Assessment of Competencies in Physical modality /Motor Control and

Seating, special furniture

Seating refers to all of the seats and their components that assist people to maintain a sitting
position. Specialized seats are designed to enhance the function of people with disabilities,
such as adapted chairs and wheelchair seats.

Positioning means placing and maintaining a person in sitting, sidelying, standing, prone or
other postural alignment. Standers, sidelyers and prone positioners are other types of
positioning devices used by people with disabilities. The goals of positioning are to improve
postural alignment and stability; to improve motor control; to prevent or minimize
contractures and deformities; to improve sensory and bodily functions; to improve attention
and arousal.

Motor control refers to the initiation and execution of movement. These seating and
positioning are designed to enhance to control the motor control of people with disabilities.

Augmentative and Alternative communication (AAC) assessment is a complex process,

that involves communicative, cognitive, linguistic, sensory and motor components. Children
and adults with physical disabilities require further assessment of their motor skills by
physical and occupational therapists who have experience evaluating individuals with
neuromotor disabilities. These team members are an integral part of the AAC assessment
process.

Individuals with more severe physical disabilities may use a wheelchair or other seating and
positioning system for all or part of their day. Seating and positioning directly affects the
ability to motorically access an AAC system, the ability to use the AAC system without
fatigue, the ability to see symbols and text on the AAC device, or a combination of motor and
sensory difficulties. Persons with severe speech impairments also frequently have problems
controlling their posture and extremities, which affect their ability to use augmentative and
alternative communication (AAC). Both aided and unaided AAC approaches require
sufficiently skilled movement of the hand, head, eye, or other body parts, which can be
difficult for persons with disorders such as cerebral palsy, amyotrophic lateral sclerosis
(ALS), traumatic brain injury (TBI) and many other conditions. One factor that can affect
motor performance is body position. Position may also influence other intrinsic and extrinsic
aspects of a person’s communication, such as cognitive performance, hearing, vision,
attention, arousal and opportunities for interaction.

The individual’s motor skills are crucial for the choice of communication system and
possible aids. Hand movements are assessed in order to determine whether or not the
individual is able to produce intelligible manual signs i.e. to vary hand shape, place and
manner of sign articulation in such a way that it is possible for a communication partner to
distinguish individual signs (Klima&Bellugi, 1979; Grove, 1990). It is clear that people with
obvious motor disabilities are unable to use manual signs, but others may also have difficulty
in performing manual signs. However, it is important to distinguish between difficulties in
producing manual signs as a result of motor disorders and problems in following an
instruction.

For individuals who use aided communication, assessment of motor function is aimed
at finding sitting positions and methods for pointing or activating keys and switches. People
with extensive motor disorders rely on a stable sitting position in order to use their motor
skills. It is therefore, important to find the sitting positions that best facilitate the use of
communication aids and other technical devices.

Successful use of assistive technology will be influenced by physical performance

capabilities (Beukelman&Mirenda, 1992; Demasco, 1994; Ratcliff, 1994). Motor skills
required for technology in and of themselves, are important because extensive motor
demands fatigue technology users. Additionally, when motor demands are high, cognitive
demands are also high. Goodness of fit has been achieved when a device minimally taxes the
motor system. Information regarding such motor demands however can frequently be
ascertained only after a period of device use, because consistency, speed, economy of motor
activity typically improves with device use (Treviranus, 1994).

For individuals who may not be able to follow verbal directions, motor skills
necessary for direct selection can be determined through play activities. The person’s hand,
arm, head, and eye gaze functions should be observed by the AAC assessment team during
the play. Tempting toys can be held out for child to reach for, visual tracking of colorful toys
can be observed and toys such as a van may be moved around to determine if the individual
can cross midline and see the range of motion available for direct selection tasks.

Small toys can be placed in arrays, and the child’s ability to reach and touch or look at
individual items can be determined. The number of items in the toy array can be increased or
decreased depending on the child’s abilities. In addition, the spacing and arrangement of the
toys can be adjusted. At the end of this process, the team should have a good sense of which
modality appears easiest for the child and the arrangement of the test materials and items
within that modality.

