Vol. 8, No. 4 Fall 2000	Previous Issues Subscribe to AT Messenger Download PDF Viewer
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Positioning for Participation

Michael Meyreles, ATP and Nancy Chipman Ranalli, P.T., New Castle County ATRC

For a typically developing student, "positioning" in the classroom may mean sitting at a desk that is the correct size and the appropriate distance from the blackboard. For a student with special needs, positioning for participation in classroom activities can mean much more. This article highlights a few of the positioning products available to make a student's participation in the classroom more therapeutic and educational.

Standing Position

Standing is a very important activity for most students with special needs. The standing position allows weightbearing through the feet and legs, helps stretch tight muscles (from sitting in a wheelchair), encourages neck and trunk strengthening, and can aid digestion and circulation. There are many different types of standing devices. Supine (backlying) standers provide support from behind, while prone (stomachlying) standers provide support from the front. Both types of standers tend to have side (lateral) supports to help the student maintain a midline position and straps to control the student's trunk and pelvis. These standers are adjustable so that the student's position can range from nearly flat to fully upright. In addition, standers typically have trays, which allow various school activities, communication devices or toys to be placed within the student's reach. Additionally, these devices are usually on wheels, allowing the student to be moved around the classroom. This encourages more interaction with the environment and enhances the student's head control.

Free standers or standing boxes allow the student to stand in an upright position while providing support for the feet, knees, hips, pelvis and trunk to help maintain an upright, midline position. Unlike prone or supine standers, these types of standing devices require the student be able to tolerate a fully upright position. As with the prone and supine standers, standing boxes typically have a work surface for the student's classwork. In the classroom, a student could be standing for nearly any activity-story time, math activities or even music class.

Seated Position

Sitting devices are numerous. The most common type of sitting device is, of course, the wheelchair. Wheelchair positioning affects a person's ability to interact with peers, participate in classroom activities, and function independently. Additionally, since the wheelchair is most likely the device the student uses most often, proper positioning in the wheelchair can prevent skin breakdown and deformity.

In most cases, the wheelchair should be viewed as an "additional" positioning device, not the sole device.

Other sitting devices include posture chairs, corner chairs and bolster chairs. These devices provide support where needed, whether it be laterally (on the side), posteriorly (in the back) or anteriorly (in the front), by using pads, straps and supports. They allow the student to concentrate on school activities, rather than expending a great deal of energy trying to keep his/her head and trunk erect. The type of chair selected depends upon the student's particular needs and the goals of sitting.

Floor Positioning

Floor (or mat) positioning can also be appropriate for the classroom. Positioning a student on the floor in sidelying or stomachlying allows the student the opportunity to get weight off the buttocks, thus preventing pressure sores. Additionally, floor positioning promotes stretching of various muscles, such as the back and hip muscles, which may get tight from sitting in a wheelchair. Various foam pieces, including wedges, bolsters and half-rolls allow the student to be positioned safely. This position would be appropriate for art activities because a supported prone position can leave one or both hands available for drawing. A supported sidelying position may allow a student more freedom of movement of his/her arms which may enhance classroom participation.

A student with special needs does not need to remain in a wheelchair for all classroom activities. Various positions-and positioning devices-are appropriate for many students. Before trying any device, it is important to consult with a physical therapist (PT) or occupational therapist (OT) who is familiar with the student. Many factors need to be considered when using a positioning device, and the student's PT or OT can make recommendations. Once the device is set up, and appropriate instruction provided, the classroom teacher or aid should be able to position the student to make the most of his/her day at school.