Wheelchair positioning and breathing in children with cerebral palsy: study methods and lessons learned.

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.