Larger car seat meets Ellie’s postural and safety needs
Ellie has outgrown her current Australian standard car seat and needs a supportive car seat with built-in harness for trunk support
Ellie is a four-year-old girl with Miller-Dieker Syndrome (Chromosome 17 Deletion). She has a double cortex lissencephaly brain malformation and epilepsy. As a result, she presents with Global Developmental Delay and significant hypotonia (low muscle tone) and weakness.
Ellie lives in Perth, Western Australia.
Step 1: Assess
Ellie lives at home with her parents and eight year-old brother (who has a diagnosis of ADHD). Emma is an NDIS participant and her parents self-manage her plan.
Ellie has started to cruise on furniture, and uses a walker for mobility. She can maintain an upright sitting position in supported seating or a stroller. Emma is unable to climb up into the car and needs full physical assistance for transfers.
Currently Ellie uses an Australian standard car seat with built-in harness, but she has recently outgrown this restraint. She’s unable to sit in a booster seat due to her postural needs. She needs a supportive car seat with a five-point harness for trunk support.
After talking to Ellie’s mother, Sue, about Ellie’s prognosis, Bec (OT) learns that Ellie’s physical status could easily regress if her eplipetic seizure activity increases. The likelihood of this happening is unknown, and she could continue on the same path of improving her posture and mobility if she is well. This lack of clarity about her future needs impacts planning for Assistive Technology (AT).
The family lives on a busy main road with a steep driveway. Ellie is transferred in and out of the car on the steep slope and Sue notes that it’s difficult for her to do the transfer because of Ellie’s size.
Bec completes a Task Analysis of Sue transferring and positioning Ellie in and out the car with her current car seat.
The main family car is a Mitsubishi Challenger which doesn’t have ISOFIX.
Bec assesses that an improved vehicle restraint option for Ellie is very urgent as Ellie has outgrown her current car seat and is travelling unsafely.
Step 2: Plan
Bec identifies key selection criteria for a suitable vehicle restraint option for Ellie. This includes a swivel base to assist with transfers, a built-in harness for postural support and a footrest. In addition extra recline may be needed from time to time.
Selection of car seats
Bec considers whether a different Australian standard car seat may be suitable, as there are car seats that have a built-in harness suitable for children as they grow (up to approx. 10 years). Bec also reviews special purpose car seats with optional swivel base and footrest features. However Bec finds out that the swivel bases require the vehicle to have ISOFIX low anchorages, therefore this option is not suitable at this stage.
Trial of car seats
Bec selects one Australian standard and one special purpose car seat to trial.
The Australian standard car seat meets Ellie's postural needs due to the built-in harness, and slightly improves transfers due to the restraint’s armrests being able to pivot up.
The special purpose car seat provides adequate postural support and recline to maintain airway when sleeping, and allows for growth. Ellie’s mother finds the swivel base easy to use and helpful with transfers and the footrest improves Ellie's comfort.
Bec completes a Task Analysis of Sue transferring and positioning Ellie in and out the car with the two selected car seats - and reviews against her initial assessment.
Bec, in consultation with Sue, selects the Australian standard car seat as an immediate solution to improve transfers, with a focus on working on medium to longer-term options for the special purpose car seat.
Ellie's family are looking at purchasing a new vehicle in the next 12 months and will ensure they choose a car with ISOFIX low anchorages.
Parent education strategies
Bec identifies that both parents need training in manual handling when lifting Ellie in and out of the car, and positioning her in the car seat.
Step 3: Implement
Bec completes an Advice to Parent form and nominates a three month review period. No medical certificate is required as Ellie will be travelling in an Australian standard car seat.
Ellie’s parents apply for funding for the Australian standard car seat under NDIS Core Supports. Bec's report documents that:
- Ellie needs the Australian standard car seat because of her disability. If she didn't have her disability she would not require a new Australian standard car seat.
- It helps her to work towards the goals and objectives in her NDIS plan including ‘to be more independent and capable in my mobility to allow me to actively participate in my day across all environments’.
- It will help Ellie to travel safely with her family and participate socially.
- It is value for money as it’s a low-cost AT that meets Ellie's short term needs.
- The child restraint meets Australian standards.
Bec identifies that the restraint is available at a local mainstream store which provides a free car seat fitting service. The parents purchase the car seat from this store and get it fitted for free.
Bec arranges a follow up visit with the family to provide education on transferring Ellie in and out of the vehicle safely, and how to manage this on their steep driveway.
Bec discusses larger car options with ISOFIX low anchorages for the future use of a special purpose car seat. Bec also discusses the longer term plan which will involve wheelchair transport.
Step 4: Review
Bec meets with Ellie and her parents and they report Ellie is comfortable in the Australian standard car seat, however they do find transfers difficult at times. They also notice that when Ellie is tired a car seat with more recline would help.
The parents have started looking at vehicles and plan to purchase a new car in the next three to six months.
Bec updates the Advice to Parent form for three months and aims to commence preparing an application for the special purpose car seat at this time.
The Maxi Guard Pro was a good short term option for Ellie and her family.