Seating and Positioning

Have you ever had to sit in a really uncomfortable position? Have you ever had to lean to one side for 2 1/2 hours just to see a movie screen past the really tall person in front of you? Do you ever feel like Goldie Locks when trying to find the perfect office chair? This one is too big. That one is too small. Then you find the one that is just right.

For people who spend significant time in a mobility device, finding the right seating and positioning products is more than just finding something to make them more comfortable. Finding the right product for the individual patient is vital.

"Any individual who requires a wheelchair or other mobility base or is required to sit for extended periods of time may benefit from a properly fitted and prescribed seat cushion," said Judy Rowley, product manager of seating, Invacare Corp., Elyria, Ohio.

There are two main reasons those confined to a seated position need a seating system. One is that seating systems are used for orthopedic reasons to prevent complications and enhance function, and the other is that they are used for wound care and prevention.

Yet no matter how big or small a problem seating systems fix, they are a great comfort to many confined to sitting.

An accurately fitted seating system promotes proper alignment of the body and enhances comfort. Many people in wheelchairs have conditions that not only prevent them from walking but also prevent them from sitting in an upright, natural position. Seating systems can help people with such physical disabilities to sit evenly, hold their shoulders in proper position, align their hips or correct other postural problems.

Seating systems also give support to help prevent future problems. Timing is important for fitting a seating system. The longer the patient sits in an incorrect position, the more potential damage is done.

"Early intervention with proper seating can reduce a client's risk of developing skeletal deformity or skin breakdown," Walsh said.

Many times a seating system can prevent weakened muscles and scoliosis, both of which are often caused by sitting improperly and are common conditions for people confined to a wheelchair. In addition to providing proper alignment, they also provide pressure relief. Cushions and positioning devices help reduce the risk for pressure ulcers forming on bony prominences such as the ischials and shoulder blades. They help protect other at-risk skin and tissue and help relieve and control abnormal tone patterns.

Seating Systems Variations

The types of seating and positioning products available are as numerous as the reasons patients need to use the products.

Seating systems can be as simple as a cushion and as complex as a completely customized seat and back replacement.

"The complexity of the system will vary depending on the client's level of involvement (with the disease)," said Elizabeth Walsh, OTR/ATP, education specialist, Sunrise Medical Inc., Longmont, Colo.

Some patients are able to use seating and positioning products right out of the box, but many need to have more customized positioning.

"There are clients who cannot be fitted appropriately with off-the-shelf seating and will require one off customization," Rowley said.

Chuck Nichols ART, CRTS, rehab technologist, Advanced Rehab Inc., Alpharetta, Ga., said that he has not had much luck with off-the-shelf positioning devices when dealing with children.

"Custom is the way to go," he said.

All seating systems require the advice of a physical therapist or occupational therapist, who work with the product supplier to measure the patient and decide on materials the patient needs to have included in the system, but customized seating must be made exact by the therapists.

After the measurements and materials are decided upon, the supplier sends the information to the manufacturer, who then makes the customized system.

Manufacturers are taking advantage of new technology to create customized positioning. For example, Invacare offers the clinician software to visualize and modify the three-dimensional shape of the cushion on the computer before sending the information in to be made. The result is custom-contoured cushions and exact support and positioning.

Because customized positioning takes time and money, the latest trend in seating and positioning is to customize an off-the-shelf product.

"Some manufacturers are trying to make it easier, so they are making a hybrid so the product is off the shelf but it can be customized," Nichols said.

Sharon Pratt, PT, product manager for Jay Products, Sunrise Medical, said that seating systems are adding modularity, the capability of customizing in the field and the ability to change with the clients changing needs.

More and more off-the-shelf seating systems offer the flexibility of adjustment to allow a proper fit to meet individual needs.

"Now it is more the system adjusting to the user versus the user adjusting to the system," Tom Borcherding, vice president of sales for Crown Therapeutics Inc., Belleville, Ill., said.

The trend seems to be moving towards off-the-shelf solutions that can be configured to the individual but also adjusted to accommodate growth or changes over time if necessary, Rowley said. Modular units allow for changes in posture and growth and can be replaced piece by piece to fit the needs of the patient.

"A well-designed seating system will offer many choices, as well as adjustability for potential growth or change, whenever possible," Rowley said. For example, Invacare offers the Infinity line of modular seating for flexibility and choices. The Infinity seats and backs are adjustable to fit the individual needs of the patient.

Some seating systems allow customization in the small things. Nichols said he has noticed that newer seating systems are more lightweight and have easier to operate, adjustable hardware. Adjustable hardware means easier fine-tuning for the clinician and a more exact fit for the patient. For example, Sunrise Medical offers the Jay Fit System, which is comprised of an adjustable contour seat and back to support the patient's pelvis and trunk. It is adjustable in the field by suppliers and clinicians, Walsh said.

Adjustability is important. It gives patients the freedom to choose what they like and dislike.

"We believe that a seating system must be flexible enough to not only meet the individual's clinical needs but also be tailored to their personal taste and lifestyle," Rowley said. "People need options and flexibility."

Supplier Education

Off-the-shelf customization requires seating and positioning suppliers to be very knowledgeable about how to properly fit a patient for a seating system. Product manufacturers often offer programs such as educational training, symposiums, seminars and clinical conferences to help in this effort.

Many suppliers of seating systems desire to become certified. The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) offers a credentialing examination in assistive technology for those suppliers who wish to become certified.

The RESNA credentialing program is designed to ensure consumer safeguards and to increase consumer satisfaction. According to RESNA, "credentialing provides practice-related knowledge based requirements against which members of the profession can be assessed."

The Assistive Technology Supplier Certificate (ATS) is awarded to service providers involved in the sale and service of commercially available devices who successfully complete the exam.

The National Registry of Rehabilitation Technology Suppliers (NRRTS) awards the credential of a Certified Rehabilitation Technology Supplier (CRTS) to NRRTS members in good standing who pass the ATS credentialing examination.

For people who are need seating and positioning, the right product is essential. By creating new methods to improve seating and positioning and by educating the supplier, the ultimate goal of creating a comfortable, supportive system for the patient can be achieved.

This article originally appeared in the March 2000 issue of HME Business.

About the Authors

James P. Brennan is a technology manager with Arch Chemicals Inc., Smyrna, Georgia. He has been working extensively with water chlorination chemistry for the past 30 years. He can be contacted at (423) 780-2007.

Jim Papac is the founder of Levo USA, Tyrone, Ga. and has 16 years in the wheelchair, seating and positioning field He can be contacted at (888) 538-6872.

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