The older children and adults who can follow simple commands can be assessed more
quickly. The non-verbal child is asked to point to specific locations and items using hands,
eye gaze, head sticks or some other form of direct selection. The individual can be asked to
point to pictures on standardized test pages or point to other materials. The assessment begins
with a detailed case history and assessment of motor functioning.

The following order can be followed to obtain a complete profile of the individual which will
help the clinician to decide the type of intervention which has to be chosen for that particular
individual:

Seating and positioning evaluation procedure

 Improper position and seating can affect a person’s fatigue and comfort levels,
emotional state and ability to attend to a particular task. Therefore, it is the first step in
assessment and should involve optimizing the individuals’ positioning for further assessment
of motor, cognitive and language skills.

The evaluation needs to begin by assessing each client in a systematic and standardized way.

First, the individual is observed in the existing chair, the way he/she is positioned. Movement
patterns, stability, and comfort are observed as well as body alignment. Seat depth and
sideways stability also need to be assessed.

Second, the chair is examined. Seat, back angles and the type of seating system( eg:
contoured seat, back insert) are observed. Third, physical needs to be evaluated i.e the person
has any musculoskeletal deformities, pressure sore. These physical problem need to be taken
into account for recommendations for improved positioning. If physical problems are found,
referrals to orthopedic specialists are needed before making any change in the seating system.

Changes in positioning should always start at the pelvis. By securing the pelvis and creating a
stable base, the alignment of the upper and lower body automatically follows. The stable
components of seating (pelvis, thighs, and hips) are positioned first. The dynamic
components of seating are then evaluated beginning with trunk, then working distally to arms
and hands and finally the head and the neck.

Evaluating motor access

According to Beukelman and Mirenda,” the goal of the motor access assessment in
AAC is to discover motor capabilities, not to describe motor deficits”. The evaluation of
motor abilities starts with an assessment of direct selection capabilities by observing the
individual for certain duration to find the types of movements he or she makes during
communication or other routine activities. Interviews with the individual, his/her family
members, caretakers, and others, will also provide information about the individual’s
movement patterns and activities. For eg, some individuals may already point with their
hands or their eyes to indicate items of choice. Such information will be helpful in guiding
the management.

There are no comprehensive, standardized, norm-referenced motor access evaluations

available. Motor access evaluations are more often criterion referenced and have a direct
relationship with the specific AAC system features. Criterion referenced evaluations involve
yes/no decisions which help to narrow down the AAC options. For example, can the
individual point? This must be assessed for all body parts, including eye and head
movements. If the individual cannot point effectively, then AAC systems utilizing scanning
should be considered.

Formal assessments follow a specific set of guidelines. Lee and Thomas (1990)
devised a comprehensive clinical access assessment manual which provided step by step
procedures for a nine stage Control Assessment Protocol. The manual also included 14
sample assessment forms. Other formal assessments are software based such as the Switch
Assessment Program and the Text Entry Assessment Program.

Informal assessments provide general guidelines and follow a less structured protocol
(Beukelman&Mirenda, 1992; Goossens& Crain, 1986, 1992; Wright & Nomura, 1985).
Informal protocols also allow for flexibility in how the assessment is presented. Anson(1994)
devised a decision matrix called the Roadmap to Computer Access Technology as a tool to
help therapists make decision regarding access methods.

Goossens and Crain (1986) described an informal MSIP assessment method devised
by staff at the Hugh MacMillan Medical Center which includes four basic areas of motor
access assessment.
M = Movement pattern
S = Control site
I = Input method (originally referred to as interface)
P = Position
It was originally designed for evaluating single switch use. It can also be applied to
the evaluation of direct selection (eg: finger pointing, head pointing, and light pointing). Over
the years with some, adaptations of technology based motor assessment made the authors to
add a new component,

*T= Targeting.

Using the adapted MSIPT format, each of the components is examined as a part of the
access evaluation.This approach provides an outline of critical areas of motor access
assessment. It can be used to steer the assessment process without holding the evaluator to a
rigid protocol.

