The science of seating and innovations in paediatric care
Occupational therapists (OTs) and other healthcare professionals have been prescribing specialist seating to help prevent health problems in people with disabilities for decades.
Padraig Finn, Physiotherapist and Seating Specialist at Yorkshire Care Equipment, has shared his insights on how approaching seating assessments from a physiotherapy perspective helps to build a full picture of the user’s needs and how recent innovation in the healthcare sector has made specialist seating options better suited to paediatric care.
Why is specialist seating important?
According to the British Heart Foundation, the average adult spends around 9.5 hours a day sat down. Almost everyone then has experienced the discomfort associated with sitting in the same position for too long. Pins and needles, numbness, back and joint pain, stiffness, and cramp are all common complaints.
But this discomfort is only short-term. Someone with good levels of mobility can get up, stretch their legs and feel better in a few minutes. Maintaining good posture whilst sitting and regularly readjusting body positioning throughout the day is usually enough to stop long-term issues developing.
For adults and children with disabilities however, prolonged sitting can have much more serious consequences. Individuals with reduced mobility cannot easily adjust themselves in their chair. This puts them at risk of a whole range of health problems, including pressure ulcers, spinal deformities, poor circulation, and respiratory issues.
Specialist seating can be custom sized to perfectly fit the individual user, providing levels of support and comfort that standard seating cannot. Features and functions can also be added and adapted to support the different, complex care needs each individual may have.
How does physiotherapy relate to specialist seating assessments?
Padraig worked as a physiotherapist in the NHS full-time for eight years. During this time, he covered numerous rotations – including musculoskeletal and respiratory physiotherapy – before specialising in neurophysiotherapy.
Neurophysiotherapy, or neurological physiotherapy, is a specialism that focuses on the assessment and treatment of individuals with neurological conditions. This term refers to any condition affecting the brain and/or spinal cord, such as, cerebral palsy, stroke, or multiple sclerosis.
Many neurological conditions are associated with mobility issues, so a specialist care chair is often recommended to support individuals with these conditions.
Padraig joined Yorkshire Care Equipment, a specialist seating and mobility aids company, in 2012. He took on a role as a seating assessor and has been using his background in physiotherapy to help his clients find the right chair for them ever since.
Explaining how his experience as a physiotherapist helps when carrying out seating assessments, Padraig said: “Specialist seating forms part of the treatment plan for an individual’s condition. Having background knowledge of different conditions allows me to match certain seating options to certain conditions. Working directly with clients, I’ve seen the intricate details of how clinical presentation can change over time. So, I’m able to tailor the features of the chair for the user’s journey with a progressive condition.
“Having anatomical knowledge also translates well into seat sizing. For example, understanding that seat height should be based on lower leg length helps both when carrying out assessments and when explaining the importance of seat sizing to other healthcare professionals.”
Specialist seating improves quality of life
The key is to think about the bigger picture of how specialist seating fits into someone’s overall care and quality of life. The right chair can provide support in lots of areas you wouldn’t initially think of.
- Skin conditions need matching to the right fabric – For someone with weeping legs, you’re looking for a chair with a durable, wipeable surface that is also soft on the skin.
- During end-stage motor neurone disease (MND) individuals experience swallowing difficulties – Choosing a chair with tilt-in-space and adjustable back angle helps their speech and language therapist to get the right angle for maximum swallow potential.
Innovations in specialist seating
As seating affects so many areas of someone’s health and wellbeing, Yorkshire Care Equipment identified a need for a chair that could be adjusted to suit individual care requirements.
Padraig has already touched on the importance of tailoring a chair to match the clinical presentation of someone’s condition. So, the company’s goal was to develop a single chair that was versatile enough to provide this level of bespoke seating solution for many different individuals.
After two years’ research and development and working closely with OTs, Yorkshire Care launched the Lento care chair.
It has proved extremely popular with loan stores, hospitals, care homes and private residents. Explaining the unique level of customisation, Padraig said: “You can change the seat height, width and depth, as well as the height of the footplate and armrests, and the backrest cushion in minutes. The best part is that you don’t even need any tools – that really impresses people when I demonstrate the Lento. It’s just so easy to adjust.
“There are different backrest options and you can change the footplate angle or add different pressure relief cushions. Plus, it’s got functions like tilt-in-space, backrest recline and articulating leg rest elevation. It really is one of the most flexible chairs out there.”
However, despite the Lento’s adjustability, there was a limit to how small the seat could be sized. During assessments, Padraig and the rest of the Yorkshire Care team found the care chair fit almost anyone who was over 5’ 2”.
