Title:
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The development of an objective measurement system to aid in the prescription of seating to non-ambulant children with cerebral palsy at risk of scoliosis
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This thesis outlines the successful development of an objective measurement
. system to assist in the prescription of seating to non-ambulant children with CP at
risk of developing scoliosis.
Non-ambulant children with CP are at high risk of developing severe spinal
deformities that can lower the standard of life and life expectancy. Postural support
is an important aspect of clinical care however the process of seating prescription is
wholly subjective.
During this study appropriate stakeholder groups were fully integrated in the
development of a system specification utilising a user centred design approach. An
initial seating system was developed to provide comparable seating posture within a
surface topography spinal imaging system and a spinal X-ray. A clinical investigation
was carried out using this system, results from 18 non-ambulant children with CP
identified surface topography to be an acceptable alternative to potentially harmful
spinal X-rays for moderate spinal curves.
Following the initial clinical study stakeholders were re-engaged and an
improved system to assess further key parameters of seating was developed. The
Seating Measurement System (SMS) was developed to measure spinal curvature
and back shape, force distribution through the torso, pressure distribution through
the seat and upper limb function.
A feasibility study was successfully carried out involving 4 able bodied
children and 6 children with CP. Results from this study identified some similar
measures or seating trends between these groups. One child with CP is presented
as a case study. Results identified that improved postural support may reduce high
muscular tone and (identified though parental feedback) improve arm function.
Results from this study were used with an osteo-ligamentous finite element
model of the spine and rib cage to simulate the non-surgical correction of scoliosis.
This study identified that patient specific simulations may be powerful tools to assist
in the prescription of optimum seating. However, to be fully utilised in neuromuscular
scoliosis models must consider asymmetrical muscular loading
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