MSIPT assessment involves the systematic examination of the five major

components. Prior to beginning the actual MSIPT assessment it is important to describe the
position of the individual and any adaptations made to positioning. Changes to the
individual’s positioning will often affect the performance of different motor skills; therefore,
it is critical to describe carefully the seating and positioning used during each MSIPT
combination. Eg: if a child has slid forward and down in his/her wheel chair (creating a
posteriorly tilted pelvis), it will be more difficult for the individual to bring upper body
forward to reach thereby, compromising the assessment of direct selection.

With young children and adults with cognitive impairments, it is important to incorporate
motivating and meaningful activities during assessment. These activities however, should not
be cognitively loading for the child. The activity demand should be simple and well within
the individual’s cognitive, language and visual abilities.

It is important to obtain general information on the client’s motor skills. The first step in the
MSIPT assessment would begin with an objective assessment of upper extremity direct
selection to determine the exact range of point accuracy.
General guidelines: When evaluating movement, identify the individual’s best possible
movement patterns, consider the range of movement, the ease of movement, and the time it
takes to contact and release the method of input. Look for the movement that have good
reliability and accuracy and can be performed with least amount of effort without any
overflow movements. Speed of movement, unless very laborious movement is generally less
of a concern at the initial evaluation stage. The speed with which a person hits a switch or the
surface of an AAC device is often less critical than the speed with which they can release the
movement.

The elements of MSIPT assessment is given below in detail:

M: Evaluating Movement

This includes:

 Upper Extremity Movement Analysis

 Head Movement Analysis
 Lower Extremity Movement Analysis
 Abnormal Reflex Patterns
 Movement Assessment Specific to Direct Selection
 Movement Assessment Specific to Scanning

Upper Extremity Movement Analysis: The upper extremity movement (arms, hands,
fingers) and head movements are more commonly used for motor access. Upper extremity
and head movement are considered more natural methods of access and allow for greater
dexterity of movement as compared to lower extremity movement. More often, the AAC
consumer can see what he or she is doing motorically when using arm or head movement.

To begin with, physical or occupational therapist should examine the ease of shoulder, arm,
and hand movements for use with direct or indirect selection relative to the following specific
movement patterns:

 Forward shoulder flexion and extension

 Horizontal abduction and adduction of the arm.
 Internal and external rotation of the arm.
 Forearm flexion and extension.
 Forearm pronation and supination
 Wrist flexion and extension
 Finger and thumb extension and isolation of movement.

The most common form of direct selection using the upper extremities involves simple
finger pointing. For this, forward and horizontal shoulder movement is combined with the
ability to isolate an extended finger. For individuals with adequate shoulder movement, who
are not able to finger point, commercial manual pointing devices and customized splints may
assist with direct selection. For individuals with poorly controlled shoulder movements, but
who have the ability to control distal finger movement, mobile arm supports may be used for
direct selection.

Head Movement Analysis: In general, physical or occupational therapist will examine head
movement for use with direct selection or scanning relative to the following movement
patterns.

 Forward flexion and extension of the neck

 Lateral neck flexion
 Neck rotation

Common methods of motor access using head movement for direct selection includes the
use of head pointers, chinsticks, and mouth sticks. These movements generally require good
head control in a variety of movement planes. Light pointers and optical pointers require less
range of movement, but require more sustained, steady control. Low tech, non-electronic eye
gaze boards (eg: ETrans) do not require a great deal of head control, however high tech
computerized pointing systems (eg: Headmaster, Freewheel) require steady head movements
and have a high cognitive load. Common methods of accessing a switch using the head
include moving the head back or to the side to hit a switch. Less common but no less
effective movements involve forward head movement for chin or forehead activation.

Lower Extremity Movement Analysis: When head and upper extremity movements have
been ruled out, then lower extremity movements such as hip/knee movements
(adduction/abduction) or foot movements (plantar flexion/ dorsiflexion) can be assessed. It is
important to select lower extremity movements that do not exacerbate pelvic alignment
issues.

Abnormal Reflex Patterns

It is best to avoid movements that are dominated by abnormal reflex patterns. For
example, pointing that is dominated by an ATNR (asymmetric tonic neck reflex) is often
inaccurate and is best avoided. For individuals using head rotation to activate a switch, the
effect of ATNR pulls the child’s visual gaze away from the AAC device and interferes with
visual scanning. The STNR affects motor access because as the individual extends his or her
arms to point or activate a switch, the head and neck extend and the individual may lose
visual contact with the AAC device or symbol overlay.

