Page 6 - Seating & Positioning Handbook, 2020

ATP Series
Positioning Priorities
By Laurie Watanabe
WHEN SEATING MUST ACHIEVE SO MANY GOALS, HOW DO YOU CHOOSE WHAT’S MOST IMPORTANT?
There’s an urgency to Complex Rehab Technology (CRT), not just for wheelchair bases, but for seating systems and compo- nents — seat cushions and backs, laterals and armrests, even cushion covers. By definition, CRT is medically necessary, and seating — to provide pressure relief, to facilitate activities of daily living (ADLs), to position head and extremities for the best visual field, the best propulsion — must perform so many tasks.
But when everything is important, how does the seating team prioritize? CRT often requires compromise, because every addition to a wheelchair potentially takes away or restricts some other function. So which goals come first?
THE VALUE OF BALANCE & COMPROMISE
Heather Price, OTR, ATP/SMS, is Stealth Products’ Regional Manager, Central South.
“It is incredibly client specific,” she said of how she prioritizes goals during a seating assessment. “I focus on three factors that are
kind of broad. I’m going to focus on function, then posture, and then comfort.
“In my experience as a therapist, I’ve always prioritized func- tion. I’m an occupational therapist, so that’s really important to me. But we need to consider the other areas, so we have to balance posture and balance comfort.”
Price referenced a former client with a high-thoracic injury
in the T1 range: “He didn’t have full trunk control. He was very tall, probably 6'4" and 145 lbs. He had a non-reducible scoliosis, so we wanted to correct that. I was focusing on posture because we didn’t want to see further problems down the road. We did a custom mold for him, fit him beautifully. His posture was great.”
Six months later, the client was hospitalized with a pressure injury and returned to Price’s seating clinic. “It had nothing to
do with seating,” Price said of the pressure injury. “It was due to laying in bed all day. He said, ‘When I was in my chair, I had a hard time pushing because of the contour of those laterals.’ Not all
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