1. Seating and Positioning

2. Let’s talk about Safe walking first.

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

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

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

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

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

8. 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.

9. 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.

10. 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)

11. 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

12. What is Optimal Sitting Posture?

13. Pelvis Trunk Lower Extremities

14. Upper Extremities Head

15. 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

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

17. 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

18. Postural Evaluation Pelvis trunk

20. Postural Evaluation LEs

22. LE ROM Measures

23. Supine (mat) assessment- LE ROM

25. Postural Evaluation UEs Head

26. Head, Neck, Shoulder, UE

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

28. Measures for Mobility Device

29. What’s being measured?

30. 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

31. 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

32. 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

33. 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

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

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

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

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

38. Positioning Aids and Wheeled Mobility

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

40. Scooters

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

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

44. Specialty Frames– Later!

45. 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

46. Orientation ReclineTilt-in-space

47. Cushions Shape –Planar v. contoured Softness Cover

48. Backrests Back height Contour v planar How far anterior

49. Trunk Support Lateral SupportChest Strap/Harness

50. Direction of force of Lateral Supports

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

52. Planar or Contoured?

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

54. Lap Board

55. Footrests/Legrests Fixed v removable Elevating v non- elevating

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

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

58. Headrest

59. wheels Camber Material Push rims Wheel locks Camber

60. Specialty Devices