Movements that cause a significant increase in abnormal tone should also be avoided.
For example, if the individual using neck extension (moving the head back) to activate a rear-
mounted head switch must rely on high amounts of total body extension (strengthening and
stiffening of the body), the alternate movements should be identified to diminish this.
Abnormal movement patterns, such as extensive internal rotation of the arm (ie; the arm
turned internally) and wrist deviation (i.e.; angled laterally), should also be avoided or again,
adaptations should be explored to minimize these abnormal patterns.

Movement Assessment Specific to Direct Selection

Direct selection is an “access method that allows the user to indicate choices directly
by pointing with a body part or technology aid to make a selection” (Church &Glennen,
1992). Movements that allow for direct selection are usually the first order priority for motor
access. Direct selection is generally faster than scanning. The hierarchy of direct selection
assessment is to focus first on the upper extremities, then the area of the head, face, and
mouth and the lower extremities.

Pointing with a finger, the most common and most acceptable form of direct
selection is usually fastest for communication. When upper extremity use is very limited
pointing with a head sticks, a mouth stick or a light or optical pointer is generally faster than
switch scanning. It may require too much head control which in turn results in fatigue in
some individuals and this must be considered during assessment. Cosmetic effects can also
occur in using such pointer which should not be ignored.

Direct selection methods fall into 3 categories:

1. Contact with physical pressure : Requires the individual to push on a membrane

surface, touch screen, or keyboard using a finger, pointer stick etc.
2. Contact without physical pressure: When individual points to a non-electronic picture
communication board with a finger, headpointer, mouthstick for pointing.
3. No contact pointing: Optical pointers and light pointers(Eye gaze).

Movement Assessment Specific to Scanning

Scanning is an access method that “involves intermediate selection steps between indicating
the choice and actually sending a keystroke or command” (Church &Glennen, 1992).
Scanning should be evaluated when direct selection movements are limited, too fatiguing, or
lack accuracy Scanning techniques refer to the methods by which an individual uses his or
her switch to select a communication symbol. It includes step scanning, directed scanning
and automated scanning.

According to Beukelman and Mirenda 1992. There are six components of switch
control and three techniques for scanning). The six components of electronic switch control
are waiting, activating, holding, releasing, waiting and reactivating. The individual must
first be able to wait for the appropriate moment to hit the switch for the requisite amount of
time, appropriately release the switch, and, as needed, continue the process by waiting and
then reactivating the switch. With each of these steps, problems can occur due to individual
inabilities. For example, a child may not be able to sustain the visual attention necessary to
wait, or may not be able to inhibit extraneous movement, resulting in accidental switch
activations. Activation and release abilities may demonstrate inconsistent accuracy due to
motor control problems. During a motor access evaluation to examine scanning skills, it is
important to look at all the 6 components to switch control.
S: Evaluating the control Site

The control site refers to the point of contact with the input device. Once the
individual is well-positioned, an inventory of voluntary and repeatable actions can be taken.
The generally accepted hierarchy of access sites is: hands and arms, followed by head, and
then feet and legs (Lee & Thomas, 1989). Hands and arms are considered first because they
are most practical body part for pointing, they allow a great deal of fine motor control if
unimpaired, and hand use tends to be more socially acceptable. An individual may be able to
control several fingers or only a single digit; stabilizers such as splints or hand held pointers
can be used. Head movement can be used to directly point to a target using mechanical or
electronic pointers, or it can be used to activate several switches.

