Chapter 2: Introduction to Wheelchair Seating and Positioning 5 Contact Hours
By: Michelle L. Lange, OTR/L, ABDA, ATP/SMS Learning objectives After completing this course, the learner will be able to: Describe the steps in a seating assessment. Identify categories of seating systems. Describe the clinical considerations in selecting seating systems. Course overview This course, designed to provide the occupational and physical therapy practitioner with a broad overview of the assessment and provision of wheelchair seating, is written at a basic to intermediate level for the occupational or physical therapist who has little or no experience in this specialty practice area. Many people require the use of a wheelchair for dependent or independent mobility, and each wheelchair provides some form of seating. Wheelchair seating directly affects a client’s position, which in turn affects function for all of that person’s daily tasks. It is essential that occupational and physical therapy practitioners be able to competently participate as members of the interprofessional team in determining the optimal seating and wheeled mobility interventions for a particular client. Common diagnoses for a client using a wheelchair include cerebral palsy, spinal cord injury, traumatic brain injury, multiple sclerosis, and muscular dystrophies. This course systematically reviews wheelchair seating considerations, beginning with evaluation and assessment. A key part of seating assessment is the mat examination, which helps determine where and at what angles a client needs postural support for optimal alignment as well as pressure distribution and relief to prevent the development of pressure injuries. Body positioning is critical; the body should be positioned to support the task that needs to be accomplished. Sitting on the sofa watching TV could accommodate a position of relaxation, but sitting at a desk, signing a report, requires a position of stability to optimize writing. Clients often must find both a position of rest and a position suitable for functional or task performance within the same seating system. This makes the evaluation process all the more challenging. Factors that affect client posture, such as vision and tone management, are also discussed. A 24-hour approach to positioning, specifically sleep positioning, is explored because of the impact sustained postures have on range of motion and orthopedic alignment both within and out of a seating system. The course explores available seating system categories and materials as well as describes specific seating challenges, including causes, goals, and suggested interventions. Dynamic seating systems are reviewed as these provide movement of the seating system and/ or wheelchair frame. A review of wheelchair frame components is also provided. Seating for specific populations, including pediatric, bariatric, and geriatric clients, as well as clients with degenerative conditions is provided as seating needs vary by client population. Wheelchair seating and the wheelchair frame are interrelated. (Specific mobility considerations will be presented in a separate course.) This course also provides the practitioner with information regarding the effects of restraint regulations on the provision of appropriate seating interventions. Traditionally, occupational and physical therapy practitioners have been exposed to minimal instruction in wheelchair seating. However, the 2011 Accreditation Council for Occupational Therapy Education (ACOTE) Standards states that graduates from an ACOTE-accredited doctoral- degree-level occupational
Summarize common positioning challenges and strategies for seated mobility. Compare and contrast effective applications to maximize seated mobility.
therapy program must be able to “articulate principles of and be able to design, fabricate, apply, fit, and train in assistive technologies and devices (e.g., electronic aids to daily living, seating and positioning systems) used to enhance occupational performance and foster participation and well-being” (ACOTE, Section B.5.10). In 2018, ACOTE amended these standards, which will be effective as of July 31, 2020, to state that a graduate of a doctoral or master’s degree program should be able to “assess the need for and demonstrate the ability to design, fabricate, apply, fit, and train in assistive technologies and devices (e.g., electronic aids to daily living, seating and positioning systems) used to enhance occupational performance and foster participation and well-being” (ACOTE, 2018, p. 30). The Standards and Required Elements for Accreditation of Physical Therapist Education Programs as noted by the Commission on Accreditation in Physical Therapy Education (CAPTE) states that the physical therapist needs to “competently perform physical therapy interventions to achieve patient/ client goals and outcomes. Interventions include … Assistive Technology: Prescription, Application, and, as appropriate, Fabrication or Modification” (CAPTE PT Program Standards 7D27; CAPTE, last revised 12/7/17) and refers to the Guide to Physical Therapist Practice (American Physical Therapy Association, 2014). Because such instruction is usually limited, it fails to adequately prepare an occupational therapist or physical therapy practitioner for this specialty area of practice. Additional training is required. Because terminology used in discussing wheelchair seating and mobility may be unfamiliar to therapy practitioners who have not practiced in this specialty area, a glossary of terms is provided at the end of this course. Those new to this practice area are encouraged to review the glossary before beginning the course. According to a report from the United States Census Bureau, approximately 3.6 million people 15 years and older use a wheelchair in the United States (U.S. Census Bureau, 2010). Each of these people also requires a proper seating system. Many funding sources – such as Medicare, Medicaid, and private insurances – require that a clinician, such as an occupational or physical therapy practitioner, provides an evaluation of the client and a letter of medical necessity for financial approval of any wheelchair seating. It is imperative that an adequate number of clinicians specializing in this practice area are available to meet this demand. This course is designed to provide information, instruction, and resources for occupational therapists and physical therapy practitioners interested in increasing their skills and knowledge in this exciting and critical practice area. The reader should expect to gain practice-specific knowledge required to better participate as a member of a seating and wheeled mobility team.
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Book Code: PTNC1023
Page 18
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