This is the single most critical area of DME and REHAB.  The way you sit and position a child in their mobility aid can mean the difference of their physiology, posture, and ability to function for the rest of their life.  Our company works with a diversity of individuals with a variety of diagnosis.  We see client's from 2 years to 99 years of age.  We find that many individuals who don't receive proper seating and mobility equipment, and are not monitored, can develop physical deformities, contractures, internal physiological abnormalities, skin break down, and other sometimes irrepairable damage. 

It is a team approach to long term good seating, from the doctor who prescribes the equipment, the therapist and the RTS who selects the equipment, to the parent who watches and alerts the team to changes, or growth issues.  A seating system is like a pair of braces, they need to be adjusted to accommodate for growth and other changes.  If the seating is monitored and altered; then the child's growth can be stunted; and there could be consequences. 

Our company selects the seating that the client will use, prior to selecting the mobility base.  The mobility base is important for function, but the seating makes the greatest impact. 

It is good to see that children, and young adults do not sit on sling seat upholstery in wheelchairs.  For years RTS's have been telling the community that severe scoliosis, kyphosis, posterior pelivic tilt, hip and leg abduction and rotation are caused from sitting in standard wheelchair upholstery.  We have seen the damaging effects in nursing homes, and in rural regions where active RTS's and Therapists are not present in numbers.  Funding certainly demands what equipment is supplied, but it is important to educate the users of the equipment to watch for the signs of poor posture; and what the consequences are.

Planar Seating: this seating type is the most prescribed equipment for children, due to its ability to adjust and grow with the child.  Most clinics provide this type of seating, as it is fairly forgiving, and is very adjustable. A solid seat, back support, lateral/ throracic supports, hip guides, an abductor, pelvic strap, shoulder harness, and maybe a head support.  Because there are no contours, the seating can be moved forward or backward, up or down to accommodate for growth.  Usually the children using this type of equipment are not at risk of skin breakdown, so it works.  The negative of this type of seating, is that the human body is curved and not flat, so the seating is not very comfortable, and forces a posture into an unnatural position.  This type of seating has been known to cause posterior sitting, that if not addressed, can lead to scoliosis, and kyphotic postures.

Contoured Seating;  This type of seating usually incorporates a contoured seat cushion to promote midline sitting, a slightly wedged cushion to keep hips the rear of the cushion, with a back support that offers good pelvic stability, and allows for upper back extension.  Usually lateral / thoracic supports are provided, as well as hip guides, an abductor, pelvic belt, shoulder harness, and may be shoe holders and a head support.

Modular Seating: This type of seating can be simple or very custom; using blocks and wedges to provide good body contact, and at the same time allow for growth and change.  These clients generally have more postural needs and require much more support to maintain an upright posture. 

Molded Seating: This type of seating is not off the shelf and is very custom.  It can be foam in place, or molded to achieve a desired effect.  Molded seating is usually provided to severely trunk weakened individuals, or individuals who have moderate to severe deformity.  In some cases this is the only type of seating that will accommodate for their contractures or deformity.  Many times these indivduals have had spine surgery to correct the curvature of their spine, had tendon releases to allow them to sit more erect.  The problem with this type of seating, is that it is very expensive, and is not forgiving to growth.  Because of the fitting seating, ten (10) pounds of growth may cause the mold to be redone.