FAQs for Parents
Here are our frequently asked questions for parents.
Here are our frequently asked questions for parents.
About CAPS Seating
Why does my child need special seating?
In order for a child to sit independently in an upright posture facing forwards, they need to be able to control their sitting ability. Most children can sit independently by the age of six or seven months, some take longer than this and for some children independent sitting is not possible, These children need the help of special seating to support them, to offer them the opportunity to develop those skills and to enable them to experience an upright posture, which allows them to interact face to face with the world and the people around them.
What is a Caps seating system?
The Caps II seat is a design based on detailed research into seating and posture at Chailey Heritage in East Sussex, and has proven its worth over years of clinical use. (Mulcahy et al, 1988. Adaptive seating for motor handicap: problems, solutions, assessment and prescription.)
Many other seating systems are based on similar principles to Caps seating, but because of its unique design and adjustability, based on research that defines the components needed to provide postural stability and control, the Caps ll seat proves its effectiveness when you sit a child in it.
It can be fitted by using an interface board on to most wheelbases, powered chairs or pushchair bases, and can also be used as a static seat on a high/low base at school or at home
Each part of the Caps system has been designed to help your child feel safe and secure and to promote a good symmetrical sitting posture, which will enable your child to have maximum function and potential to development.
The standard Caps backrest has a removable padded back cushion mounted on a backboard, a headrest mounting is sited up from the top of the backrest. A variety of headrests can be used dependent on clinical need. On either side of the backrest are the adjustable side (lateral) supports these help to hold the trunk in an upright (midline) position. At the bottom of the backrest is an attached lower (sacral) pad which supports a neutral position of the pelvis from behind.
The seat cushion sits onto the base board, the foam of the cushion is comfortable, but firm. It is flat at the back under the bottom, but ramped at the front to allow the thighs to be well supported. At the side of the seat cushion are adjustable hip guides, these help to control the pelvis and keep it in a good position.
A removable knee block is mounted below the seat at the front of the chair. Each kneecup can be individually adjusted to offer optimum control, the knee block holds and supports the pelvis and thighs/hips in position from the front. The chair will have a hip-belt fitted to assist with pelvic stability and may have a shoulder harness or chest strap on it.
Removable leg rests are attached to the seat rails and these have multi adjustable footrests which allow support, control and individual positioning of the lower legs and feet. It is important to support the feet at all times to give enough stability for the rest of the body to feel secure, but it is vital that the feet are secured with the foot straps when the kneeblocks are in place, so that the kneeblocks can provide comfortable alignment for the legs.
The Caps seat can also be made to incorporate a moulded backrest.to provide improved support for the trunk posture if necessary.
The chair will have been individually made especially for your child, based on a clinical physical assessment by your child’s seating therapist, and measurements taken at the time. The chair itself is adjustable, in seat depth, width and back height, which allows for growth. There is a choice of colour for the covers, and these can be removed for washing. The harnesses and hip belts are wipe clean and are made with a soft padded material where they contact the child.
Why has a Caps seat been suggested for my child?
Your child has been assessed by seating therapists as having difficulties with sitting. In order to help overcome these problems, he/she needs to be able to experience sitting using equipment which promotes safely supported postures, and practice how to use movement patterns from this supported sitting base. This will enable your child to learn and develop the skills and use these movements and postures independently to play and to be part of the world around them. The Caps seating system will offer your child the opportunity to explore, experience, and learn about posture and movement with safety and support, whilst enhancing their feeling of independence and self-worth.
Why does my child need knee blocks?
To sit upright a child needs to be able to bend its knees to place and take weight properly though their feet, to keep their hips and pelvis in good alignment, and stack their body, shoulders and head aligned above the pelvis. If your child cannot sit independently they might have problems controlling the position of the pelvis. The pelvis forms the base of support in sitting and needs to be stable to allow control of the trunk and the head.
Kneeblocks help the child to control their pelvis by holding it from the front of the body. The kneeblock and the hip guides of the seat control the long bones of the upper legs, this helps hold the hip joints in the correct position, and stops the pelvis from moving forward on either side. The knee blocks also hold the legs in a straight position stopping them rolling apart (abducting), pulling in (adducting) or both legs pulling over to one side (windsweeping).
