Best seating condition in children with spastic cerebral palsy: One type does not fit all.
A 15° forward seat tilt boosts reaching in kids with unilateral spastic CP yet impairs it in bilateral spastic CP—individualize seating prescriptions.
01Research in Context
What this study did
The team watched kids with spastic CP reach for toys while they changed the seat.
They tested one group with unilateral CP and one with bilateral CP.
Each child sat flat, tilted 15° forward, and tilted 15° back while cameras tracked every arm move.
What they found
Kids with unilateral CP reached farther and smoother when the seat tilted forward.
The same forward tilt made kids with bilateral CP reach worse.
Head position stayed the same no matter how the seat tilted.
How this fits with other research
Ju et al. (2010) also saw that small postural changes alter reaching in spastic diplegia.
Their work used reach direction; Mattana used seat angle. Both show tiny shifts matter.
O'Sullivan et al. (2018) tracked how bilateral CP gait worsens over time.
Together the papers warn that bilateral CP bodies fatigue fast, so a forward tilt may overload already weak trunk muscles.
Ohan et al. (2015) showed unilateral CP hands open late. Mattana shows giving those kids a forward tilt lets the hand travel farther, possibly buying time to shape the grasp.
Why it matters
Stop prescribing "one-size" tilt-in-space chairs. Check the CP type first.
If the child has unilateral spastic CP, try a 15° forward seat for tabletop work.
If the child has bilateral spastic CP, keep the seat flat or add trunk supports before any tilt.
Re-assess reaching each time you change the chair; the same angle can help or hurt.
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02At a glance
03Original abstract
BACKGROUND: The effect of forward-tilting of the seat surface and foot-support in children with spastic cerebral palsy (CP) is debated. AIM: To assess the effect of forward-tilting of the seat surface and foot-support in children with CP on kinematic head stability and reaching. METHODS: Nineteen children functioning at Gross Motor Function Classification System levels I-III participated [range 6-12y; ten unilateral spastic CP (US-CP) and nine bilateral spastic CP (BS-CP)]. Kinematic data were recorded of head sway and reaching with the dominant arm in four sitting conditions: a horizontal and a 15° forward (FW) tilted seat surface, each with and without foot-support. RESULTS: Seating condition did not affect head stability during reaching, but did affect kinematic reaching quality. The major reaching parameters, i.e., the proportion of reaches with one movement unit (MU) and the size of the transport MU, were not affected by foot-support. Forward-tilting had a positive effect on these parameters in children with US-CP, whereas the horizontal condition had this effect in children with BS-CP. IMPLICATIONS: A 15° forward-tilted seating and foot-support do not affect head stability. Reaching in children with US-CP profits from forward-tilting; in children with BS-CP forward-tilting worsens reaching - effects that are independent of foot-support.
Research in developmental disabilities, 2017 · doi:10.1016/j.ridd.2017.09.016