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Wheelchair Positioning and Breathing in Children with Cerebral Palsy: Study Methods and Lessons Learned


  • Lee Barks PhD ARNP,

    Nurse Investigator, Corresponding authorSearch for more papers by this author
    • Lee Barks, PhD ARNP, is a nurse investigator at the Tampa, FL, VA HSR&D/RR&D Center of Excellence.

  • Peggy Shaw BSOT OTR/L

    Occupational TherapistSearch for more papers by this author
    • Peggy Shaw, BSOT OTR/L, is an occupational therapist with extensive experience in wheelchair assessment and fitting and oral motor therapy with individuals with severe physicial disabilities.


In children with cerebral palsy (CP), poor trunk control can lead to spinal deformity, pulmonary compromise (Canet, Praud, & Bureau, 1998), and increased health risks and costs of long-term care (Braddock, 2002). Evidence links posture and pulmonary function, but the influence of wheelchair components on pulmonary function is unknown. This article reports on a study evaluating pulmonary measurement in wheelchairs and how it affected children with CP. The objectives of the study were to (a) describe recruitment and retention of school-aged children with CP and (b) discuss participants' response to the protocol. Using a wheelchair simulator, participants experienced five seating parameters while pulmonary mechanics measures were recorded. A process log captured participant recruitment and retention challenges and response to the protocol. Recruitment was challenging; retention was 50%. The protocol was feasible for 50% of participants, none of whom could participate in conventional pulmonary function testing. Among the study's participants, facemask and seating simulator acceptability were 75%, improving with participants' increased verbal communication abilities (verbal children tolerated the procedure best). The facemask was vulnerable to tilt; 75% of participants experienced fatigue.