Potential movement and control sites

A. Head control: forward/ backward and left/ right movement of the head
B. Chin control: forward/ backward and left/right movement of the chin, as with a chin
controlled joystick
C. Mouth/ Tongue/ Lip or Puff/ Sip control
D. Hand control: up/down and left/right hand movement
E. Arm/ Elbow control: movement of the elbow outwards or sliding the arm forward and
backward
F. Shoulder control: elevation/ depression or protraction/ retraction of the shoulder
G. Leg/ Knee control: inward/ outward movement of the knee
H. Foot control: left/ right and up/down movement of the foot

Once reliable movements and control sites have been identified, it should be paired
with various input methods
I: Evaluating Input Method

Input method refers to the equipment the individual will use to communicate. The
primary function of the input device is to accurately detect the control signals made by the
user. The input mode can be a standard key board, a Touch window, or an eye gaze board. It
can be a single switch or a joystick, or it can be combination of equipment, such as head
pointer with a standard key board, or a switch with a dynamic screen, voice output device.

.Information regarding movement contributes to the input method phase of evaluation.

Factors that must be considered during this part of the evaluation include: (a) the appropriate
type of input method relative to the individuals movement skills, and (b) the accuracy
associated with the combined movement and input method. Choices of input method depend
upon whether the individual is using direct selection or scanning.

a) Input Methods for direct selection: When the individual is using direct selection, input
methods are combined in logical ways. Hands, feet, and adapted pointers can be
combined with different types of key boards. Eye gaze is associated with transparent eye
gaze boards or frames. Sometimes switches are direct method of communication such as
AbleNet’s Bigmack or Enabling devices’s Talking Rocking Plate switch.

Computer based AAC systems often use arrow keys, the mouse, trackballs,
trackpads, and mouse emulators to control the cursor. A mouse requires more range of
motion than the other methods of input. Although a significant amount of fine motor
control is needed to operate these cursor control devices. While evaluating individual’s
ability to control cursor functions, the variables addressed are, the type of the device (eg.,
mouse, trackball, trackpad) and its position, the type of button mechanism, adjustments
for the speed at which he cursor moves (i.e., tracking speed), double click speed and the
visual size of the on-screen cursor. Targeting accuracy will depend on these variables.

INPUT METHODS INPUT DEVICES

Hand/ digit (s)/ Standard key board
Feet/ Toe (s) Assisted key board
Manual pointer Alternate keyboard Membrane
Chinstick Depressable
Headpointer Low tech communication boards
Mouthstick
Adapted splints
Eye gaze Eye gaze board ( ETRAN)
Eye gaze frame
Light pointer Eye gaze board
Optical pointer Low tech communication boards
Light activated keyboard
Sonar or infrared sensor to on-screen keyboard.
Mouse/ mouse emulator On-screen keyboard
Trackball, Trackpad Communication displays
Joystick, multiple directional switches
Switch Direct switch activation, e.g., voice output talking
switches
The simplest and most common input devices are mechanical micro switches or switch
arrays. These can be used when the control act involves a movement that causes some body
part to make contact with and move a switch surface. The body part making contact with the
switch and the degree of control of the action determines the switch size, shape, and contact
surface. Head contact would dictate a soft surface but does not require a large surface for
targeting. The strength and range of the movements and the presence or absence of
involuntary movements or tremors determines the resistance or force and travel required to
activate the switch.

The type of switch chosen during the evaluation will depend on such factors such as size,
force or pressure, feedback, amount of travel, weight, moisture, resistance, safety and
whether it is single, dual or multiple switches.

 Switch size depends on the body site or the degree of movement accuracy at the site.
 The amount of force or pressure requires to activate the switch will vary depending on
the type of switch.
 Feedback refers to the information that a switch gives back to the individual to
indicate whether the switch is on or off. It can be auditory in the form of
beeps/clicks/visual/tactile. The amount of travel refers to the distance to the point of
travel. (Goossens& Crain, 1992).
Different Types of switches

AbleNet Access Switches

 Eyeblink switch

The switch or switch array should be oriented and positioned to accommodate the
range and direction of the control act. The position of the switch must also balance the range
of movement required by the switch position with the number of involuntary actions detected
due to closer proximity of the switch to the resting position of the controlling limb.

b) Input Methods and Scanning: When an individual is using scanning, there are four
principal features that must be evaluated relative to scanning system. Those are Scanning
techniques, scanning patterns, switch types, and switch action. Scanning techniques
 include step scanning, automatic scanning, and directed or inverse scanning.
Scanning speed is another critical variable. Scanning speed is the amount of time it
takes for the cursor to move from one cell to the next. Most AAC devices have ways to
change the scanning speed. Scanning speed should not be set so high that accuracy is
compromised.