That’s about 80% of the population. It’s pretty impressive for one chair, but it did leave 20% people who the Lento couldn’t cater for.
Little Lento – the children’s care chair
It became apparent that there were not enough flexible options for paediatric specialist seating. Children with disabilities and long-term conditions were not getting the same opportunities for enhanced quality of life as adults.
So, in 2018, Yorkshire Care Equipment began research into paediatric care chairs. Towards the end of 2019, the company then launched Little Lento.
Little Lento is a versatile care chair solution, designed specifically for paediatric care.
All the features have been carefully adapted from the original Lento care chair. So, Little Lento has all the flexibility and clinical benefits of the adult model, but now the dimensions have been scaled down for paediatric care.
Why is proper seat sizing important for children with disabilities?
Correct seat sizing is vital for any specialist seating – the custom fit is really the key to providing someone with the support they need.
If the seat isn’t sized correctly, then you risk doing more harm than good. A chair that’s too wide can encourage leaning, whilst one that’s too narrow can cause friction and lead to tissue breakdown.
In children, the risks of getting it wrong are greater because they are still developing. This is especially true when it comes to posture.
If identified early, poor posture can often be corrected, or at least limited. But incorrect seat sizing puts the child at risk of developing further poor posture. This can lead to additional health problems such as restricted respiratory input, further curvature of the spine, shortening of muscles and increased pressure loading in specific areas.
In short, incorrect seat sizing can impede the development of children with disabilities. Whereas proper seat sizing will support their continued development, which is something every child deserves.
Adjustability is key
To give a specific example, head and shoulder positioning is possibly one of the hardest areas to correct when dealing with seating. So, when doing a seating assessment or sizing a chair for a child, it is vital that you do not encourage the head forward.
When people see a gap between the neck and headrest, their instinct is often to fill it by adding in large cushions to support the head. Don’t do that. This forces the head forward. Forward head position makes it harder for a child to see what’s going on around them and engage with others. Over time, it can also lead to permanent curvature of the spine.
Instead you want to look for a headrest that can be adjusted to accommodate someone’s head position – so one where you can change the shape of the head cushion or resize it by adding/removing padding. From a physio’s perspective, head/shoulder positioning and support should always be considered with possible active physiotherapy treatment, e.g. lengthening of muscles, in mind too. If you’ve got something adjustable, then it can be easily adapted as someone improves so the chair still works for them.
With children, having a chair that allows for sizing adjustments has the huge added benefit that the chair can grow with the child. In today’s world, this really helps with cost-effectiveness. One chair sees a child through most of their developing years. As funding for specialist care equipment is often limited, getting good value for money is key.
What are the key benefits of Little Lento?
Now that Little Lento has officially launched, Yorkshire Care have started carrying out more assessments for paediatric seating.
Padraig has summarised the top five benefits of the children’s care chair in his professional opinion and based on feedback from clients:
I’ve spoken about the importance of adjustability when specifying chairs for children throughout and Little Lento is ultra-adjustable. That’s the standout feature for me. You can make adjustments for arm height, seat width, seat depth, leg length, back height, back angle and ankle positioning really easily. Paediatric chairs don’t always offer that level of flexibility and if a chair is adjustable, you often need special tools and training. That’s not the case with Little Lento.
One of the first things people comment on when they try Little Lento is how comfortable it is. A lot of paediatric chairs designed for postural support are uncomfortable if you’re sitting for long periods. But Little Lento is able to meet postural needs whilst still providing comfort.
3) The number of accessories
There’s a huge list of other accessories you can get to make Little Lento even more versatile. Things like hip guides, harnesses, thoracic laterals and profiled head cushions make it flexible enough to meet lots of different clinical presentations.
4) Value for money
For the amount of adjustability you get, Little Lento really is good value for money. Features you often pay extra for – like tilt-in-space plus back angle on the same chair – come as standard. Local councils, loan stores, and SEN schools in particular can make significant long-term savings. They can reuse the same chair time and time again by readjusting it to fit different children. The alternative is to buy a bespoke chair for each child, which obviously ends up costing a lot more.
5) The look
Little Lento isn’t clinical looking. That’s something I find is often important for parents. They want their child to have a chair that feels like it belongs in the living room or their bedroom, rather than one that looks like it belongs in a hospital.
It’s available in lots of different colours too. So, kids love the fact they can personalise their chair and get it in their favourite colours.
For more information on Little Lento or advice on specialist seating, visit www.yorkshirecareequipment.com or call 01423 799960.