Do the knee blocks hurt my child’s knees?
If the seat depth and knee blocks are adjusted properly they should not hurt your child’s knees, they are well padded and individually adjusted. They need to be in contact with the knee to hold the pelvis in a good position against the back of the seat. Sometimes the child may have a red mark on the knee but this should fade after a few minutes out of the seat. Always check that your child has their pelvis as far back into the seat as it can go, and that their lap-strap is done up firmly and not loose at all, and these factors should help the child to feel more stable and secure.
What if I can’t get the knee blocks on?
Try repositioning their bottom further back onto the seat. If the knee block does not fit it is likely that your child is not sat back enough in the seat, your child’s pelvis needs to be upright, not tilted back so they slump (some children have problems bending to sit and need extra help, ask your therapist for advice on putting your child in the seat if you find it difficult). Also check that the seat cushion is properly tucked into the seating system, as it may have been moved and not replaced properly.
Check that your child has not outgrown the seat depth. Discuss with your therapist if they need a seating review.
Have I always got to use the knee blocks?
If prescribed, knee blocks are a very important part of the seating system, and need to be used as much as possible as they hold the child straight in the seat in a stable posture. This enables the child to maximise their function and help them to develop secure hip joints.
What is the chest harness for?
Your child may need a chest harness if the seat is used in a pushchair or as mobility equipment (such as in a wheelchair or powered chair). It is harder for your child to control their upper body when the seat is moving. Your child also needs to learn how to come forward and sit back into the seat, this enables them to develop sitting balance.
Sometimes a harness helps the child to correct its posture by giving a gentle pressure reminder that they are leaning forward, this allows the child to correct its posture back to the upright position using the right movement. Your child may also use a tray as something to prop onto to help them learn trunk control, and therefore may not need the shoulder straps if the chair is static.
Does the harness need to be tight?
No, the chest harness should not hold the child firmly back against the seat otherwise the child will not experience the subtle movements required to develop sitting ability in a controlled way. The child needs to be able to move its shoulders back to allow it to use its arms freely.
Should the harness be worn at all times?
No, If your child has the ability to lean forward and sit back without the harness, they should have some time free of the straps when the chair is not moving to allow them to practice this skill.
What about the harness being too small when I put my child on a winter coat?
The harness straps are multi-adjustable to allow for various types of clothing. Your therapist will explain how to adjust the harness if you struggle.
Does the hip belt have to be used at all times, should it be tight?
Yes. Like the knee block, the hip belt is an essential part of the seating, it needs to be snug fitting across the front of your child’s pelvis. If the hip belt is loose it is harder for the child to sit correctly. The hip belt is there to control and help your child to stabilise the pelvis. The hip belt needs to go under big coats not around them.
Is using a hip belt or harness restraining my child?
No. When a hip belt or harness is prescribed as part of a seating system by a qualified therapist it is part of the postural equipment being used to promote better seating ability, rather than restraining, it should be enabling your child to function by offering increased stability.
Why does my child need a moulded backrest?
There can be several reasons your child needs a moulded backrest. Most proprietary seating systems have a backrest which is fairly flat and symmetrical, covered with a soft foam pad for the child to rest against. However learning to sit requires that your child should be able to bring its body weight forward over its sitting base and lift its head upright on its neck. Some young children do not have this ability, they may go very stiff and not bend, or be very floppy and need substantial support to give them postural stability. A moulded backrest gently teaches your child to come upright and learn head control in supported stages, rather than expecting them to manage it all at once.
If your child’s back profile has become curved, expecting them to sit against a flat backrest will give them insufficient postural support and might cause further complications and deformities. Caps seating uses a unique material called Lynx which is individually moulded by the seating therapist to meet your childs postural needs and conform exactly to your child’s back profile.
What is static/dynamic sitting balance?
