Conclusion Wheelchair seating can appear fairly straightforward from a distance. As clinicians explore this subject in more depth, however, it becomes clear that wheelchair seating can be quite complex, with significant medical and functional ramifications for the client. It is imperative that all occupational and physical therapy practitioners are able, at a minimum, to determine if a client is seated optimally. Optimal seating matches the client’s body dimensions and shape, matches required body angles, provides adequate postural support and stability, distributes pressure, and optimizes function. If a client has complex seating needs that cannot be adequately met by an individual clinician, scope of service requires referral to experts in this area of practice. This course systematically delved into seating and positioning. Assessment, particularly the mat exam, is critical in determining the required support surfaces and angles of support for an individual client. Clinical considerations that affect seating interventions were also addressed. Any client who sits in a wheelchair is at risk of pressure injury development, and a combination of pressure distribution and pressure relief is required to mitigate this risk. Vision and posture are interrelated, and the seated posture must respect visual requirements. Sometimes visual intervention is required to correct issues that negatively affect posture, such as midline shifts. Tone management can reduce muscle tone in specific areas of the body or in the body as a whole. Thus, tone management can change postural support requirements, and those requirements may fluctuate with ongoing tone management intervention. Clients with degenerative conditions will also present with changing functional abilities and an increasing need for postural support over time. Therapists working in the practice area of wheelchair seating must keep these clinical considerations in Glossary ● Accommodate : Make an adjustment for a specific purpose. ● Amyotrophic lateral sclerosis : A nervous system disease that weakens muscles and impacts physical function. ● Asymmetrical tonic neck reflex : A reflex that is activated as a result of turning the head to one side. As the head is turned, the arm and leg on the same side will extend, while the opposite limbs bend. The reflex should be inhibited by 6 months of age in the waking state. ● Asymmetry : Lack of symmetry or balance. ● Athetosis : Writhing motions caused by abnormal contractions of the muscles. ● Back canes : Support the back rest and provide handles for a wheelchair to be pushed. ● Cellulitis : A bacterial infection of the skin and the tissue under the skin. ● Cerebral palsy : A congenital disorder of movement, muscle tone, or posture. ● Dystonia : Involuntary muscle contractions resulting in repetitive motions and abnormal postures. ● Friction : The force resisting the relative motion of solid surfaces, fluid layers, and material elements sliding against each other. ● Hemiparesis : Weakness on one side of the body. kyphosis: An exaggerated rounding of the back. lipoma: A fatty tumor. ● Lordosis : A condition in which the spine in the lower back has an excessive extended curvature. Resources Assessment Wheelchair and Seating Evaluation Jill Sparacio, Jessica Pedersen, Mike Babinec (2007, 2014, 2016, 2018) http://www.nrrts.org/Education/Wheeled%20Mobility%20 and%20Seating%20Evaluation%20fillable.pdf
mind when making equipment recommendations. Body shape is affected by more than the wheelchair seating system, however. Many clients spend less than half of each 24-hour day in their wheelchair. Other postures must be evaluated, particularly the position in which the client sleeps. If the client is positioned in destructive postures outside of the wheelchair, orthopedic changes may result that will eventually require changes to the wheelchair seating system. Once the assessment has been completed and clinical considerations examined, the therapist must begin to match the product to client parameters. This course addressed specific categories of seating systems, followed by seating interventions designed to address individual seating challenges by area of the body. Some seating systems and components move in response to client movement to diffuse extensor tone, provide movement, and protect the client and equipment. This is called “dynamic seating.” Seating interventions vary by population. This course presented specific seating considerations for pediatric, bariatric, and geriatric populations. The use of restraints is a common concern in dealing with the geriatric population, particularly in long-term care settings. This concern, along with relevant regulations and documentation, was also addressed. This practice area may seem overwhelming to the learner who has read through all of these issues and complexities. However, providing optimal seating for a client can also be very rewarding, as proper positioning optimizes function and supports medical needs. As therapists, we are uniquely qualified to consider the many benefits to providing a stable and well-supported upright posture. ● Lymphedema : A buildup of fluid caused by damage to or destruction of lymph nodes. ● Multiple sclerosis : A disease in which the immune system destroys the protective covering of nerves. ● Muscular dystrophy : A group of diseases that cause progressive weakness and loss of muscle. ● Non-reducible : No movement at a joint. ● Obliquity : Deviation from the horizontal or vertical, or the angle created by such a deviation. ● Pannus : In the case of an obese client, a pannus may hang from the abdominal area over the groin and between the legs. ● Reducible : Available movement at a joint. ● Scoliosis : A lateral curvature of the spine. ● Seat rails : Horizontal components of the wheelchair frame that provide the structure for the seat. ● Seating and positioning : Often used interchangeably. Positioning is the practice of determining an optimal body position and supporting it in a static or dynamic way. Seating refers to the actual system used to maintain the identified body position. ● Shear : When surfaces laterally shift in relation to each other. ● Spinal muscular atrophy : A genetic disorder that affects the control of muscle movement.
Postural Care Posture 24/7 https://posture24-7.org/ Pressure National Pressure Injury Advisory Panel https://npiap.com/
EliteLearning.com/Physical-Therapy
Book Code: PTNC1023
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