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Level of Sitting Scale (LSS)
Availability
Please visit this website for more information about the instrument: Level of Sitting Scale
The Level of Sitting Scale can be found in Chapter 6 of the Seated Postural Control Manual – Research Version manual and can be ordered from: Seated Postural Control Manual – Research Version.
Classification
Exploratory: Cerebral Palsy (CP)
Short Description of Instrument
Construct measured: Static sitting with or without postural support
Generic vs. disease specific: Generic
Means of administration: Examiner administered.
Intended respondent: Administrator.
Background: The Level of Sitting Scale (LSS) is a global index of a child’s sitting ability. The LSS, a modification of the Level of Sitting Ability Scale (LSAS) (Mulcahy et al., 1988) classifies the overall level of postural support needed for those who require seating assistance, or the amount of postural stability demonstrated in a sitting position for those who can sit independently. The LSS is an 8-point ordinal classification index (Level 1 to Level 8) designed to classify sitting ability and has been used in children with varying neuromuscular disorders.
Comments/Special Instructions
The LSS evaluates current performance while sitting on a bench. The child's hips and trunk should be flexed so that the trunk (defined by a line joining the first thoracic vertebra and the sacrum) is inclined at least 60 degress, and; the child's head  position is either neutral with repect to the trunk or flexed. The position must bemaintained for a minimun of 30 seconds to pass Levels 2 through 5. If the sitting position is independently maintained for 30 seconds, the child is then requested to shift his trunk and re-erect or is further encouraged to do so by being offered a toy to reach.
Scoring
It is comprised of an ordinal scale ranging from 1 (unable to sit for 30 seconds with one person assisting) to 8 (able to sit independently for 30 seconds and move in and out of base of support in four directions).
 
Administration Time: 5–10 minutes
Rationale/Justification
Strengths/Weaknesses: This has not been tested in a group of children with only cerebral palsy, so it is not clear if the psychometric properties are similar if only looking at children with CP across ages, functional level, and CP type. It is rapid to perform and does not require special equipment.
 
Psychometric Properties: When comparing means of scores of change in the LSS between groups of children with neuromotor disabilities who were expected to have a change in their postural control and those who were not, the LSS did not differentiate between these groups. Intraclass correlation coefficient was 0.996 when combaripng scoring of 2 separate scorers on the same day. Scores on the LSS have been shown to correlate with level of seating support, with lower scores indicating need for more supportive seating systems.
References
Field DA, Roxborough LA. Responsiveness of the Seated Postural Control Measure and the Level of Sitting Scale in children with neuromotor disorders. Disabil Rehabil Assist Technol. 2011;6(6):473–482.
 
Roxborough L. Seated Postural Control Measure Manual. Chapter 6: Administration and Scoring: Materials required for test administration and the standardized testing and scoring procedures Vancouver, BC: Sunny Hill Health Centre for Children; [cited 2016 11 July]. Available from: http://www.bcchildrens.ca/our-research/participate/sunny-hill-health-centre/seated-postural-control-measure.
 
Additional References:
 
Green EM, Mulcahy CM, Pountney TE. An investigation into the development of early postural control. Dev Med Child Neurol. 1995;37(5):437–448.
 
Field DA, Roxborough LA. Validation of the relation between the type and amount of seating support provided and Level of Sitting Scale (LSS) scores for children with neuromotor disorders. Dev Neurorehabil. 2012;15(3):202–208.
 
Field DA, Roxborough LA. Responsiveness of the Seated Postural Control Measure and the Level of Sitting Scale in children with neuromotor disorders. Disabil Rehabil Assist Technol. 2011;6(6):473–482.
 
Fife SE, Roxborough LA, Armstrong RW, Harris SR, Gregson JL, Field D. Development of a clinical measure of postural control for assessment of adaptive seating in children with neuromotor disabilities. Phys Ther. 1991;71(12):981–993.
 
Mulcahy CM, Pountney TE, Nelham RL. Adaptive seating for the motor handicapped: problems, a solution, assessment and prescription. Physiother. 1988;74:531–536
 
Pountney TE, Cheek L, Green ED, Mulcahy C, Nelham R. Content and criterioin validation of the Chialey Levels of Ability. Physiother. 1999;85:410–416.
 
Saether R, Helbostad JL, Riphagen, II, Vik T. Clinical tools to assess balance in children and adults with cerebral palsy: a systematic review. Dev Med Child Neurol. 2013;55(11):988–999.
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