Eveline is an 11-year old girl who lives in Oslo with her family. She attends school every day together with a group of children with different disabilities. The focus of her education is communication, interaction with others, physical activity and good experiences. Her day consists of both individual lessons and group lessons. Eveline is a happy-spirited, social girl who enjoys thrilling experiences such as speedy bike-rides and being wheeled around fast in her wheelchair.

Clinical background

Eveline has cerebral palsy with a functioning level of GMFCS IV. Best function is seen in her left hand, with the right hand mainly used for support purposes. She scores IV on MACS classification of hand function. She is not able to move around when positioned on the floor. For upright positioning, she uses a standing frame. She is unable to sit on her own and in order to maintain a sitting position her body requires a lot of external support.

Goals for sitting

Eveline is a tall child and still growing. Her therapists are worried about the development of scoliosis. It is therefore extremely important that her seated position helps her maintain a stable and neutrally positioned pelvis, which will give her spine and head a natural curvature. This will help to keep her head in midline. If her upper body and head fall outside of the midline, gravity can over time contribute to the development of joint contractures.

Important goals for sitting:

• Provide and maintain a neutral and stable pelvis
• Provide the best position for optimal postural control
• Optimize arm and handfunction
• Increase functional reach
• Provide opportunities for social interaction with her classmates and caretakers

Approach

The Krabat Jockey Plus was chosen for Eveline. The saddle seat positions her hips in a rested position (30 degrees abduction, 60 degrees flexion, slight outwards rotation) which allows her pelvis to be in a neutral position and maintain like this over time. The position of the feet slightly underneath her gives her a wide base of support. The table helps support her right arm and hand. Her upper body also needs additional support to prevent her from falling out of position. For Eveline to achieve independent mobility, the Krabat Sheriff Plus was chosen. With the attachment of the one-handed arm drive, Eveline is able to wheel herself around short distances at school.

Outcome

The positioning of Eveline’s feet underneath her upper body has shown improved postural control as she uses her feet as active support points. In this way, Eveline takes advantage of her involuntary spasticity in a positive way to increase her degree of control in her upper body. Traditional flat seats with foot supports in front of the upper body does not provide enough stability for Eveline and her pelvis comes out of position when the spasticity kicks in. This causes her upper body to sag to one side resulting in her head no longer centered. However, on the saddle seat, her head, neck and back are centered midline which optimizes her hand and arm function. With a centered head it is also easier for Eveline to interact socially.