Frugal innovation in adaptive seating for a child with cerebral palsy (Gross Motor Function Classification System...

Cerebral palsy (CP) classified as Gross Motor Function Classification System (GMFCS) Level V results in severe postural impairment and complete dependence on external support for upright sitting. In low- and middle-income countries such as South Africa, access to specialised adaptive seating devices within the public healthcare system is severely limited. Frugal innovation the adaptation of readily available, affordable resources to meet complex rehabilitation needs represents a promising strategy to address this gap.

We report the case of a 12-year-old male (pseudonym: Jessie) with a confirmed diagnosis of CP GMFCS Level V, born at 28 weeks gestation following antepartum haemorrhage. He presented with profound generalised hypotonia, absent independent trunk stability, poor head control, postural asymmetry in sitting, complete dependence on caregivers for all activities of daily living, and bilateral visual impairment. He had outgrown his transporter buggy (a caregiver-propelled basic pram-style mobility device) and was unable to maintain a safe upright sitting position in a standard basic folding frame wheelchair due to postural collapse. Baseline assessment using the validated Posture and Postural Ability Scale (PPAS) yielded a total score of 3/12 (frontal: 1/6; sagittal: 2/6). A commercially available car seat was selected based on systematic individual anthropometric and postural assessment. Low-cost modifications were applied using repurposed materials: a trunk control harness (repurposed buggy fabric), a seat belt extension, an abduction wedge (sponge foam), a polystyrene footrest, and a wheelchair attachment system (Velcro straps). A built-in four-position tilt-in-space feature was used to optimise hip flexion angle. The total material cost was negligible. Following the intervention, PPAS scores improved to 12/12 (frontal: 6/6; sagittal: 6/6), representing improved postural alignment as measured by PPAS across both planes.

A commercially available car seat, systematically modified using low-cost repurposed materials through a structured, physiotherapy-guided fitting process, achieved improved postural alignment as measured by PPAS in a child with GMFCS Level V CP. This case provides proof-of-concept that structured, physiotherapy-led modification of commercially available car seats can achieve significant postural correction in children with GMFCS Level V cerebral palsy in low-resource settings.