Seating and Mounting for Optimum Function
By Emma Emmerich
One of the challenges of working in South Africa, is that there isn’t always a multi-disciplinary team on hand to address an individual’s needs. Often a professional must work in isolation, with a large case load, solving a range of issues. This frequently involves the seating and positioning of the person.
During my 17 years as an Occupational Therapist, I have worked in many settings and completed many post-graduate courses. Although these courses differed in content and approach, certain principles threaded through many of them – one of these was seating and positioning for function.
As you are probably aware, people with motor impairments often spend long periods of time seated in a wheelchair. Supporting a correct seating posture is critical to ensure the individual’s safety, and to prevent secondary complications like pressure sores or joint contractures, whilst trying to facilitate optimal function. For people with a communication disability, it is also important to consider positioning and seating to ensure effective access to an AAC device.
As an OT trained in Neurodevelopmental Therapy, I often assist in determining what an individual’s seating/positioning needs are. Positioning must take into account the actual position of the person in their chair/wheelchair/bed, as well as positioning of any devices used by the individual. I also consider all the possible positions an individual might want to spend time in throughout their day, so that they can have access to their communication device at all times.
In general, I like to consider the six principles as suggested by Beukelman and Mirenda(2005) to guide my assessment and intervention:
- Using myself as a reference: people without motor impairments automatically position themselves for safety, comfort and function. Is the same being achieved for the person?
- Ensure a stable base of support: often individuals with motor impairments need external support by way of straps, belts, harnesses, lap trays and splints. Are these safely and comfortably positioned, in a way that is acceptable to the user?
- Decrease the influence of atypical muscle tone: provide support for individuals with low muscle tone, and avoid eliciting reflex patterns from individuals with increased muscle tone. Has guidance been sought on these patterns?
- Accommodate fixed deformities and correct flexible deformities – aim for symmetry and stability. What is known about the person’s body and the way it can move, and what is comfortable?
- Provide the least amount of intervention to gain greatest level of function: the person should be able to move and not be completely restricted by external supports.
- Provide opportunities for resting: individuals should be able to rest safely when not using their communication device, or not in their wheelchair.
Once both the individual and I are happy with the seating, I need to consider the positioning of the communication aid/device. Its position depends on the access method employed by the user. The position of the device can sometimes even aid in supporting the user’s posture e.g. for a person with poor head control, positioning the device higher than eye level and tilting the chair, provides a good, comfortable, supported head position.
Sometimes an individual’s diagnosis can guide the positioning of AAC access methods e.g. people with Athetoid CP often struggle to control arm movements in midline, and might be more accurate to the side. Another example would be a person with hemiplegia, where positioning the communication device or access method to the functional side will support function.
Another aspect to consider relates to the individual’s visual needs. If a person uses their peripheral vision to look at objects, they might prefer to have their communication device mounted to the side. Observing what the individual does to accommodate for his/her specific visual needs should guide me and the team in supporting the positioning of the individual. A neuro-optometrist who specialises in the complex vision of people with a neurological impairment can be a valuable source of information.
People using eye tracking to control their computer have very specific mounting needs, as positioning is critical for the eye tracker to effectively track the user’s eye movements. I can’t help but think of a particular young woman who, when seated in her wheelchair could access her eye tracking system successfully. At home, however, the family preferred her to sit on the sofa when in the lounge, instead of in her wheelchair. As a result, her mounting system (the same one that worked so beautifully whilst seated in her wheelchair) was completely unsuitable when in the lounge, and an alternative mount was required in that situation.
There are so many mounting options available, and if you’re overwhelmed by the responsibility of choosing the appropriate mounting solution, like I initially was, our virtual mounting service can help you. You simply provide us with all the necessary information, and we will assist you to find an appropriate solution. With just a few photos of what you’d like to mount, and where to use it, we’ll create a virtual 3D image of the device in place – so you can get a good idea of how it would look and how it could be used.
If your team would like to know more about the basic principles of seating, and the options available for mounting various devices, please join us at our upcoming workshop:
on 16th August 2017 in JHB