SCANNING SCANNING SWITCH TYPES SWITCH

TECHNIQUES PATTERNS ACTIONS
Step Linear Pressure Single

Automatic Circular Pneumatic Dual

(air sensitive)
Directed or inverse Group – item Motion Multiple
Row – column ( mercury,
Column- row infrared)Photosensitive
Block Physioelectric
(muscle tension)
Sound activated

Directed linear scanning

P: Evaluating the Position of the Input method

The optimal position for a switch or input device relative to the movement site is
within the individual’s range of motion. A direct access AAC device should be positioned on
the wheelchair tray more towards the side, rather than at the midline. Positioning of the input
device should not interfere with the AAC user’s routine daily activities. Using a sequential
trial and error approach, we should try different positions to determine the best arrangement
relative to motor skills, visual skills and input methods.

T: Evaluating Targeting Methods

Targeting refers to the ability of an individual to access a desired symbol using direct
selection or scanning. It typically requires a combination of visual and motor skills, though
for individuals relying on auditory plus motor skills. It also involves congition and memory.
Targeting accuracy is affected by the layout of symbols, symbol size, and spacing. When
using scanning, scanning patterns are key factors. Targeting assessment will help to
determine the maximum number of symbols, the minimum size of symbols, and the
minimum spacing between symbols that can be accessed with accuracy and reliability.

In MSIPT assessment, targeting is addressed during the evaluation of movement and

during the selection of appropriate input methods.

 Assessing Targeting with Direct Selection( using targeting grid).

 Assessing Targeting with Scanning.

Moreover, there are two related motor assessment concerns: identifying a motor
technique that the individual can use during the assessment process and identifying a
technique that the individual can use for alternative access in the long term. These two
concerns might result in the selection of the same motor technique for both the assessment
and for long term access. Also as in the case of assessment in seating and positioning, the
involvement of physical and/ or occupational therapists in the assessment of motor access is
critical for individuals with severe motor impairments.

SPECIAL FURNITURES

Active seating allows the individual to move, encouraging flexibility and

movement. Adaptive seating provides positioning support and allows the child better
interaction with their environment. Adaptive car seats and seatbelt guards provide safety and
support for special needs kids. Positioning rolls and wedges provide proper positioning for
eating, transportation and exercise. Adjustable tables, trays and easels accommodate many
seating systems and provide a stable learning environment.
ARTICLES:

1. Positioning for Head Control to Access an Augmentative

Communication Machine

Julie L. Bay
American Journal of Occupational Therapy, 1991

The purpose of this paper was to study the effect of therapeutic positioning on the functional
use of augmentative communication equipment. Recent literature on therapeutic positioning
as it affects muscle tone and functional activities is reviewed. The effect of positioning
intervention on rate and accuracy of head-controlled typing on an augmentative
communication machine was measured. The rate of typing was found to increase
significantly and the percentage of accuracy was found to decrease significantly with
positioning intervention. A third measure combining rate and accuracy (accuracy rate) also
increased enough to reach statistical significance. These results suggest that positioning
changes do affect head control in the functional use of a communication machine. Because of
the combined areas of expertise needed to adequately address positioning, head control,
communication, and overall function, a team approach to clients with these concerns is
advocated.

2. The Effect of Seated Positioning on Access to AAC For an

Adolescent with Cerebral Palsy

Hannah J. Young, B.S., Lauramarie Pope, M.A., Mari Therrien, Ph.D, Janice Light, Ph.D
Department of Communication Sciences and Disorders, The Pennsylvania State University

Introduction
Communication is fundamental to participation in all aspects of life. Children with cerebral
palsy (CP) may have difficulty speaking and require AAC . AAC access is the techniques an
individual uses to physically control his or her AAC system. Seated posture has long been
thought to influence an individual’s motor skills . Costigan and Light (2010) demonstrated
that the conventions of functional seating improve upper-extremity range and motion for
accessing AAC for children with CP

Objective
Investigate the effect of seated positioning on the accuracy (in both initiation and
termination) as well as the efficiency of access to AAC for an adolescent with athetoid CP

