Posts Tagged ‘positioning’

A Balanced Look at Seating and Positioning

Wednesday, October 19th, 2011

Pride Mobility’s Julie Polin and Mike McCarthy discuss the needs of wheelchair users, emphasizing the need for a clear understanding of the need. Their article, reprinted here, first appeared in Mobility Magazine.

Providers and clinicians share the same ultimate goal of ensuring that a client’s needs are fully met in the most complete and efficient means possible.

When it comes to a client’s seating and positioning needs, it is necessary that all parties involved have a clear understanding of how this is best accomplished.

Understanding the Need

A complete wheelchair evaluation is necessary to address what an individual requires from his or her seating system, which may include cushions, backrests, headrests and trunk, arm and leg supports.

Only through a thorough seating evaluation can the client’s needs be understood. While the evaluation is the clinician’s key area of focus, providers, as product experts, should take an active role on the evaluation team.

A stable and comfortable position in an appropriate wheelchair is critical to the patient’s comfort, health, productivity and independence. Individualized seating and positioning systems can enhance breathing capacities, prevent skin breakdown, minimize pain and greatly improve overall functional abilities of an individual.

The factors that determine what seating components are going to work best for the client are numerous, but on a general level, are similar to those of other rehab equipment.

The patient’s level of injury, his or her capability, body type and activities of daily living must all be factored in, so this information should be gathered during the initial evaluation process

Know What Is Available

Seating requirements vary from a simple out-of-the-box solution to a highly complex, custom-built power positioning system.

Staying up to date on the latest equipment available and the reimbursement rules that govern its provision is a full-time job in itself. Providers must work diligently to educate themselves and their referral sources on the ever-growing number of seating solutions available.

Numerous educational opportunities can be found within the industry. By investing in education, providers can serve as a valuable resource to the clinician. Clinicians should therefore make time to meet with providers by scheduling in-services.

Providers are an excellent source of information on the options available to meet the client’s needs. Listen to what they have to say regarding the products they carry and why they are best suited to meeting your patient’s needs.

Providers should engage clinicians for feedback when reviewing the benefits of a product they would like to provide. Chances are the clinician has experience working with the product or a similar item and can offer an informed opinion.

Clinicians will also be able to estimate how many of their patients use the product, giving providers an idea of its demand and potential applications. Clinicians should remain realistic in their expectations. Understand the reimbursement and economic reality for each client. If you are recommending equipment that cannot be funded, then the patients’ needs are not going to be met.

Providers should create a system that takes the guesswork out of the reimbursement process. Develop an easy tool for your staff and referral sources to match International Statistical Classification of Diseases, Ninth Revision codes (ICD-9 codes) with the local coverage determinations (LCD) and match the demo equipment available to this tool.

When providers and clinicians work together to stay up to date, they are capable of giving the client access to the broadest range of equipment available.

Efficiency Is Essential

Patients and clinicians depend on providers to deliver seating solutions accurately and quickly. To stay competitive, providers must take steps to ensure that efficiency is a paramount part of their business operations.

To ensure efficiency, providers should evaluate their purchasing history and identify trends regarding the seating products they provide. A clear picture of the most commonly supplied products should emerge. Efficiency can be improved by purchasing your most popular products in quantity.

Providers should partner with a high-quality manufacturer that can provide many solutions to diminish the need to order from multiple vendors. Again, this can dramatically reduce overhead, reduce product lead time and shrink the margin of error.

Product reliability is an essential ingredient to ensuring the satisfaction of the patient, clinician and provider. Replacing or repairing a seating system leads to downtime for the patient, frustration for the clinician and quickly drives up provider costs.

If you select a manufacturer who produces and stands behind high-quality products, there will be fewer service calls.

Think Long-Term

Providers must work with clinicians to keep the patient’s future needs in mind. Will the back you provided easily integrate with the positioning components they may need in the future? A commitment should be made to carry products and parts your customers may eventually need or that will serve their changing needs.

Choose products that can be easily modified to prevent having to purchase additional items. Identify which products work best with the other equipment you are providing.

Compatibility is key. Offer cushions and other seating products that work with all of the chairs you provide. This keeps both patient and provider costs and down and makes future adjustment fast and easy. Ensure customizations are provided in a timely and cost-effective manner. It is important to consumers that their customizations are performed accurately and as quickly as possible.

