Positioning Early & Often Counts

Bowing of the long bones is a frequent complication of Osteogenesis Imperfecta (OI). One of the most common bones to bow is the femur. This is due not only to the fragility of the bones but also to the normal mechanical stress that is put on the bones during normal muscle pull and sitting activities.

Some children with OI are of shorter stature than their typical counterparts. Some need seating devices. Many of the seating devices designed for infants and young children are too large for the average child with OI. These children often end up sitting with knees bent and rolled out (Ring Sitting). It is not uncommon to see a child sitting with feet crossed at the ankles and no weight distributed through the feet. Although this is a comfortable posture to assume while in an infant seat or a stroller, it does not encourage optimal biomechanical stresses across the legs.

Optimal sitting posture allows weight bearing through the pelvis with the knees in neutral rotation. Knees should be flexed at a 90 degree angle and feet should be supported to allow weight bearing. If a child is able to use the whole lower body to support himself in sitting, it is easier to work on head and trunk control.

The following pictures are an example of how to adapt a stroller for optimal alignment.

The first photo depicts a child sitting in his stroller. Note the position of his legs. He sits in a similar position on the floor and in his high chair. This posture facilitates femoral bowing.

The second photo shows how the stroller is easily adapted with upholstery foam. The seat depth is the distance from his buttocks to his knee. The seat height is the distance from his knee. The seat height is the distance from his knee to the bottom of his foot. The seat width is the distance from the outside of one thigh to the outside of the other thigh when legs are held comfortably close together. One can use an electric carving knife to contour the seat to the correct size and develop adequate thigh support along the outsides of the thighs.

The third photo demonstrates the outcome of sitting on a contoured foam support in the stroller. Notice how nicely the legs are positioned and how comfortable the child appears.

If you have further questions concerning positioning or would like to have a formal seating consultation for your child, please call the Therapeutic Services Department at (302) 651-6010. When scheduling, identify your child's diagnosis so that the most appropriate Occupational or Physical Therapist will see your child.