Page 12 - Seating & Positioning Handbook, 2020

ATP Series
Positioning Priorities
can’t verbalize, you’ll know they’re not comfortable. Sometimes there’s a lot of grimacing. Sometimes there will be a lot of vocal- ization that tells you: ‘I’m not okay with that.’
“I prioritize function always, because I think that’s the most important piece of the puzzle. But you can’t do it at the cost
of comfort. If we don’t have the perfect fit for [a client] with
his scoliosis, but he’s more comfortable and he’s more likely to be functional, then we’re going to give a little on that postural support to give him that comfort and to give him that function. It’s tough. If you can’t get all of them at 100 percent — and it’s quite rare that you’re going to get everything at 100 percent for
very involved patients — I think it’s the balancing act of the three. As therapists and ATPs, we can be so fixated on posi- tioning and getting everything correct that we forget that piece, and then you have abandonment of that equipment. You might have to give up a little bit in those other areas to achieve that comfort.”
Chesney agreed. “It’s important to let them know: It’s okay if you don’t like things. There’s tons of options, and your feedback is what helps me pick different things to try. It’s not hurting my feelings; you’re the one that has to sit in this. You need to be comfortable and happy with what we’re picking.” m
Giving Clients & Caregivers the Room to Be Human
To understand why clients and caregivers don’t always follow through with the recommendations given by their Complex Rehab seating teams, be honest: Do you follow all the advice your dentist gives you during checkups?
Angie Kiger, M.Ed., CTRS, ATP/SMS,
is the Clinical Strategy & Education Manager for Sunrise Medical. She believes that as the seating team prioritizes clinical goals, they also need to know what clients and caregivers face every day.
“The importance of building rapport with the client: That to me dictates a lot on where you’re going to go and where your priorities are,” Kiger said. “Because custom complex rehab is shaped to the individual, as a clinician you’re trying to take measure- ments, you’re looking at the diagnosis, you’re looking at coding... and what’s going to truly make or break you is what happens in the real world with that client.
“It’s like when you go to the dentist and your dentist says, ‘Have you been flossing?’ And you say, ‘Absolutely, three times a day.’ But you don’t say for how many days. You can create the most ther- apeutic, most supportive seating system ever. But if your client doesn’t understand or buy into why they need to be seated and positioned properly, or their care- givers don’t understand, then what you’re doing is kind of futile.”
That disconnect can lead to equipment that isn’t used optimally.
Kiger said, “When you talk about seating functions — and you talk about tilt and recline in particular, which a lot
of people focus on for pressure relief to prevent or decrease the possibility of contractures or pressure injuries — you say, ‘We recommend this.’ But those specific functions are only as good as the person who actually does them.”
What Is the Reality?
So how can a clinical team learn about clients and caregivers well enough to build seating that will be used consistently?
“It’s not necessarily a standard form or data evaluation process,” Kiger said. “You have to really balance everything. I have
to find out: What is the reality? What is actually going to happen? I’d rather under- stand that and recommend equipment that they’re more likely to use.”
Here, Kiger added, is where seating decisions can get controversial. If you believe the “best” seating system is the one that’s consistently and correctly used, then the best system isn’t necessarily the most complex one. Sometimes, getting clients to consistently and correctly use a seating system requires compromise.
“I may not get 100 percent of what I personally believe to be the best solution for the client,” Kiger said. “However, I’d
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