Partner with a manufacturer that can quickly and reliably deliver custom seating sizes, and if necessary, can help fabricate unique components to reduce time and cost. Clinicians should educate providers on the progression of a client’s need. If a patient’s ability is likely to improve or decline, a plan that encompasses these changes should be discussed with the provider.

When providers and clinicians work closely together to meet seating and positioning needs, a great outcome is easily attainable. The needs and goals of each simply need to be understood and addressed.


Wednesday, October 19th, 2011

by Jeff McDaniel, ATP
Active American Mobility

Ideal wheelchair posture enforces neutral body alignment. The head is balanced over the spine, and the spine is balanced over the pelvis. The shoulders should align slightly behind the pelvis. Poor positioning causes skin irritation, loss of mobility, and breathing difficulties. A wheelchair evaluation team should perform a wheelchair evaluation for each individual’s unique ability and needs. A comfortable wheelchair position is vital for health and productivity. Along with providing mobility, a wheelchair should provide function, comfort, stability, safety, skin protection, and postural control. It goes without saying that matching the users needs to the best wheelchair is extremely important to meeting these goals. However, it is equally important to provide the accessories that work in conjunction with the wheelchair to provide the most positive outcome as possible. In order to achieve these goals, one aspect that must be considered is lower body/extremity positioning. Wheelchair users can profoundly affect the stability of their wheelchairs, a factor that should be considered in wheelchair design and in the process of wheelchair selection and training.

Pelvic Positioning
Many physical conditions cause an uneven pelvis, and a proper evaluation will identify the cause. Tight hamstrings and limited hip flexion causes posterior tendencies. Additionally, improper wheelchair seat depth, improper back angles, and improperly adjusted footrests can cause this tendency as well. An anteriorly tilted pelvis may result from loose hamstrings and weakened stomach muscles. A pelvic rotation and obliquity can result from uneven muscle tone, contractures, and a poor seating system. There are many types of solutions to correct and/or accommodate an uneven pelvis. One simple solution is a properly fitted and adjusted pelvic positioning belt. Both forward and backward pelvic tilt can be corrected to a certain extent with a properly positioned belt. Two point, four point, or harness belts assist positioning. For wheelchair users that present with hip extensor tone, sub-asis bars may need to be considered. Padded leg harnesses should be considered with active wheelchair users that require pelvic positioning as they allow for pelvic positioning without sacrificing pelvic mobility.

Lower Extremity
The ideal positioning of lower extremities should:
· Provide 25% loading of the legs at the feet
· Provide functional knee angle positioning within range of motion limitations
· Provide functional angle alignment within range of motion limitations
· Provide slight hip abduction within range of motion limitations

Hip adductors provide lateral support at the hips or knees. They come in numerous shapes and sizes but should not apply so much pressure that skin integrity would be compromised. It is extremely important to consider transfers when selecting hip/knee adductors; a side transfer will require removal of the pad while transferring. An abductor provides abduction of the hips and knees. These also come in various sizes and mounting options. An abductor mounts between the legs at the front of the wheelchair and again, transfers should be taken into consideration when selecting the hardware. Foot positioning must consider the range of motion at the knees. I personally feel that the footrests should be as close to 90 degrees whenever possible. This promotes stability and reach. A simple exercise is to place your feet under your chair and reach forward like you are grabbing something in front of you. Then try the same thing with your feet out in front of you. You should notice a great deal more of stability and reach when your feet are under you versus when they are in front of you. However, wheelchair configurations for adults often times to not allow for 90 degree legrests due to caster interference, so be sure and verify caster clearance when recommending this option. Angle adjustable footrests are also needed if there is an ankle range of motion limitation. Shoe holders can be attached to the footrests to restrict movement of the feet for individuals that either have no lower extremity movement or control. However, keep in mind that this option will restrict any functional movements the individual may have. Padded footboxes often times are a more effective alternative as they do allow for functional movement while providing a safe and protective foot support. Ankle huggers are also a good option, as they do not restrain the feet as much as a shoe holder. However, it is important to verify good skin integrity as they do cause sheering and pressure above the ankle.

To view these options, please see the following manufacturers. They all offer different types of options and accessories that may help wheelchair users “keep their feet on the ground” or their footplate at least.

To schedule an evaluation or consultation with Jeff please call 281-495-4400.