontal toy bar was used to hang favourite toys and helped in developing reach and grasp.

Alice at 18 months.

By 20 months old, Alice’s head and trunk control had improved, and the lateral head supports had been removed. The back piece of the head support was left to cue her neck from going into extension and compromising her airways during meals. The lateral trunk supports had been lowered to allow greater trunk, arm and hand movements. The picture shows Alice at 21 months.



Aims of using of the Squiggles changed slightly to include:

• Encouraging self (finger) feeding and independent spoon feeding
• Improving reach and grasp
• Further developing fine motor skills

At 55 months, Alice relies on her Squiggles seat primarily for joining her family at the table for mealtimes, but also for her continued home programme. The most significant component of the Squiggles seat now is the 4-point pelvic harness and pommel, as Alice still has a tendency to go into extension.

The tray continues to be used for table top activities such as fine motor work, cognitive play or oral-motor therapy, but also as a cue to stop Alice bending over and undoing the Velcro on her shoes!

Alice's family finds the compact size, easy breakdown and assembly of Squiggles very helpful in broadening Alice's horizons with sight-seeing, camping and cross country trips.

At 41 months, Alice holds her brother's hand while they are sightseeing.

Here is Alice at 48 months helping her father sweep their vacation cabin.

 
In this picture, Alice (again 48 months) reaches across her tray to the picnic table.