The right specialist seating is essential if pupils with disabilities are to take part fully in school, writes Annette Whitaker
Whether in an educational setting or at home, children spend a large proportion of their day seated. For a child with a physical disability, especially one that limits or prevents their movement and ability to stand independently without support, the amount of time they spend sitting is likely to increase significantly.
Having a comprehensive postural management plan that takes into account the time spent at school or nursery and seating systems used is essential; good postural care and support has a direct benefit on the physical, psychological and emotional wellbeing of a child. This in turn impacts on a child’s capacity for learning, their ability to develop other skills and integrate with other children on a social level. For teachers and teaching assistants (TAs) working with children with disabilities, having a thorough understanding of a child’s postural support needs and subsequent plans or exercise regimes will ensure they’re able to work with the child to enhance the classroom experience and encourage greater opportunities to learn, develop and grow.
Postural management plans
According to the Government’s guidelines published in May 2018, Postural Care and People with Learning Disabilities: Guidance, having “the right equipment and positioning techniques can help to protect body shape in people with movement difficulties”. Every child with a physical disability that affects their mobility should therefore have a postural management programme, devised as part of their wider healthcare package by an occupational therapist or physiotherapist.
Each plan should be tailored specifically for the individual child and consider their daily routine and activities that impact on their posture and function, and take into account of any specialist equipment prescribed or used. It will comprise detailed information on any orthotics, surgical interventions (passed and planned) and details on any regular therapy sessions undertaken. Any equipment and night time postural support should also be included to create a round the clock plan.
The benefits of good postural management:
- improvement in quality of life
- improved daily functioning and participation
- increase in comfort
- reduction of agitation and disruptive behaviour
- reduces the risk of contractures
- improved overall positioning.
The physical and psychological effects of poor postural care and its impact on the shape of the body can be severe and life threatening. In some cases, poor posture can lead to airways becoming compromised, leading to dangerous infections like pneumonia. Additionally, poor postural care can cause the body shape to deteriorate, which in turn can result in further health problems as organs may become distorted, causing more pain and discomfort. For children and young adults, this can be even more serious, as their bodies are constantly growing and changing, making the need for 24 hour postural management even more important.
As well as those with physical disabilities, some children with profound and multiple learning disabilities may also be subject to a postural management plan, as they will often sit and lie in limited positions, leading to a high risk of body shape distortion.
Having the right support at school
Specialist seating at school must be specific to a child’s needs and enable them to participate fully, with opportunities to learn and engage with teachers and other children. However, educational settings can “inherit” seating systems or wheelchairs from children who have since moved on. These generic pieces of equipment can be shared by more than one child; however unwittingly, this could cause longer term deterioration of a child’s physical condition and impact on their ability to participate fully at school.
A recent report, Postural care for people with intellectual disabilities and severely impaired motor function: a scoping review (Robertson et al., 2018), identifies a shortfall in knowledge shared by health and social care professionals with teachers and TAs, resulting in a lack of awareness of the importance of postural support. Some health conditions are caused or made worse by a lack of the right kind of support. The effects of scoliosis, for example, will increase if left unsupported. Even when this is identified, finding a solution is still a struggle, with lack of funding being one of the biggest barriers.
There’s a common assumption that a wheelchair will fit a range of situations and cater for both a child’s seating and postural needs, but this is often not the case. A powered wheelchair might be higher off the ground than a classroom chair, making the child feel isolated and singled out.
A specialist seat can enable the child to participate as fully as possible in lessons, allowing them to sit with their peers and giving them the chance to form social bonds. Specialist seating can also help the learning process, for example enabling children with sight or hearing impairments the opportunity to sit closer to the teacher.
Specialist seating that gives the correct postural support, used both at home and school, can reduce the need for time off through illness. Keeping the spine correctly supported can reduce the likelihood of scoliosis and the need for invasive surgery further down the road. Expensive surgery puts great pressure on the NHS and local health authorities, so investing in the right supportive specialist seating is actually saving money in the long run.
While many children have functional seating at home that allows them to sit in a working position for mealtimes and therapy, little or no consideration is given to comfortable seating that also provides postural support. Children with disabilities are often left with nowhere comfortable to sit that offers the level of support they need so they are forced to lie on the floor, or risk injury from falling off a sofa.
The need for comfort is also linked to time spent in the classroom: a child who is sat comfortably will be able to focus and learn, more so than a child who is in discomfort or pain.
Specialist seating can also apply to car seats, which are not currently considered to be essential and are not provided by local authorities. However, not having this type of seating can put lives at risk when travelling and even prevent children with disabilities from accessing education altogether.
What can school staff do?
Teachers and TAs play an important role in the development of children in their care. Having an in-depth understanding of a child’s postural management plan and their ongoing needs will ensure they’re able to benefit fully from all aspects of school life. Some children with an education, health and care (EHC) plan may have equipment specified within it that’s funded by the local authority – but this is not commonplace and the focus is usually on other areas of support.
However, if you feel a child would benefit from a specific type of seating at school, this can be specified within their EHC plan and funded as part of their overall healthcare package by the local authority. As each EHC plan is reviewed on an annual basis, if seating is not included in the current plan, there will be an opportunity to detail the need for it in the review. Once specified, and supported by a health or social care professional, the local authority then has a legal obligation to fund the equipment.
Further Information
Annette Whitaker is a parent of children with physical and learning disabilities and is part of the nursing team at Newlife the Charity for Disabled Children:
www.newlifecharity.co.uk
