Adaptive seating and adaptive riding in children with cerebral palsy: In children with cerebral palsy

Physiotherapeutic interventions in children with cerebral palsy (CP) are generally focusing on the child’s functioning and his/her ability to perform activities in daily life. Children with CP perform many daily activities in the sitting position, such as reaching while eating, playing, or during school tasks. This functional activity largely depends on the ability to control posture, balance, and arm and hand motor skills. Thus, many interventions aim to enhance the child’s postural control and upper extremity function. The need of children with CP to improve mobility has led to the development of seating interventions and the adaptive riding intervention. This thesis suggests that in children with spastic CP functioning at GMFCS levels I-III two forms of postural interventions, i.e., specific forms of adaptive seating and adaptive riding, may improve children’s functioning, and enhance their postural control during sitting while performing arm reaching. - In children with US-CP, GMFCS levels I-III, FW-tilting with foot-support is associated with better reaching performance; in children with BS-CP, GMFCS levels I-III, a horizontal seat surface with foot-support is associated with better reaching. - The feasibility study on TDAR intervention in children with BS-CP, GMFCS level III, suggested not only that TDAR intervention and the complex evaluation protocol were feasible, but also that 6 weeks of TDAR may be associated with improved gross motor function and postural adjustments Our systematic review on the effect of AdSS in children with severe CP (GMFCS levels IV-V) revealed that the nine best studies available had a low level of evidence. Most promising seems to be AdSSs consisting of a combination of trunk and hip support which may be associated with better postural control and – in turn – better upper extremity activity. This type of AdSS may also be provided as a special purpose AdSS, that may have the potential to improve children’s activities and participation. It should be realized that the low level of evidence of the available studies precluded firm conclusions. This implies that additional research in this area is urgently needed