The effects of an adaptive seating device on postural alignment and upper extremity function in infants with neuromotor impairments

摘要

The purpose of this study was to examine the effects of a contoured foam seat (CFS) on postural alignment and on a functional upper extremity activity of engagement with toys in infants with neuromotor impairments. Parental perceptions regarding the use and effects of the CFS at home were also assessed. The participants were four infants, ages 9 to 18 months, with diagnoses including cerebral palsy and Down syndrome who were unable to sit independently. An individualized, contoured foam seat was fabricated for each participant. A randomized, alternating treatments design was employed which included the following three interventions: (1) Treatment A was a commercial highchair; (2) Treatment B was the commercial highchair with a thin foam liner on the seat; and (3) Treatment C was the CFS used as an insert in the commercial highchair. Infants were videotaped for 5-minute observation periods, alternating Treatment A during the baseline phase and alternating Treatments B and C during the intervention phase. Using momentary time sampling, postural alignment was rated from videotapes by blinded raters using anatomical markers and visual guides placed on the highchair back. Engagement with toys was rated by recording the number of hands in contact with a toy and the number of hands or forearms in contact with the highchair tray. A semi-structured interview was conducted with mothers of the participants following three weeks of CFS use at home. Results indicated a clear, sustained effect of the CFS on improving postural alignment for all participants. The data did not support an effect of the CFS on increasing bimanual play for any participants. For two participants, increased ability to play with toys while arms were free from support of the tray was observed when using the CFS. All four mothers reported that they liked using the CFS, and that they believed the CFS had beneficial effects for themselves and their infants. These findings supported the efficacy of a low-cost seating intervention for infants with a variety of neuromotor impairments. Suggestions for other dependent measures reflective of functional skills for infants and ideas for future efficacy studies of adaptive seating devices were described.