Page 90 - Handbook of Electronic Assistive Technology

Chapter 3 • Functional Posture 77

Assessment Findings
MEDICAL
John has dyskinetic (dystonic) cerebral palsy Gross Motor Function Classification System
Level V (Palisano et al., 1997), and presents with very strong extensor patterning of his
limbs and rotation of his head and neck. When he is relaxed, John has low central muscle
tone (e.g., in his trunk, neck and pelvis) and high distal tone (e.g., upper and lower limbs).
He is on a high level of medication to manage his dystonia. John receives all his nutrition
through a gastrostomy tube and has a high level of seizure activity.

Social/Environmental/Psychological
John lives at home with his parents and younger sibling. He attends a school for chil-
dren with complex special needs as a day pupil. Their home has been fully adapted and
is wheelchair accessible. John is a very sociable young boy who loves interaction with his
sibling and peers and is showing some potential for higher-level communication; he cur-
rently uses eye blinking as his communication method.

Physical
Key findings of the physical assessment are:
• Very strong dystonic patterning.
• Strong extensor tone with adduction of his lower limbs.
• Lateral spinal curve convex to the right (this is still correctable).
• ATNR evident at times.
• Able to be placed in seated position when relaxed, but unable to maintain this without
support.
• In sitting, his pelvis is oblique raised on the left but this is not evident in lying.
• Loss of hip flexion in the left hip, only able to achieve 80 degrees of flexion.
The following postural management goals were identified for John:
• To improve comfort and reduce pain.
• To increase seating tolerance and therefore enable increased participation in activities
and education.
• To facilitate a stable functional position to enable assessment for electronic assistive
technology access.

Identified Seating Requirements
It is identified that John’s seating needs to:
• Accommodate his reduced hip flexion on the left side as this then reduces his pelvic
obliquity.
• Maintain maximum flexion on the right to anchor position and to inhibit extensor
pattern.
• Maintain his hips in an abducted position to assist in inhibiting his extensor patterning.