When we talk about static sitting balance, what we mean is the ability of your child to sit still on a box or flat seat, with their feet flat on the floor, their hips and knees bent at about right angles with their body, head and shoulders held in an upright position over their pelvis, leaving their hands free to play. Before they start to do anything your child needs to be able to achieve this on their own without using equipment or being supported by someone, and they need to be able to stay in that position unaided.
Dynamic sitting balance is how we describe the ability of your child to move around whilst seated. Dynamic sitting allows your child to sit in the static sitting position, but be able to independently lean forward, backward or to the side and regain position without any help and without having to hold on with their arms. They should also be able to lift their feet up off the floor when sitting,adjust their body position, and control their balance while they do this.
Why can’t my child sit?
Children who have problems with the central nervous system (such as cerebral palsy, learning difficulties, stroke and genetic disorders etc.) may have difficulties with muscle control, lack strength, balance, or find it difficult to integrate sensation and perform movements. This affects their potential to experience normal movement patterns and learn postural control.
These difficulties can present as the child being unable to bend or straighten their limbs, roll over, lift their head, sit, stand or walk. If a child cannot move in and out of these usual postures easily there is the possibility that they may become stuck in poor ‘abnormal’ postures, research shows us that this can result in fixed deformities.
The ability to sit upright and move in and out of your base of support is a very difficult thing to do. Babies need to learn this by experiencing the posture and the movements, this then becomes more effective as they practice the skills of learning to control and balance their head and trunk and manage their limbs to form learned patterns of movement.
How can I help my child to learn to sit?
The central nervous system has the ability to alter the body structure and the brain pathways, it does this by learning from the environment in which the body exists, and the sensation and movement the body experiences. This re-moulding process is called neuroplasticity. Neuroplasticity can be used as a positive influence for your child’s development.
Therapists work with your child by using exercises to help train your child’s central nervous system, this enables them to experience normal patterns of functional movement. However therapy time is always limited and these positive patterns and postures need to be experienced for a greater percentage of time in order for neuroplastic changes to occur. This is why clinicians suggest that postural seating equipment can help, because it is there in the background providing correct support while the child is playing and learning.
Using research based equipment such as the Caps seat can offer your child the benefit of being held in a good, well supported sitting position which allows a controlled amount of positive movement patterns for greater periods of time. Postural equipment should be used in lying, standing and sitting positions in a planned approach every day for your child to get the greatest benefit.
Is the CAPS II Seating system safe for Transportation?
Travelling in a vehicle whilst seated in a wheelchair is normally safe if you follow basic safety guidelines. Whilst thousands of people are killed on the roads each year almost none of these deaths include people seated in wheelchairs.
The highest risk to most wheelchair users occurs whilst getting on or off the vehicle. The hazards of normal driving, cornering and heavy braking often present a greater hazard than those of a crash and should be considered accordingly.
Each new seating system and wheelchair should normally be assessed for use in a vehicle and you should be given information this by the person issuing the equipment.
If not please ensure you check with them as soon as possible.
The following key points should always be considered:
How is the seat secured?
Ensure that the seating system is fully secured onto the locking interface board, which secures it to the wheelchair. The red safety strap must also be securely fastened around the wheelchair push handles. If you are unclear about this stage please contact your local clinician, supplier or Active Design.
How is the wheelchair secured?
The wheelchair should be secured into the vehicle by the transport provider (bus driver). It should normally only be used forward facing and will normally be secured with a four point tie-down system (special webbing belts at each corner).
How is the occupant secured?
The transport provider should secure the user with an extra seat belt (similar to that used in a car).
Care should be taken with the placement of the lap strap to ensure it is placed so as to lie across the hips in a position where it will anchor the pelvis and not ride up into the abdomen. The shoulder strap should be positioned across the torso and over the shoulder, ensuring the strap neither cuts into the neck or slides off the shoulder.
Posture belts & harnesses should remain fastened.
Is there any further information?
If you want further information please download the guidance document LFT075.
"If I knew then what I know now"
CanChild has a range of resources and research available online. One that might be of an interest is a piece of research on parent’s reflections on raising a child with cerebral palsy.
Please click here to view the full article.