Guidelines for Functional Use of the Rifton Advancement Chair

The Rifton Advancement Chair is a front-leaning chair for children with disabilities, used to teach them sitting. With optimum use, and gradual removal of the support prompts, the Advancement Chair can help a child develop improved sitting skills.

Children who are very dependent can gain strength and postural control for sitting, using the Rifton Advancement Chair. Caregivers can customize the supports for each child, and reduce, or gradually remove the prompts as the child’s motor skills improve. In the Advancement Chair, many children can achieve independent sitting; some even graduate to regular classroom chairs.

This article is presented as a series of topics:

Features:

• Chair Seat and Back and Chair Strap Options
• L-Bars and Arm Prompts
• Trunk Support and Anterior Support
• Head Rest
• Abductor and Leg Prompts
• Footboard and Sandals/Wedges
• Casters and Push Handle.

Further Information:

• Advancement Chair: Prompt Use & Reduction and Skill Building.
  

The Rifton Advancement Chair comes in three sizes: Small, Medium, and Large.

Figure 1	Figure 2

The Chair seat and back are contoured for optimal posture, and come with removable seat and back pads, for comfortable positioning.

The Advancement Chair backrest angle is adjustable, from 90° upright, to 15° of backward tilt. To obtain this, loosen both oval knobs behind the backrest, and move it to the desired angle, tightening the knobs again at the selected position (Figure 2).

The seat depth can be adjusted by loosening the two knobs under the seat and sliding the backrest forward or back. Tighten the knobs again when the backrest is in the desired position.

To adjust the seat height, turn the long handle under the seat. Each half turn moves the chair up or down a ½" increment (Figure 3).

Figure 3	Figure 4

The seat tilt is adjusted by turning the second handle under the seat, which is reached from the rear (Figure 4). This elevates or lowers the rear of the seat and the chair back. The pivot occurs at the front of the seat. Turning this handle can tilt the seat from 5° back, to 20° forward. Care must be taken that the child is positioned safely and not placed leaning too far forward. (For use of the forward-tilt feature, see section below: Advancement Chair Prompt Use & Reduction and Skill Building)

The seat has two chair strap options to assist with stabilizing the pelvis: the center-mounted strap, and the hip or pelvic strap.

The center-mounted strap consists of two separate straps with soft foam sleeves (Figure 5). These both attach to the center back (rear) of the Chair seat. The two straps are brought forward and both placed along the center of the seat, and the child sits on them, with the straps resting in reach between the child’s thighs. The straps are then separated and brought individually over the legs, each one placed snugly and comfortably around the thigh, and then secured laterally to the sockets on each side of the back (rear) of the Chair seat. This alternative to the more typical hip strap gives a very stable base for developing sitting postural control.

Figure 5	Figure 6

The more traditional hip or pelvic strap can be purchased and may be used in lieu of the Center-mounted strap. It attaches into narrow slots at the edge of the seat, and is secured over both thighs. There are three positions for the hip strap, for more anterior or more posterior options. To change the position of the hip strap, the clips that attach the strap to the seat must be disengaged. Reach under the seat to release each clip. Push the front half of the clip first, then the rear half (Figure 6). The clip will then come out. Insert it into the desired slot and push down firmly until you hear it click into place. Pull on the strap to check that it is secure.

The L-Bars and Arm Prompts are an essential component of the Rifton Advancement Chair. (For further explanation about the purpose and use of Arm Prompts while sitting, see section below: Advancement Chair Prompt Use & Reduction and Skill Building)

L-Bars provide an attachment and hinge mechanism for the Arm Prompts. Insert the metal tongue of the L-Bar into the rear slot in the seat and tighten the knob under the seat (Figure 7). Caregivers can use both right and left L-Bars with Arm Prompts simultaneously. Or, depending on the child’s current therapeutic goals and functional activity while in the Chair, one L-Bar and Arm Prompt may be used at a time.

Figure 7	Figure 8

When in use, the L-Bars should be swung forward and latched securely in place. When needed, the hinge can be opened by pressing the light blue latch – this enables the L-Bar to swing out of the way (Figure 8). This is ideal for easy access to the child. Should the caregiver wish to remove the L-Bar for easier transfer of the child into or out of the chair, simply loosen the knob under the seat and remove the hinge and L-Bar as one unit.

