by Mike Duenas, ATP,
Active American Mobility and Medical Supply
Pressure ulcers (Decubitus) can be some of the most serious problems associated with clients using wheeled mobility for long periods of time. A seating system for many clients can be as basic as a foam back & seat. Some higher involved clients need to have a “Custom Molded” system to fit their actual body shape and size. This seating system if manufactured & produced properly can help many clients achieve the proper seating and posture they need while using their mobility equipment. This seating system will also help prevent the medical costs of hospitalization due to the possible development of a decubitus ulcer. Many clients that need this seating have no way to shift their body weight to allow pressure relief on any given area at a time. Pressure points can vary from person to person however; most areas are the in relation to the pelvis, spine, shoulders, back & head. Trying to eliminating or minimize the pressure (points) over these body surface areas is the goal. A custom molded system can provide the maximum amount of body surface support. The weight distribution helps prevents occurrences of decubiti. It will also increase comfort, and supports the client by distributing their weight over the broadest possible area.
When a Therapist and or ATP looks at providing a custom molded seating system for a client, they should be thinking of how having the clients upper body bear some of the overall body weight. Properly created and positioned trunk laterals & appropriately angled back supports will allow for a desired level of contact, support, and weight distribution. It’s really all about the best contouring & seating surface that can be made. A custom-molded seat may be produced in the same manner as the back cushion. In most cases you will create both the seat & back during the same evaluation. With today’s technology, a shape capturing system can make this process very easy and will help you create and make adjustments to the seating surface electronically at the same time, before you save the file. There are quite a few (manufactures) choices when deciding on custom molding. There are also a number of pros and cons associated with any of the molded systems that need to be considered.
“Pros” of creating and using a custom molded system are:
1. A properly molded seating system will increase comfort and postural support for your client.
2. Molded systems can help prevent decubiti “pressure wounds”.
3. Can help functional ability for the client’s body stability while reaching and or working with both upper and lower extremities.
4. Help prevent additional skeletal deformities while the client uses the system.
“Cons” of using a custom molded system are as follows:
1. Once molded, most systems, depending on the type of materials, are hard or next to impossible to make changes once they are produced.
2. Client is most likely set in a “Fixed” seat to back angle. Reclining type wheelchair frames do not work well because the molded seating & exact fit to client’s body shape.
3. If these molded seating systems are not done properly, it can actual cause more issues with pressure points against the client’s body and or other deformity issues can develop.
Manufacturers / Types
The quickest and easiest custom mold to fabricate is a “Mold-in-place” type mold. These types of systems require a seat and or back cushion that will allow you to remove and or install foam pieces into them first. The form pieces may be of several different types of density & thicknesses. Once you have created a very close fit with the form you can then insert a plastic bag that will serve as“Void” filler. You will take to chemicals that once mixed together will soon become a liquid foam that when poured into the plastic bag, it too will began to set-up and maintain its shape. You will need a very large and open area to produce this system and to help with the small amount if any, of extra product that will possibly fall to the floor. Basically once you pour the foam, you have to place the client on top of the cushion to allow the foam to set and capture their shape. Once it has set, cut any extra produce off and close the cushion cover. These systems are for both seat & back cushions however, they might only provide mild to moderate control for your clients. If your client is more heavily involved and needs more postural control, you might need the next system mentioned.
Another system uses molding bags that when a client is placed upon them and a vacuum removes all the air within, the client shape is captured. Think of two “bean bag” chairs you would sit on, both bags mold to your body form. Then while removing the air and shaping as you do, the bags become very firm. It’s basically a temporary mock-up mold of the intended seating system. Once the molding process is completed, a plaster cast (oldest method) or an electronic digitized file (newest meathod) is then sent to the manufacturing company. It in turn uses the plaster cast or digitized file to produce the finished foam seating system. This type of system allows for great freedom in design while providing good contouring. Also, the cover of this type of seating system is smooth, completely seam-free, and moisture-proof. This eliminates hot spots created by seams and other breaks in the seating system cover, and protects the integrity of the underlying foam. These same systems can also be created with air holes that allow liquids to move away from the clients skin. It also helps cooling and body temperature.
Whichever system you use, understand that you should have the proper training and certificates necessary to provide your clients with the best healthcare products and services they deserve.
Michael s. Duenas / ATP
Active American Mobility
13003 Murphy Rd, G1
Stafford, Texas 77477