Enabling Jay to participate in classroom activities in his Everyday Activity Seat
Jay is a four year old boy, born prematurely at 35 weeks with hydrocephaly (excess fluid around his brain) and had a shunt (drain) inserted. Jay has no specific diagnosis, but has global developmental problems including partial sight, impaired hearing, low muscle tone, a smaller than usual head, epilepsy, and sensory problems. In seating, it is Jay’s low muscle tone and sensory problems which cause the greatest need.
Jay is low toned (hypotonic) and his joints are loose (hyper-mobile). As a result, he finds supporting himself against gravity difficult, but he can prop himself for very short periods. He is also able to roll from his back to his tummy (supine to prone). Jay has good head control, but is not yet sitting independently. When seated on a therapy bench, Jay hunches over into a flexed position, which places him at risk of spine curvature (kyphosis) in the future.
Due to his limited vision and hearing as well as low tone, Jay does not like to be challenged and his motivation is limited. He has a tendency to rock back and forth, and will take up whatever physical support he is given.
Jay’s abilities can be classified as level 2 on the Chailey Box Sitting Scale and level V on the Gross Motor Function Classification System (GMFCS).
Goals for Sitting
• Provide optimal support to encourage upright sitting
• Provide lateral femoral support to prevent falling outward (abduction) of legs
• Provide a secure, stable seat for safety during rocking movements
• Provide tilt-in-space to change posture when fatigued
• Provide high-lo mechanism for management in classroom
Jay was assessed in the Everyday Seat (size 1) in October 2012. He had no restrictions in his hip or hamstring range of movement. The Everyday Seat was adjusted to his individual body dimensions accordingly. The four-point pelvic harness was used to provide the desired pelvic stability, and Jay required a harness and tray to provide additional anterior support.
Jay required a different harness (narrow style) which provided better support at his shoulders. Jay’s therapist considered that the seat maintained him in a good position, with pelvic stability, neutral hip alignment (no abduction), and with an upright trunk and head. Jay’s head position was especially important as it allowed good “chin tuck” for feeding (the slight downward tilt of the head which keeps the air and food channels aligned to prevent choking).
The hi-low mechanism allowed Jay to access different areas of his classroom in his seat, and assisted the school staff with moving and handling procedures.
In addition, the tray allowed Jay to participate in arts and crafts activities in class, and as the photograph shows, the wheeled base allowed Jay to participate in Physical Education classes to the best of his abilities.