Page 19 - Mobility Management, May 2019

harness styles to choose from with dynamic or static harnesses and chest supports to meet the user’s needs.”
And finally, he added, “Don’t forget the feet! Because of the weight of the legs, foot position has a huge influence on the position of the pelvis and, therefore, the trunk — if the feet are not stably supported at the proper height to evenly distribute pressure under the thighs and pelvis, the user will slip into a less functional position which is difficult to maintain.”
Creating All-Day Support
An eternal challenge when working with complex rehab clients is that they are always changing — as their conditions progress or as they naturally age, for sure, but also just as they tire during the day.
“A person in the morning can be totally different than what you see in the afternoon,” Sayre said. “Their core stability has probably been altered by what they’ve had to do throughout the day.”
Someone who doesn’t appear to need lateral support in the morning, Sayre explained, could need that support later in the day. The job of the engineers who design seating and mobility systems includes being able to offer core stability later in the day, but not saddling clients with unneeded equipment when they don’t need it, such as when they’re stronger in the mornings.
“Part of the challenges in designing and development is what
can we do to give that person alternative solutions?” Sayre said. “Do they really need laterals, or can we use a different kind of contour for the backrest? Can we contour it around them a little bit more so we can remove the laterals? They may not need that support in the morning, but in the afternoon, they will.”
Sayre pointed out that while core stability is certainly needed for activities such as self propelling or using a joystick effectively, it’s also important to other bodily functions.
“We talk about dynamic activity, but let’s talk about static inactivity,” she said. “Breathing, digestion, bowel movements, the vascular system. If that person has a little more core stability, they’re able to take a deeper breath. They can open up their diaphragm. Hopefully, there’s less chance of them ending up with pneumonia. Look at feeding and core stability: eating and being able to get a drink. If you have that seating system and you open up that chest cavity and you extend the spine and tighten that pelvis and stabilize it, that will help those bodily functions.”
A crucial reason to provide core stability is that for better or worse, the body will find a way to stabilize itself... and not all of those ways are clinically efficacious.
“The body is extremely intelligent,” Sayre said. “It’s just instinctive. I feel like every person we work with, we can make them or break them. People are very complicated. That’s why we call it complex rehab.” m
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