Page 7 - Seating & Positioning Handbook, 2020

the time, but he was an active guy, and sometimes [the laterals] would interfere with his propulsion. And they interfered with independent transfers. He also said he felt pitched forward, which we thought was angle placement of the backrest. We tried to modify it, and we still couldn’t solve that problem.”
The seating choice that worked better proved that less can be more: “We ended up trying an off-the-shelf back that had a little bit of contour, a lot less than what he had. So it didn’t fully correct that scoliosis, but it was night-and-day [improvement] in function.”
This example demonstrates a common seating conundrum. “It’s hard as a therapist,” Price said, “because that’s what we’re taught: Focus on posture, we want to fix everything. But functionally, if he’s not going out and living his life, what good is it? If he’s not using his chair, it’s kind of a waste. That’s where you have to have that balancing act. I’m still focused on [posture], but not at the cost of function. And I think that can be applied broadly to any goals we’re looking at. I think the other two goals take a back seat to our functional goals.”
PROTECTING THE SKIN
Alex Chesney, OTR, ATP, is the Clinical Sales Manager focusing on education for Quantum Rehab. Of her previous tenure at TIRR Memorial Hermann in Houston, Chesney said, “Occupational therapists actually do the seating and wheeled mobility, and the physical therapists do bathroom equipment. At TIRR, we had
the patients for 90 minutes a day, and we were required to do everything for them. We had to prioritize: ADLs, their wheel- chair, when are we ordering the wheelchair, family training,
technology. We were juggling it all, but it gave us a really good picture of how everything carried over because we were with them all day. So if I did switch anything on the seating system,
I would notice it in my session while working on cooking or dressing. It helps that you get the full picture of how what you’re picking actually impacts them in other skills.”
That insight carries over to Chesney’s current strategy about choosing seating and positioning components.
“What’s hard with seating and mobility in clinic,” she said, “is when you see somebody really quick, or you focus on the posi- tioning as far as [the client’s] body structure and what they look like and how they’re optimally positioned, we’re not always thinking about your transfer. What about caregivers? Does the client have anybody who can remove that lateral, do they have anybody that could help them get out of that deep contoured backrest?”
Given her tenure at TIRR, Chesney is always thinking about pressure injury risk. “Coming from that neurological background with spinal cord injury, they’re always at highest risk for pressure injuries,” she noted. “So that’s my bread and butter when I was looking at somebody for mobility equipment. You’re looking at their level of injury, their function, all those things. But a lot of times my first priority was ‘How am I going to protect your skin?’ From a positioning standpoint, it was ‘Do you have the strength to do a weight shift from a manual wheelchair?’”
Price took the client’s pressure injury history into consid- eration when prioritizing her goals: “If they come in and they already have a pressure injury, that’s something we’re definitely
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MOBILITY MANAGEMENT | SEATING & POSITIONING HANDBOOK 2021 7 9/15/20 10:08 AM