Page 8 - Seating & Positioning Handbook, 2020

ATP Series
Positioning Priorities
going to be focusing on. If their pressure injury or risk is resulting from poor posture, then we’re going to focus on that posture component, versus when I’m teaching somebody just about relieving pressure; I think that falls under function, where we’re trying to keep all the body systems healthy.”
Some of the most challenging situations are with clients that Chesney nicknamed “in-betweeners,” who might be candidates to self-propel an ultralightweight manual wheelchair, or might end up in a power chair. “Maybe they have upper-extremity func- tion, and you’re thinking, ‘If they got a little stronger, I can see that within a year, they could be a full-time manual wheelchair user. But right now, they’re pretty weak, so maybe power is going to help them more functionally.”
THE PRESSURE RELIEF HIERARCHY
For these clients, Chesney said she liked to try an ultralight- weight manual wheelchair: ‘Can you do a weight shift? The rec- ommended requirement right now in the SCI [spinal cord injury] literature is every 30 minutes for two minutes. Doing that depres- sion weight shift, where they have to push up on their armrests or wheels and get clear of their buttocks, that’s extreme. You have to be a very strong para to do that.”
If the client couldn’t manage a traditional push-up, Chesney tried alternatives: “Can they pull up to a surface, if they have lim- ited trunk control? The surface has to be lower: Could they pull up to a chair, could they pull up to a therapy mat, and could they lean over, go to their left side and go to their right side, and clear
Positioning Priorities: An ATP Supplier’s Perspective
Mobility Management asked Brian Perkowski, CRTS, ATP, Branch Manager of National Seating & Mobility’s Wall Township, N.J., office, how he prioritizes the many different positioning needs a Complex Rehab seating and wheeled mobility client can have.
Q: How do you determine what functions the seating system needs to achieve? Do you start with a list of functions that all wheelchair users need, then add more specific needs (e.g., head positioning) according to each specific client?
Brian Perkowski: It’s extremely important to listen to the client and caregiver for direction as to what functions their seating
system will require. Understanding their goals is critical for a successful outcome. Incorporating their goals, therapist and physician recommendations, and supplier knowledge of product ensures the end user has a comprehensive seating system that provides support, is aesthetically appealing, and most importantly, meets their functional needs.
Q: All positioning goals, from preventing pressure injuries to supporting transfers, seem vital. But building a seating system is often give and take. How do you prioritize? BP: Prioritizing goals is no easy task, but again, listening to the client often provides clues as to what is most important to them. Professionally educating the client through the use of demo or trial equipment, histor- ical experience and the use of technology via pressure mapping or 3D scanning may help to guide a client towards making a decision that the entire complex rehab team is comfortable with for the seating system.
New wheelchair users and their care- givers, regardless of age or functional and cognitive ability, tend to refer back to the therapist or ATP to assist in deciding on proper seating systems, as their under- standing of their needs and products
is new and developing. However, more experienced end users will often come to the evaluation with an idea, and some- times a very specific idea, of what it is they are looking for in their seating system.
My experience has shown that changing a cushion for someone that has used a
particular style or brand with good results for five to 10 years is often not a good idea. The Complex Rehab seating teams that I work with always provide education on new products so that all options are on the table.
Q: Can you think of situations in which other circumstances impact your prior- itization? For example, if you’re seating
a young child, cognitive, social and emotional development are crucial.
BP: Considering social and developmental goals for all clients, especially in pediatrics,
is very important. Designing a piece of equipment that meets functional needs and provides the ability to be the most barri- er-free primary means of mobility for a young child can be the difference between full inclusion at recess or sitting off to the side.
Another point to consider would be what I call “customer buy-in.” If the customer doesn’t like the product, for
any reason, they are less likely to use it. It seems like common sense, but sometimes we might try to recommend a product that the client is just not fully on board with yet.
In our professional minds, we justify
the end result, but non-use is a failure
to all. This carries over to the caregiver, especially with clients who are dependent. A home environment that is not set up
for an appropriate, but very large, heavy, and bulky piece of equipment can result in non-use and actually create a situation where the client is in bed more often
than in their seating system, resulting in contractures or other medical issues. m
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