Measurement of the functional impact of adaptive seating technology in children with cerebral palsy

Abstract

Many young children with cerebral palsy have motor impairments that affect their ability to sit and do activities unsupported. They often rely on special adaptive seating devices for postural control and stability. Healthcare practitioners generally accept that these products improve functioning in children with cerebral palsy. However, little empirical proof exists. The objective of this thesis is to propose a theoretical foundation to ground adaptive seating outcomes research and provide evidence of the functional effect of these technologies on children with cerebral palsy and their families. Chapter 1 describes a measurement framework based on an adaptation of the World Health Organization’s International Classification of Functioning for Children and Youth. The measurement framework and research overview serve as a conceptual and scientific underpinning for the investigations that follow. Chapter 2 presents a randomized controlled crossover trial designed to detect immediate changes in the printing legibility of 30 first and second graders with cerebral palsy who used two different types of school furniture. The trial found that compared to the use of conventional school furniture, the use of special ergonomic school furniture did not appear to change the immediate printing legibility or other aspects of handwriting quality for ambulatory children with cerebral palsy. Chapter 3 reports on the conceptual development and content validation of the Family Impact of Assistive Technology Scale (FIATS) – a new, parent-report measure of the effect of adaptive seating devices on the lives of children with cerebral palsy and their families. At this first stage of development, the preliminary FIATS included nine contributing subscales that measured child autonomy, caregiver relief, child contentment, activity performance, caregiver effort, family and social interaction, caregiver supervision, child safety, and technology acceptance. Chapter 4 describes an item reduction process used to improve the measurement properties of the FIATS. With the assistance of 50 parents of children with cerebral palsy, the FIATS was shown to have acceptable internal consistency and test-retest reliability. In Chapter 5, the 64-item FIATS was used in an intervention study to estimate the effect of two special-purpose, adaptive seating devices on the functioning of 30 young children with cerebral palsy and their families. One device provided a child postural support on the toilet, while the other device offered sitting support on the floor or in a chair. This study provides evidence of the meaningful effect of these devices on the lives of children and their parents and family members. Chapter 6 further explains the findings of the FIATS intervention study by examining the influence of the same two seating devices on parents’ reports of their child’s activity performance using the Canadian Occupational Performance Measure. We showed clinically important differences in activity performance for important self-care and play activities when their children used the study devices at home. Chapter 7 describes the contribution of the thesis to the scientific literature on adaptive seating device outcomes. Future research directions are proposed to measure and advance awareness of the time-dependent, multidimensional impact of adaptive seating devices on the functioning of children with cerebral palsy.