Treva's rehab team designed an orthotic solution to provide anterior support for her severely involved trunk.

he combination of severe scoliosis and abnormal muscle tone can present a ,& real seating dilemma for the rehab team. When the client’s need for function, good visual acuity and social interaction are factored in, the seating options become even more limited. Usually, the seating prescription for someone with severe scoliosis and abnormal muscle tone involves custom carving or molding a seat and back and tilting the person in space. However, this poses a problem when the priority is to keep the person upright and functional. A case in point is Treva, a 17-year-old with left hemiplegia and myelodysplasia at the T8 level. She has a severe, collapsing scoliosis with a pelvic obliquity and a tendency to pull to the left. She also has fixed knee extension and plantar flexion contractures, along with a history of chronic skin breakdown. Treva’s physician referred her to physical therapy at the Millet Learning Center in Saginaw, Mich., for a seating evaluation in September 1991. She has been a student at the Center since 1979, and seating has been an ongoing challenge for her. In early childhood, a team of professionals Treva has the