Method Design
•Single-subject, alternating treatments design
•Intervention 1- old seating position (OSP)
•Intervention 2- new seating position (NSP) following the conventions of functional
seated position

Participant
•14-year-old male with athetoid CP
•Frequent involuntary muscular movements

Procedures
Sessions held 1x/week for 1 hour.Participant completed 10 trials of target selection in both
NSP and OSP each session. During each trial: Researcher said “Trial X, go” Participant
attempted to select the target (jellybean switch) in order to activate an iPad to play personally
motivating music videos or movies. Sessions were video recorded and coded for all
dependent measures by the first author after each session.Twenty percent of trials coded for
reliability

Clinical Implications
Investigating an individual’s access is a critical part of an AAC assessment. When assessing
access, consideration should be placed on the individual’s ability to initiate the target
movement as well as his/her ability to terminate the movement.Individuals with complex
motor needs require an extended amount of time and multiple practice opportunities to learn
new motor responses under new conditions. Given the importance of seating and positioning,
it is critical to involve a multidisciplinary team including an occupational or physical
therapist in the provision of AAC services.

Future Directions
Additional research that investigates the effect of seated position on AAC access is needed to
ensure the generality of results.
Future research should…
•Incorporate participants with varied motor skills
•Incorporate other access methods
•Investigate the effect of seating and positioning on the functional use of AAC in a real-world
context
•Evaluate the use of, and outcomes associated with, multimodal technology
•Explore how selection accuracy and efficiency are impacted by the integration of multiple
technologies.

3. Analysis of Upper Extremity Movement in Four Sitting Positions: A

Comparison of Persons With and Without Cerebral Palsy

James J. McPherson, Richard Schild,

Sandi J. Spaulding, Paula Barsamian,
Carol Transon, Scott C. White

The American Journal of Occupational Therapy

1990

The purposes of this study were to compare the arm movements of persons with and without
cerebral palsy and to determine if the alteration of the seat angle of a chair affected the
quality of those movements. Twelve subjects-3 men and 3 women with spastic cerebral palsy
and 3 men and 3 women without any known anomalies that could affect arm movements-
were studied. The number of movement elements constituting a reach was used to measure
the quality of movements. The findings demonstrated Significant differences in the number
of movement elements used by the subjects with and without cerebral palsy regardless of
position. No significant differences could be attributed to the seating positions. Implications
are discussed in relation to the method used in the analysis of movements and the effect of
the findings for research and treatment.

4. Functional Seating for School-Age Children With Cerebral Palsy:

An Evidence-Based Tutorial
F. Aileen Costigan and Janice Light

LANGUAGE, SPEECH, AND HEARING SERVICES IN SCHOOLS

Vol. 42 • 223–236 •
April 2011

Purpose: This tutorial is designed to teach speech-language pathologists (SLPs) best practices
to support functional seating of children with cerebral palsy (CP) in the classroom and in
school-based therapy sessions. This tutorial teaches SLPs to (a) recognize the positive effects
of seating intervention, (b) identify the characteristics of functional seating that may produce
these positive effects, and (c) realize their role in supporting functional seating for school-age
children with CP.

Method: The research reporting positive effects of seating intervention for school-age
children with CP is presented according to the International Classification of Functioning,
Disability and Health (World Health Organization, 2001). Recommended guidelines for
functional seating for school age children with CP are gleaned from the research evidence.
The specific role of the SLP in providing functional seating for children with CP is then
discussed.
Conclusion: Seating intervention may produce positive body structure and function,
activities, and participation effects for school-age children with CP when appropriate
equipment is provided for weight bearing, the pelvis is positioned for stability and mobility,
and the body is properly aligned. SLPs can support functional seating for school-age children
with CP by communicating with professionals with seating expertise and by invoking and
monitoring recommended guidelines for children with basic and complex seating needs,
respectively.

References:

Beukelman,D.,Mirenda,P. (1998). Augmentative and alternative communication.2ndedn. Paul.

H. Brokes publishing.

Glennen, S. L., &DeCoste, D. C. (1997).Handbook of Augmentative and Alternative

Communication.Cengage Learning.

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