Page 6 - Seating & Positioning Handbook, 2021-2022

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Words Matter: Educating Consumers on Restraints vs. Supports
Wheelchair users and their family members can balk
at hip belts, butterfly harnesses and other positioning components... in part because they see such devices as restraints, like car seatbelts designed to prevent move- ment. Parents object to “tying down” their child to the wheelchair, and wheelchair users can worry that such supports make them look more disabled than they feel.
Tina Roesler, PT, MS, ABDA, Director of Clinical and Business Development at Bodypoint, said a RESNA resource may be able to help to educate consumers.
Explaining the Differences
“There’s a great position paper from RESNA that really explains the differences between postural supports and restraints,” Roesler noted. “If you think about postural supports as limiting or stopping unwanted movements, that definition actually matches the OSHA [Occupational
Safety & Health Administration] and the HIPAA guides for restraint. It’s the definition of one.
“But when you justify
and discuss it in relation
to it being a positioning
device that helps limit
one motion to help
facilitate functional
activity — that’s the
key. I don’t think we
always do a good job of
explaining why I would
want someone who’s a
paraplegic to wear a pelvic positioning belt; they think of it as a seatbelt or a restraint. But explain what it can do: Maybe they’re working at a job where they have to do
a lot of reaching. And if they have this pelvic positioning belt on, perhaps they can reach that much further without having to reposition. It makes things easier for them in that environment.”
Promoting Functional Movement
In fact, the RESNA Position on the Application of Wheelchairs, Seating Systems, and Secondary Supports for Positioning vs. Restraint makes that distinction.
“There are numerous regulations and policies that define a restraint and subsequently either require or limit the use of these devices in healthcare and long term care settings,” the paper says. “In wheelchair seating systems, assistive technology practitioners often use postural support devices (PSD) such as pads or straps to limit or control a specific movement of the body. In this way, postural support devices may be perceived as restraints.
“However, PSDs are typically much more complex, and their major role is to provide support to increase function rather than to restrain and limit functional movement. For example, an anterior pelvic support (e.g., pelvic belt or subASIS bar) is used to limit a specific movement of the pelvis or buttocks — typically migration forward on the seat. The static position of the pelvis supports the function of the upper extremities and trunk for improved reach and propulsion of the wheelchair.”
To access the paper, go to resna.org, and click on Resources in the navigation bar. m
Bodypoint’s Evoflex can move out of the way when not in use — appealing for clients concerned about the optics of supports.
6 SEATING & POSITIONING HANDBOOK 2021-22 | MOBILITY MANAGEMENT MobilityMgmt.com