Equipment Needs Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009

Overview Seating Systems Mobility Equipment Optimal orientation in space Key seating angles Support surfaces Mobility Equipment What are we want to accomplish with our seating system

Developmental Factors Emergence of sitting – with neutral pelvis Mobility of the lumbar spine Development of postural control for trunk stability Upright active sitting posture Developmental Issues that Influence Seating system

Seating Assessment General Information Medical History Social History Daily Positioning Transportation Current Equipment Function Musculoskeletal Eval

Posture & Movement Assessment for Equipment Supine & Sitting Evaluation Posture Alignment : trunk and pelvis: pelvic tilt, obliquity, pelvic rotation, kyphosis, lordosis Alignment of LE: flexion, extension, adduction, abduction, internal rotation, and external rotation Movement In Supine In Sitting Transitions

Impact of Posture and Movement in Assessment for Equipment Current Equipment Positioning Transition Client and family satisfaction Use-ability Skilled – independent Requires some assistance Dependent

Seating Assessment Critical Areas Seating angles Seat to back angle Seat to calf rest angle Calf rest to footplate angle Optimal orientation in space Support surfaces Transition in and out of equipment Client and family expectations (goals) of equipment Motor planning abilities

Mat Assessment Pictures

Knee Extension in Sitting Pictures

Knee Range of Motion Supine Pictures

Pelvic Mobility in Sitting Pictures

Lower Extremity Movement Effect on Pelvis/Spine Knee extension and hip flexion can effect the pelvis and lower spine

Key Seating Angles General Considerations Support hips in maximum (optimal) flexion while allowing the pelvis and spine to remain in neutral alignment Support lower leg so the knees are in a comfortable degree of knee flexion with sufficient slack in the hamstrings while allowing neutral pelvic alignment Support ankle at the angle which allows for alignment of the ankle joint structures and supports the LE

Key Seating Angles Specific Considerations Seat to backrest angle Variables Seat to calf rest angle Calf rest to footrest angle

Optimal Orientation in Space General Objectives Influence degree of muscle readiness Maximize function in most upright position Maximize physiological functions Respiration Digestion Elimination Maximize postural alignment and control

Optimal Orientation in Space Specific Considerations Postural Control for function Alignment Optimal position to activate BOS Movement for function Comfort Endurance

Support Surfaces Surface of the seat, back, and positional components create the interface between the user and the seating system Properties of these surfaces directly impact the systems overall effectiveness

Support Surfaces Specific Properties Surface contact area Planar Simple Contour Generalized Contour Aggressive Contour Surface flexibility External support

Frame Styles Important to have Seating Specialist on team to determine frame style Frames have features that make the difference between independence and dependence

Frame Styles Stroller Manual wheelchair Recliner wheelchair Side folding frame Rigid frame Recliner wheelchair Tilt in space wheelchair Tilt and recline wheelchair

Power or Manual Control unit Environmental Interfaces Head Hand Foot Parental override Environmental Interfaces “Bells and Whistles” Power recline Power Tilt in space Elevate Stand

Frame Features Backposts Seat rails Footrest hanger styles Footplates Armrests Rear wheels Forks/caster blocks Headrest Mobility

Goals of Seating Optimize Function Maximize postural alignment Minimize postural supports Pressure relief Accommodate deformity Accommodate joint limitation Relieve pain/improve comfort Reduce influence of stiffness

Outcome of Seating Enhance function Encourage independence Free upper body for function Facilitate interactions Peer Environment

Successful Seating Includes Thorough assessment Precise problem solving Unique application of technology

Equipment Needs Margo Prim Haynes, PT, DPT, MA, PCS Mary Rose Franjoine, PT, DPT, MS, PCS 2009