Seating and Positioning

Let’s talk about Safe walking first.

Goals of Therapeutic Positioning Maintain biomechanical alignment Prevent deformity Comfort Pressure relief/distribution (skin integrity) Improve function Work in combination with other equipment (function)

How do people who are not disabled sit? Why can’t people who are disabled do the same?

Implications for people who are disabled Skin –pressure sore –shearing –abrasion Deformity –fixed –flexible Function

Pressure Ulcer Staging Pressure ulcer grading information from National Pressure Ulcer Advisory Panel (NPUAP), 1992

Stage I Nonblanchable erythema of intact skin. The heralding lesion of skin ulceration. Also- skin discoloration, warmth, edema, skin hardness

Stage II Partial thickness skin loss involving epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

Stage III: Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

Stage IV Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structures (for example, tendon or joint capsule)

Factors that increase likelihood of pressure sore development Incontinence Heat Moisture Nutrition Infection Friction Sitting tolerance Secondary diagnoses Cognitive abilities Clothing Age Time:Pressure Continuum

What is Optimal Sitting Posture?

Pelvis Trunk Lower Extremities

Upper Extremities Head

What is the Usual Process for getting Seating and Wheeled Mobility Equipment? Initiation into system Get Equipment OR Evaluation Equipment Trial/Simulation Prescription Receipt of Equipment Follow Through

The Process Initiation into system Get Equipment OR Evaluation Equipment Trial/Simulation Prescription Receipt of Equipment Follow Through

Seating and Positioning Evaluation Evaluate posture/function/etc in current system Determine repair v. replacement of parts Mat evaluation –Supine –Sitting Simulation and equipment trial

Postural Evaluation Pelvis trunk

Postural Evaluation LEs

LE ROM Measures

Supine (mat) assessment- LE ROM

Postural Evaluation UEs Head

Head, Neck, Shoulder, UE

Pelvis Trunk Shoulders Arms Head So… what do you see?

Measures for Mobility Device

What’s being measured?

In addition to physical assessment… Environmental assessment- what locations? What measures? Cognition- why? Social supports- why? Function –Able to use equipment –Able to perform functional tasks with mobility/seating equipment

In addition to physical assessment… Environmental assessment- what locations? What measures? Cognition- why? Social supports- why? Function –Able to use equipment –Able to perform functional tasks with mobility/seating equipment

In addition to physical assessment… Environmental assessment- what locations? What measures? Cognition- why? Social supports- why? Function –Able to use equipment –Able to perform functional tasks with mobility/seating equipment

In addition to physical assessment… Environmental assessment- what locations? What measures? Cognition- why? Social supports- why? Function –Able to use equipment –Able to perform functional tasks with mobility/seating equipment

The Process Initiation into system Get Equipment OR Evaluation Equipment Trial/Simulation Prescription Receipt of Equipment Follow Through

The Process Initiation into system Get Equipment OR Evaluation Equipment Trial/Simulation Prescription Receipt of Equipment Follow Through

The Process Initiation into system Get Equipment OR Evaluation Equipment Trial/Simulation Prescription Receipt of Equipment Follow Through

The Process Initiation into system Get Equipment OR Evaluation Equipment Trial/Simulation Prescription Receipt of Equipment Follow Through

Positioning Aids and Wheeled Mobility

Mobility Bases The first question? When do you choose powered mobility? When do you choose manual mobility?

Scooters

Powered Mobility Bases Conventional Powered Wheelchair –Drive Type Belt Direct Drive –Drive Location Front-wheel Rear-wheel mid-wheel

Manual Mobility Bases Industrial (Depot) Low-end- semi lightweight, barely adjustable Mid-range- lightweight, limited adjustment High-end- lightweight (or extremely lightweight), very adjustable

Specialty Frames– Later!

Positioning Aids Recommendations & Interventions A. Orientation 1.Recline 2.Tilt in Space B. Cushions C. Backrests D. Arm Rests E. Foot Rests F. Seat Belt G. Lap Board H. Trunk Support 1. Lateral Support 2. Chest Strap/Harness I. Head Rest J. Wheels 1. Camber 2. Material 3. Push Rims 4. Wheel Locks

Orientation ReclineTilt-in-space

Cushions Shape –Planar v. contoured Softness Cover

Backrests Back height Contour v planar How far anterior

Trunk Support Lateral SupportChest Strap/Harness

Direction of force of Lateral Supports

Planar or Contoured? What types of supports do you see?

Planar or Contoured?

Armrests Full v desk length Stationary v Adjustable height Fixed v moveable v removable

Lap Board

Footrests/Legrests Fixed v removable Elevating v non- elevating

Pelvic Positioning Support (aka Seat Belt) Types of Straps Direction of force

LE positioning Lateral support- –Hip Guides Medial support- –Abductor (pommel)

Headrest

wheels Camber Material Push rims Wheel locks Camber

Specialty Devices