the seating assessment process. The specific assessment steps may vary with the setting and team composition. Intake Assessments are more successful when the clinician has accurate and comprehensive client information. Much of this information can be gathered ahead of time to reduce the time of the assessment itself. A variety of forms are available to streamline this process. (See the Appendix for an example.) The client interview can both verify and complete any information obtained ahead of time. The interview may include other team members, including caregivers. Again, this process should always be family centered, including the client and caregivers in the decision- making process. The intake itself typically includes the following: ● Demographics. ● Medical information, including diagnoses, surgical history, pending surgeries, medications, height and weight, and any precautions. ● Client and caregiver goals. ● Home and vehicle accessibility. ● Vision and hearing status. ● Communication skills. ● Sensation. ● Pain. ● Skin integrity, including persistent redness and current or previous pressure injuries. ● Independence in occupations such as activities of daily living (ADL), instrumental activities of daily living, work, leisure, etc. Current wheelchair seating, if any, should be assessed and listed in the documentation, including the age of the seating system, all seating components, the client’s seated posture, how many hours a day the client is in the seating system, and – from the client’s perspective – what is working and not working with his or her wheelchair seating. The therapist should also document all other equipment, including the mobility base, equipment used in ADLs, and any other assistive technology. Wheelchair skills, including transfers, sitting balance, and level of mobility, should all be addressed in the documentation. Mat examination The mat examination is a critical component of a seating assessment (Minkel, 2018). This step is sometimes skipped due to lack of time and/or need for additional help with transfers and handling. For example, the assistance of another person may be needed to transfer the client on or off the mat or to help support the client in sitting on the edge of the mat. The mat examination is essential to determine the seat angles and support surfaces required by the client and should be completed in supine and sitting on the edge of the mat table. If the mat examination is not completed, the seating system may not meet the client’s needs, and time and money will be wasted in the long run. During the mat examination, the client is assessed both in supine and sitting on the edge of the mat table. The clinician should describe the client’s reflexes and muscle tone and the influence on body movements and posture and note any range-of-motion limitations. It is important to look for causes of limitations, not just symptoms. For example, if a posterior pelvic tilt is noted, the therapist should determine why this is present. It may be that the client’s hips do not flex to 90° or that his or her hamstrings are tight and pulling the pelvis posteriorly. Note where the client’s posture is “non-reducible” versus “reducible,” as the first posture will need compensation, and the second posture can be corrected within the available range of motion and comfort, while maintaining function. Starting the mat assessment in supine eliminates the influence of gravity and allows assessment of available range of motion, which affects the seated position. Starting with the pelvis, the clinician should assess whether a neutral pelvic position and symmetrical spinal alignment can be achieved. Next, the clinician should flex the client’s hips and knees (one leg at a time) slowly until the pelvis moves out of neutral (typically into
a posterior pelvic tilt). The point at which the pelvis is still in neutral determines the seat-to-back angle of the seating system. If the hips cannot be flexed to 90° without movement of the pelvis, then a seated angle of greater than 90° is indicated. Hip abduction, adduction, and internal and external rotation should also be assessed. Assessment of knee extension with the hip flexed to the available maximum range (popliteal angle) will determine the angle of the lower leg support (footrest hanger) to the seat. With the client sitting on the edge of the mat table, note the position of the head, neck and trunk control, influence of tone and reflexes, and how much support is required to maintain an upright and aligned seated position. The clinician determines what seat-to-back angle (or trunk-to-thigh angle) promotes an upright head (even if a head support is still required) and how much lateral and anterior trunk support will be required to facilitate a seated position. Activity idea: Using the form from the Appendix, conduct a mat examination on a colleague. Measurements Body dimensional measurements are often taken at this point, sometimes by or with the assistance of the complex rehabilitation technology supplier. A metal tape measure or calipers may be employed. Measurements taken in sitting include shoulder width, chest width, chest depth, hip width, distance between the knees, upper leg length, lower leg length, and foot length (Figure 1). Other measurements include the distance from the seat to the top of the head, occiput, top of shoulder, axilla, inferior angle of scapula, elbow, and iliac crest (Figure 2). Each of these measurements determines the final dimensions of the seating system itself (Minkel, 2018). Figure 1: Measurements Taken Seated on the Edge of the Mat Table, Anterior View
Note . From “Seating/Mobility Evaluation,” by the State of Illinois, Department of Healthcare and Family Services, n.d., retrieved from http://www.hfs.illinois.gov/assets/hfs3701h.pdf . Figure 2: Measurements Taken Seated on the Edge of the Mat Table, Lateral View
Note . From “Seating/Mobility Evaluation,” by the State of Illinois, Department of Healthcare and Family Services, n.d., retrieved from http://www.hfs.illinois.gov/assets/hfs3701h.pdf .
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Book Code: PTNC1023
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