A comparison of flat and ramped, contoured cushions as adaptive seating interventions for children with neurological disorders

This study is a part of an ongoing effort to address the lack of rigorous, scientific evidence to inform the prescription of adaptive seating interventions for children with neurological disorders. The aim is to investigate one aspect of the seat - the cushion, at the same time as developing a battery of tests which are objective, easy to implement and reliable with which adaptive seating interventions can be measured. Method: A total of 35 school-aged children with neurological disorders were assessed in a bespoke adaptive seating system to compare the use of a flat and a ramped, contoured cushion. The measures used were an accelerometer to measure stability, two actigraphs to measure activity, a pressure mapping system to measure weight distribution, goniometry to measure posture and activities to measure functional ability. Results: The results generally support the use of ramped, contoured cushions over flat cushions. The accelerometer and pressure mapping system show particular promise in future research. The actigraphs were unreliable, although other models may prove more suitable. The goniometry produced the best results, although it was the least reliable to implement and the seated functional activities need further work. Interpretation: The methodology showed in a number of ways that ramped contoured cushions were more effective than flat seat cushions for a heterogeneous population of children. Accelerometry and pressure mapping showed particular promise for advancing research and practice in the area of adaptive seating, with further work required in other areas. In particular, it is recommended that future efforts pursue the use of more reliable electronic measurement.