The right and left Arm Prompts are attached using the Clamp and Post (Figure 9). The Clamp can attach anywhere on the straight portions of the L-Bar. The Post slides into the Clamp and has optional positioning for rotation and height. The Arm Prompts mount onto the post and are very versatile, allowing you to achieve the best position for the particular child (Figure 10). See Arm Prompt Adjustability for a more detailed description of Arm Prompt positioning.

Figure 9	Figure 10

The Trunk Support consists of two lateral pads (Figure 11). These can be adjusted in width and angle by loosening the knobs at the back of the chair and moving the pads as needed, and then re-tightening the knobs. The height of the Trunk Support is adjusted by squeezing the blue triggers at the back of the chair and sliding the Trunk Support up or down along the two tracks at the rear of the backrest. The Trunk Support clicks into place at the desired height.

Figure 11

The Anterior Support is a wide padded strap that clips onto the Trunk Support brackets. This length adjustable strap gives support in front of the child at the height of the lateral pads. To remove it, simply lift the clips straight up.

The Head Rest is intended for safety or as a backstop for a child who may suddenly extend the head back while in functional sitting. There are two Head Rest options, Contoured, for slightly more lateral support, and Flat for posterior support only. The Head Rest fits in the same two tracks at the rear of the backrest as the Trunk Support. To insert the Head Rest or to adjust it up and down, squeeze the two latches with your fingers. When the Head Rest is at the desired height, release the latches and make sure it is securely in place (Figure 12).

Figure 12

The Abductor fits into the square socket underneath the seat at center front (Figure 13). Under the socket is a latch; pull this before inserting the Abductor, and then let the Abductor “click” into the desired position – closer to the seat, or out nearer the user’s knees.

The Leg Prompts are used alternatively to the Abductor (Figure 14) and fit into the same square socket as the Abductor, using the same latch. Place the two padded straps comfortably and securely on the child’s lower legs and adjust them to obtain the best position for the user, medially or laterally.

Figure 13	Figure 14

The Footboard comes assembled on the chair (Figure 15). The simple latching system for the Footboard allows the caregiver to adjust it forward or back, by clicking the latches up, and then down to lock in desired place. The footboard slides back under the chair if desired for transferring the user in or out of the chair.

Figure 15	Figure 16

The Sandals are used to position the user’s feet on the footboard. There is a sandal base that is placed in the desired position by loosening and tightening the knobs on the side of the base. The sandal attaches to the sandal base with a single latch (Figure 16). You also have the option to use Wedges to provide a dorsiflexion or plantarflexion angle for the foot position. The wedge is placed on the base, and the sandal secured on top. To accommodate leg length discrepancy, raise one sandal with two wedges stacked opposite, one on the other.

The Casters lock by pressing the locking lever on each Caster thus achieving complete stability of the Chair. When unlocked, Casters are excellent for maneuvering. The Push Handle comes with the Small chair and allows the caregiver to push it anywhere easily and comfortably.

The Advancement Chair: Prompt Use & Reduction and Skill Building

By using the Advancement Chair, children who are dependent can gain strength and postural control for more independent sitting. With the Advancement Chair, the caregiver can customize support for each child, and in time, reduce or remove the prompt support, thus facilitating the improvement of the child’s motor skills. The Advancement Chair teaches sitting. Children may achieve sufficient stability to graduate to regular classroom chairs. Besides improved sitting the forward-tilt capacity of the chair can improve a child’s sit-to-stand transfer ability.

There are two common sitting postures: leisure sitting and functional sitting. In leisure sitting, the person leans back against a back support that is angled backward, and arms are typically at rest. This position, referred to as the reclining position, is for resting, or for receiving information.

In functional sitting, the person is leaning slightly forward from the hips, and may use the shoulders and arms for activity and movement, such as eating or writing. When speaking, a person is also usually in the functional sitting position. This is referred to as the front-leaning or forward-leaning position (Figure 1).

Figure 1

The Advancement Chair can be used for functional sitting and for leisure sitting. It is intended to help a child learn how to sit in the functional position, and will place certain therapeutic demands on the child during training. A child may need to be given opportunity to rest with the chair in the leisure position, as well.

