FRISCO, TEXAS — A student requires postural wheelchair supports for comfort and to keep airways open. These can include head supports, pelvic positioning belts, postural harnesses and torso alignment supports. But how does a student transporter ensure that student is safe in the school bus?
The question took on more gravity following the death of a 13-year-old girl with cerebral palsy in Polk County, Florida earlier this month, after she suffered a “silent seizure” in her wheelchair on the school bus.
A panel of experts convened at the TSD Conference on Monday to discuss the importance of teamwork in meeting student needs for proper support and positioning during transportation. Like with the student’s IEP, decisions rely on feedback from students and their families, physical and occupational therapists, doctors, nurses, bus drivers and aides, teachers, vendors, medial suppliers, equipment manufacturers, child passenger safety technicians and even insurance companies.
“You try to do too much,” Sue Shutrump, supervisor of occupational and physical therapy for Trumbull County ESC in Ohio told attendees. “You’re used to people giving you huge challenges and just making it work.”
Instead she recommended transporters point out issues to therapists to brainstorm solutions and offer input when new chairs are ordered, or chair modifications are made. Interdisciplinary training can be planned on the use, fit and safety precautions surrounding wheelchair accessories and components.
The panel also pointed to the RERC on Wheelchair Transportation Safety, which offers guidelines for using secondary postural support devices by wheelchair users in a transportation environment.
A survey of the audience only showed that about a half dozen of approximately 80 attendees indicated they or a member of the transportation department currently are invited to the IEP meeting to influence these discussions. The panel then explained the various postural supports and why they can be challenging in a transportation setting.
Chris Yarber, regional sales manager for wheelchair securement manufacturer and trainer Q’Straint, pointed out that often the pelvic positioning belt is confused with the crash-tested WC-18 lap belt. The pelvic belt is not crash tested, and its materials, fasteners and attachment points are not strong enough to be used without the WTORS lap belt.
Shutrump, who is also a TSD Tenured Faculty member, said postural harnesses also cannot be used alone. That’s because fasteners and attachment points are not strong enough or crash tested and proven to provide occupant protection in a crash. If not used without the pelvic support belt, the student can submarine under the belt—or the harness can ride up and choke the student.
Head supports are also not crash tested and transportation can’t be denied if they are not available. Panelist Danielle Morris, an outpatient physical therapist for Our Lady of the Lake Regional Medical Center in Baton Rouge, Louisiana, added that transporters should check with physicians, as some head supports, such as the Hensinger collar, are not safe for transportation.
“Why are you adding this collar in the first place? You want to select the softest and lightest collar that will meet the medical need,” explained Miriam Manary, senior engineering research associate with the University of Michigan Transportation Research Institute and a TSD national advisor. “With the stiff ring around your neck, the head comes forward. If the chin strikes something stiff, you get a high force along the spine.”
When head rests are used, Shutump said they should be positioned close to the back of the head, be no more than two inches from the rear of the head, the middle of the headrest be aligned with the top of the student’s ears. Also, it cannot allow the head to fall behind or around the headrest, which can restrict natural forward head and neck movement.
Morris said she advises the removal and securement of lap trays from the wheelchair before the student enters the bus, because the equipment can become projectiles in the event of a crash. Shutrump added that the trays must be secured to a stationary object on the bus that is at least five times the weight of the tray.
And if a student requires the lap tray due to circulatory problems, she said a foam tray should be fastened to the chair with Velcro.
If a student requires a pommel or thigh/leg supports during transport, Shutrump said they should not be relied on to prevent sliding forward in their wheelchair.
The panel also discussed the proper use of child safety restraints.