Seating and Positioning Slide 2 Lets talk about Safe walking
first. Slide 3 Goals of Therapeutic Positioning Maintain
biomechanical alignment Prevent deformity Comfort Pressure
relief/distribution (skin integrity) Improve function Work in
combination with other equipment (function) Slide 4 How do people
who are not disabled sit? Why cant people who are disabled do the
same? Slide 5 Implications for people who are disabled Skin
pressure sore shearing abrasion Deformity fixed flexible Function
Slide 6 Pressure Ulcer Staging Pressure ulcer grading information
from National Pressure Ulcer Advisory Panel (NPUAP), 1992 Slide 7
Stage I Nonblanchable erythema of intact skin. The heralding lesion
of skin ulceration. Also- skin discoloration, warmth, edema, skin
hardness Slide 8 Stage II Partial thickness skin loss involving
epidermis and/or dermis. The ulcer is superficial and presents
clinically as an abrasion, blister, or shallow crater. Slide 9
Stage III: Full thickness skin loss involving damage or necrosis of
subcutaneous tissue that may extend down to, but not through
underlying fascia. The ulcer presents clinically as a deep crater
with or without undermining of adjacent tissue. Slide 10 Stage IV
Full thickness skin loss with extensive destruction, tissue
necrosis or damage to muscle, bone, or supporting structures (for
example, tendon or joint capsule) Slide 11 Factors that increase
likelihood of pressure sore development Incontinence Heat Moisture
Nutrition Infection Friction Sitting tolerance Secondary diagnoses
Cognitive abilities Clothing Age Time:Pressure Continuum Slide 12
What is Optimal Sitting Posture? Slide 13 Pelvis Trunk Lower
Extremities Slide 14 Upper Extremities Head Slide 15 What is the
Usual Process for getting Seating and Wheeled Mobility Equipment?
Initiation into system Get Equipment OR Evaluation Equipment
Trial/Simulation Prescription Receipt of Equipment Follow Through
Slide 16 The Process Initiation into system Get Equipment OR
Evaluation Equipment Trial/Simulation Prescription Receipt of
Equipment Follow Through Slide 17 Seating and Positioning
Evaluation Evaluate posture/function/etc in current system
Determine repair v. replacement of parts Mat evaluation Supine
Sitting Simulation and equipment trial Slide 18 Postural Evaluation
Pelvis trunk Slide 19 Slide 20 Postural Evaluation LEs Slide 21
Slide 22 LE ROM Measures Slide 23 Supine (mat) assessment- LE ROM
Slide 24 Slide 25 Postural Evaluation UEs Head Slide 26 Head, Neck,
Shoulder, UE Slide 27 Pelvis Trunk Shoulders Arms Head So what do
you see? Slide 28 Measures for Mobility Device Slide 29 Whats being
measured? Slide 30 In addition to physical assessment Environmental
assessment- what locations? What measures? Cognition- why? Social
supports- why? Function Able to use equipment Able to perform
functional tasks with mobility/seating equipment Slide 31 In
addition to physical assessment Environmental assessment- what
locations? What measures? Cognition- why? Social supports- why?
Function Able to use equipment Able to perform functional tasks
with mobility/seating equipment Slide 32 In addition to physical
assessment Environmental assessment- what locations? What measures?
Cognition- why? Social supports- why? Function Able to use
equipment Able to perform functional tasks with mobility/seating
equipment Slide 33 In addition to physical assessment Environmental
assessment- what locations? What measures? Cognition- why? Social
supports- why? Function Able to use equipment Able to perform
functional tasks with mobility/seating equipment Slide 34 The
Process Initiation into system Get Equipment OR Evaluation
Equipment Trial/Simulation Prescription Receipt of Equipment Follow
Through Slide 35 The Process Initiation into system Get Equipment
OR Evaluation Equipment Trial/Simulation Prescription Receipt of
Equipment Follow Through Slide 36 The Process Initiation into
system Get Equipment OR Evaluation Equipment Trial/Simulation
Prescription Receipt of Equipment Follow Through Slide 37 The
Process Initiation into system Get Equipment OR Evaluation
Equipment Trial/Simulation Prescription Receipt of Equipment Follow
Through Slide 38 Positioning Aids and Wheeled Mobility Slide 39
Mobility Bases The first question? When do you choose powered
mobility? When do you choose manual mobility? Slide 40 Scooters
Slide 41 Powered Mobility Bases Conventional Powered Wheelchair
Drive Type Belt Direct Drive Drive Location Front-wheel Rear-wheel
mid-wheel Slide 42 Manual Mobility Bases Industrial (Depot)
Low-end- semi lightweight, barely adjustable Mid-range-
lightweight, limited adjustment High-end- lightweight (or extremely
lightweight), very adjustable Slide 43 Slide 44 Specialty Frames
Later! Slide 45 Positioning Aids Recommendations &
Interventions A. Orientation 1.Recline 2.Tilt in Space B. Cushions
C. Backrests D. Arm Rests E. Foot Rests F. Seat Belt G. Lap Board
H. Trunk Support 1. Lateral Support 2. Chest Strap/Harness I. Head
Rest J. Wheels 1. Camber 2. Material 3. Push Rims 4. Wheel Locks
Slide 46 Orientation ReclineTilt-in-space Slide 47 Cushions Shape
Planar v. contoured Softness Cover Slide 48 Backrests Back height
Contour v planar How far anterior Slide 49 Trunk Support Lateral
SupportChest Strap/Harness Slide 50 Direction of force of Lateral
Supports Slide 51 Planar or Contoured? What types of supports do
you see? Slide 52 Planar or Contoured? Slide 53 Armrests Full v
desk length Stationary v Adjustable height Fixed v moveable v
removable Slide 54 Lap Board Slide 55 Footrests/Legrests Fixed v
removable Elevating v non- elevating Slide 56 Pelvic Positioning
Support (aka Seat Belt) Types of Straps Direction of force Slide 57
LE positioning Lateral support- Hip Guides Medial support- Abductor
(pommel) Slide 58 Headrest Slide 59 wheels Camber Material Push
rims Wheel locks Camber Slide 60 Specialty Devices Slide 61
