The needs of power mobility patients are highly specialized, and their seating and cushioning needs are case in point. While there are some similarities between power mobility seating needs and those of other mobility patients, there are some key differences, as well, says Jill Kolczynski, product manager for Quantum Rehab.
“One of the main differences is that usually with power mobility, people have decreased strength in the torso or the upper extremities,” she says. “Generally, that’s what qualified them for a power mobility system to begin with.”
Power mobility patients might have more complex seating needs and require a more supportive seating system due to that upper-body weakness, Kolczynski explains.
It’s important to get the right seating solution for power mobility patients, because the wrong system could cause many problems. “You could cause contractures in areas where there’s not contractures, because the patient is constantly tensed up in that area,” she says. “You could cause pressure sores if you use the wrong materials and they are not immersed enough in their seating system.”
Cushion and Padding Considerations
When it comes to cushions, there are various options to address patients’ varying needs. They might need support, pressure relief or both. Cushions can also have different shapes to help increase support and pressure relief. The more they are immersed in the cushion, the more support they will have, Kolczynski explains.
Other features besides the cushion that are also often needed are pads to help support and provide positioning. These includes hip guides that are pads on the outside of the hips to provide support in that area, as well as pads that go on the outside of the thighs to help position the legs more closely together. This helps patients whose legs might otherwise splay because they have one muscle group that is stronger than the other, she explains. Conversely, patients might require an abductor, which is a pad that goes between the legs to relief pressure at the knees or other areas in cases when patients’ legs pull too closely together.
On the back end of things, there are laterals to provide side-to-side support to ensure that patients don’t lean too much to one side or the other. “You could respiratory issues, you could have access issues, and obviously if you’re leaning on one arm, then that leaves you with only one arm to use for your day-to-day activities,” Kolczynski explains. “So if you can support the torso, that leaves both arms free.”
Also, negating pressure sores is an important consideration. If the patient transfers in and out of the chair a great deal, that motion causes sheer, which can cause pressure sores. So the patient needs material that lets them slide more easily. Heat and moisture are other considerations to keep in mind.
Not surprisingly, there are various technologies akin to what is available in mattresses and support systems for other types of patients, but they have to mesh with other mobility patient concerns to be used, Kolczynski explains. For instance, there are power mobility seating options with alternating pressure, but adds they are rarely used because they might be at odds with other patient needs.
“A lot of the time that will raise your seat-to-floor height too high to be functional for the client,” she says. “If you can find another solution that is lower that lets them maintain function while relieving the pressure, then you wouldn’t go to something like alternating pressure.
“You can go to things like air, you can do gel, because those types of materials can provide immersion,” she continues, “and those materials offer softer support without going to something like alternating air.”
Assessing Needs
A key element to a provider’s ability to successfully serve a power mobility patient’s seating needs is having RESNA Assistive Technology Professional (ATP) credentialed staff involved in evaluations, Kolczynski says. “More and more, we’re seeing some of the funding agencies require this,” she adds. (Additionally, Quantum Rehab maintains its own certification program for it dealer network.)
Ensuring proper seating requires that everyone involved in the process must work together, Kolczynski explains. That team must work with the patients to help them explain their needs, desires and daily activities. The physician needs to provide medical input on the client’s past condition, current situation and anticipated needs. Usually an OT or PT will also be involved to check the range of motion and assess abilities. And the family’s involvement is important, because they might illuminate factors that the client might not bring up. Also, the family might have special needs that should be taken into account, such as transportability limitations.
“It’s important to consider each client individually, and see what their needs are,” she says. “Having all of those people involved and working as a team toward assessing needs and finding that final product is very important.”