The Advancement Chair is unique in that it is designed to accommodate the supported front-leaning position. The Arm Prompts on the L-bar play a key role for this position. When a child with poor head or trunk control is placed into the Advancement Chair, be sure the Arm Prompts are placed in a position to allow partial weight-bearing through the upper extremities. Supporting a child in this position encourages active head control. Children with low tone of the upper trunk and neck gain strength and head control for independent sitting.

Many caregivers notice that the front-leaning position also stimulates breathing, coughing, and vocalizing. When a child, who is usually reclining, is placed into a forward-leaning position, there is a dramatic increase of drooling, coughing and clearing of the lungs. If this is the case it is recommended to start with short sessions in the front-leaning position, gradually increasing the time as the lungs clear.

Before beginning to work with a severely involved child in the forward-leaning position, make sure the child is able to tolerate at least 90° of hip and knee flexion. A very involved child may initially need all the prompts provided with the Advancement Chair:

• Head (posterior, or posterolateral support)
• Trunk (lateral, or anterolateral support)
• Arms (forearm weight-bearing)
• Pelvis (stabilized pelvis with pelvis/hip strap)
• Legs/Feet (leg abduction or adduction, leg/foot stabilization)

With all prompts in place, even a very involved child can practice lifting the head from a flexed position. The stabilization of the trunk and shoulder girdle with the arm prompts and trunk support, helps the child focus on extending the neck and head against gravity, building strength with practice.

The use of this chair and training with specific therapeutic goals, can occur in short sessions throughout the day. Configure the Advancement Chair for each child. Prompt use during practice sessions should challenge the user’s trunk control to develop postural stability. Remove the prompts as strength and stability improve. With the L-bars removed, the Arm Anchor from Rifton can be an alternative to the Arm Prompts (Figure 2).

Figure 2

A typical sequence of prompt removal, promoting the child’s development of independent sitting is as follows: (Figures 3 and 4)

• Remove the head support as the child gains independent head control.
• Loosen or lower the Chest Prompt as the child’s trunk control improves. As stability improves, the anterior strap may be removed, so the child sits with lateral support only. Eventually, the Chest Prompt may be removed leaving only the Arm Prompts.
• Remove Arm Prompts, leaving the Chest Prompt in place. These two supports can be alternated during the day, depending on the activity the child is doing and the need for active arm use. Either configuration will promote strength for more independent trunk control.
• Many children make significant gains in postural control and no longer need the Arm Prompts or the Chest Prompt to maintain a sitting position, as long as their pelvis and legs are stabilized.
• Next, remove the leg and foot stabilizing prompts. At first a child may still need something to prevent the feet from pulling back under the chair, (such as the posterior lip of the sandals without straps). The child learns to maintain sitting without their leg and foot position secured or stabilized.
• When this is accomplished, then lastly, remove the center-mounted strap.
• Eventually the child may progress to sitting on a regular chair without support for short periods of time.

Figure 3	Figure 4

The Advancement Chair’s unique design places a child in a functional sitting position. Prompts can be removed as strength and postural control are gained and more independent sitting is achieved.

Another therapeutic use of the Rifton Advancement Chair is the practice of sit-to-stand transfers, with the chair seat in the forward-tilt position (Figure 5). Weight-shifting from the buttocks to the legs can be done while the caregiver is holding the child’s hands, forearms, or shoulders, and is made easier by the 20° forward tilt of the chair seat. This may also be practiced independently by the child, while the forearms are in the Arm Prompts, and no other prompts are in use.

Figure 5

The versatility and adjustability of the Advancement Chair and its capacity for prompt reduction and removal, serves a wide variety of children with neurodevelopmental disabilities who improve motor skills while using this item. Caregivers and families will benefit by understanding the full possibilities of the Advancement Chair.

The Advancement Chair meets the criteria of the MOVE Curriculum, a function-based and child-centered approach to teaching life skills. More information about Mobility Opportunities Via Education is available at www.move-international.org.

NOTE: Portions of this article are based on material from The MOVE Curriculum by Linda Bidabe, and Children with Severe Disabilities and the MOVE Curriculum by Gilbert Thomson.

This article does not replace the direct personal advice of a medical professional.  Correct use of the Advancement Chair requires the prior approval and ongoing guidance of a qualified therapist.