The importance of early intervention
Because the early years are so critical to child development, many experts advocate early intervention and 24-hour positioning. Early intervention and proper positioning can improve physical, cognitive and sensory development, ultimately helping to maximise a child’s future potential.
Without positioning, changes in muscle and bone can have a more profound effect on functional ability than the original neurological damage. Babies can develop abnormal tone and postures before their first birthday.
And without independent mobility by 18 months, a child may demonstrate learned dependence. If unable to move, children may become passive, learning to be helpless rather than learning how to do things for themselves. Consequently, they may lag behind peers in cognitive development.
Early intervention: start with an assessment
You child has individual needs that require an individual solution. To get the right positioning products, start by getting an assessment from a clinical specialist, such as a physiatrist (a physician who specialises in physical medicine and rehabilitation) or a physical therapist.
Your clinical specialist should conduct a thorough hands-on evaluation including:
- Describe general resources and abilities in activities for daily living
- Range of motion and flexibility in the spine, pelvis and leg joints
- Postures that are flexible and those that are fixed
- Functional needs and limitations
- Respiratory function for sleep positioning equipment
Then the specialist will use that information to select the best device for supporting therapy goals. Postural management should be designed to complement and reinforce therapy to increase the chances of changing motor patterns. To get the best fitting, ask the specialist the following questions:
- Does the solution accommodate changing needs, like your child’s growth?
- Can there be a trial of the proposed solution before the doctor or physical therapist writes the final prescription?
- Can we be instructed in how to use the equipment?
24-hour positioning concept
The 24-hour positioning concept
24-hour positioning applies to all ages, but leading authorities say it is especially critical to the growth and development of babies and children.
Also known as “postural management,” 24-hour positioning extends posture control to the bed and the bathroom as well as other activities and emphasises the value of standing. This individualised approach makes use of positioning equipment and may include orthotic devices, physical therapy and exercise, and education.
The push for 24-hour positioning emerged from the realisation that eight to 10 hours of sleep with no posture control can overpower all the physical therapy and other healthy efforts during the rest of the day.
With no positioning while they sleep, people with physical disabilities can actually lose ground on their therapy goals as misalignment and muscle imbalance launch a sneak attack throughout the night. Windswept legs, or pelvic obliquity, are a common example of structural damage that may develop in bed.
Postural management provides multiple benefits:
- Promotes development. Positioning equipment replicates normal positions and movements to guide the child toward normal development.
- Prevents or reduces deformity. Abnormal posture and abnormal movement patterns create abnormal stresses upon bone by building muscle imbalance between opposing muscle groups. That can lead to a vicious cycle of further shortening of some muscles and lengthening of other muscles, which can make things worse. 24-hour positioning strives to create normal stresses upon bones with symmetrical posture and consistent movement patterns within limited boundaries.
- Improves ability. By freezing out unwanted movements, positioning equipment allows the child to concentrate on specific motor or cognitive tasks, leading to increased levels of activity,
- Improves comfort. Children with physical disabilities often experience pain, including muscle pain, joint pain and muscle spasms. Positioning soothes pain.
- Improves sleep. Pain frequently interferes with sleep in children and adolescents with physical disabilities. By reducing pain, positioning promotes optimal sleep throughout the night.
Lying and early sitting
For daytime use and sleeping, lying supports address the importance of a symmetrical reclining position. Corrected posture is achieved with the use of supports and blocks, such as provided with the Early Activity System (EAS).
Early sitting helps babies between 3 and 7 months develop motor control of the eyes and mouth plus anti-gravity movement of the body. The child should sit with proper support and positioning—as upright as possible—to promote extension in the spine and open up the chest cavity for good breathing and the head up for visual interaction. Postural seating systems position an infant to explore, learn about the world, and participate in feeding as well as therapies.
The modular Early Sitting System (ESS) supports children over 18 months so they can sit with legs extended. The dynamic trunk support allows movements to be made with the upper body and promotes balance while sitting.
Seating systems such as the Kimba Neo emulate an upright sitting posture, providing a stable sitting base, trunk support and the foundation for active movement of the head, arms and hands. The design should allow therapists to optimize posture, function and comfort. Adjustability provides clinicians with the tools to maximize pelvic stability, trunk and head alignment, and leg and foot positioning.
Most have a modular design, so the seat can be used with and moved to a variety of stroller, wheelchair and stationary bases. Parents and kids like the option of mounting with the child either forward-facing or rear-facing. Stationary bases with adjustable height can be used as a high chair and for eye-to-eye interaction with other children.
The tilt-in-space feature on some wheelchairs plays an important role in seating and positioning for some users.
- Positioning. Tilting back 5 to 15 degrees can use gravity to help position the user for better posture.
- Pressure management. Researchers have determined that 45 degrees of tilt (midway between horizontal and vertical) is needed for effective pressure management. That angle reduces pressure by one-third by distributing weight over a larger area. Tilting at various degrees throughout the day also provides relief.
With tilt-in-space, the user rotates back, maintaining the same seat-to-back and seat-to-leg angles.
For about types of seating based on level of need, please see Seating and Positioning.
The need to explore
Most able-bodied children develop early motor and cognitive skills simply through their own curiosity. They see the world around them and feel compelled to explore. They learn to move so they can see and touch and taste the fascinating objects around them. Reaching leads to rolling, then sitting, then crawling, then pulling to stand, walking and running.
Children with special needs have the same fascination with anything beyond their grasp. But children with physical disabilities often miss out on experiences that fuel normal development. These children benefit from adaptive equipment that enables them to explore and interact. As much as possible, disabled children should follow the typical development schedule of able-bodied children.
Walking is important
Walking frames give children a taste of independence while spurring their physical and emotional development.
Why is walking so important? On the physical side, it trains the muscles, coordination and ‘body sense’ (proprioception), and improves balance. Developmentally, it promotes the extention of the hips and straightening of the pelvis. Neurologically, it trains spatial awareness and supports sensory perception. And of course, it also offers great social benefits, in that it allows kids to see eye-to-eye, explore their surrounds, and improve their independence and self-confidence.
Take a look at our Frequently Asked Questions for more information.
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