Rick’s Experience with
Dynamic Seating Insert

Written by Nancy Hylton, RPT, LO - Mother of Rick. Nancy is an internationally renowned physical therapist

My son Rick is 21 years old and has moderate to severe Spastic Quadriplegia.  He has used a ultralite Quickie GPS since he was 11 years and gained good self propelling proficiency over level surfaces and ramps indoor.  He has never has the strength or coordination to self propel outside and over uneven ground.  In these cases, at camp etc. he used a power scooter to get around quickly and effectively.

In Spring of 2004 we began what became a very lengthy process to get funding for power.  Rick received his new chair in June 2005.  I began to notice fairly quickly that he was hanging on the right armrest and this was having a negative impact on his Spasticity, supported standing and supported step taking.  Flexor hypertonus was increasing on the right more than left and he was becoming more asymmetric.
He loved the freedom that his new chair gave, but needed to spend much time in his manual chair to  manage better posture and  trunk activation.  I was contemplating removal of his right armrest, but worried that this might make him feel very unsafe in the power chair while driving.

In September 2005, we began to have access to a CoreWerks prototype wobble board.  Rick loved to sit on this and play ball during his PT sessions.  Even though he has always been very posturally insecure and disliked surprise movements (Ï don’t like my balance.”)  he enjoyed sitting on the wobble board and has become more and more active.  I realized that somehow this is what he needed to be sitting on in his powerchair, to try to counteract the negative effects on his body.

In Dec 2005, a Propiotek insert was temporarily installed in his power chair.  The seat cushion was too thick disturbing his back support and so we used his 2inch thick standard manual foam seat.  With this change he was again happy and within 1-2 weeks I noticed that he was no longer leaning on the right arm rest.  When verbally reminded, he was able to put his shoulders back and sit up straight while driving.  The permanent installation occurred in Jan. 2006; he has had the seat altogether about 1 month.  His posture and trunk strength are improving and I am no longer worried about his use of the power chair causing physical deterioration in his skills.

Changes noticed  since use of CoreWerks seat in Rick’s Powerchair:

1.  Rick spontaneously comments how comfortable his chair is and how much he likes it.

2.  Rick’s posture is again more symmetric and he sits taller without leaning on his right arm.

3.  He is more spontaneous in his monitoring of sitting posture and pushes his shoulders up and back without verbal cueing.

4.  He spontaneously steadies himself in the car by placing his right hand at the end of the armrest with shoulder back and right arm in extension, exclusive of long-standing 20 degree elbow flexion contracture.

5.  His lumbar lordosis is again decreasing in standing after increasing with the use of his power chair.

6.  When asked, he says that the new seat  “makes his body softer and stronger.”