Apr 28, 2017 The Essential Specialist Seating Checklist With over 30 years experience as an Occupational Therapist specialising in the provision of specialist seating, Martina Tierney outlines the essential checklist for specialist seating in her most recent blog. She lists 10 key chair checks to conduct for patients in order to get the maximum postural support and clinical benefits from a specialist chair. An individual should be assessed by a Seating Specialist and this may or may not be conducted in conjunction with a clinician such as an OT or PT. The recommended chair should be adjusted to meet the patient's individual postural and pressure care needs; do not accept a ‘one size fits all’ solution as each patient will require features and functions to suit their individual needs and requirements. Ensure each of the following 10 essential functions are accommodated by your chosen seating to achieve best clinical results as proven in Seating Matters' 2-year clinical research study. A randomised control trial was carried out across multiple healthcare facilities in Northern Ireland from which they devised evidence based, best practice tips for providing Seating Assessments in order to achieve transformation results similar to those experienced as a result of the research study. Some of the most significant results from the research study included: An 88% reduction in pressure ulcers. A 56% reduction in the use of restraint. An 80% reduction in the use of high cost pressure cushions. Discover more about Seating Matters’ clinical research project here. 10 Clinical Essentials to get the Best from Specialist Seating 1. Load the Body Ensure the body is fully loaded and that every part of the body is in contact with the chair to redistribute pressure away from areas that are at risk of redness and pressure injuries. Think about loading of the head, trunk, legs, arms and feet of the patient in the chair. 2. Support the Pelvis In assessing seating and positioning you should always start with the pelvis as the pelvis provides the base of support for the client sitting in the chair. Martina's Top Tip: The width of your hand should fit easily between the patient and the side of the chair. If the chair is too wide it will encourage a pelvic obliquity. The Importance of Pelvic Positioning If the pelvis is tilted then this will encourage the person to fall either laterally resulting in a pelvic obliquity- or backwards resulting in a posterior pelvic tilt - By supporting the pelvis the client is less likely to slide or fall. The Seating Matters Phoenix™ and Sorrento™ have adjustable seat widths to accommodate changing user dimensions or various users in a multi-user environment. Various seat widths are available on all chairs and padded arm covers can also be used to vary seat width. 3. Support the Femurs When seating a patient you must ensure the seat depth is adjusted to adequately load the thigh. Martina's Top Tip: Leave the width of two fingers between the edge of the seat and the back of the leg. If the seat depth is too long it encourages sliding resulting in a posterior pelvic tilt. If the seat depth is too short the legs will not be fully loaded, which will result in increased pressure going through other parts of the body. All Seating Matters chairs have seat depth adjustability. In addition the Atlanta™ and Monaco™ chairs have a ramped seat to reduce the risk of sliding. 4. Load the Feet The feet take 19% of the body weight so it is imperative that they are fully supported. Loading the feet reduces sliding, provides proprioceptive feedback and encourages even weight distribution. A footplate is essential and is therefore standard on all Seating Matters chairs. The footplate on the Seating Matters Phoenix™ and Sorrento™ is height and angle adjustable. 5. Support the Trunk As far as possible try to ensure the patient in the chair maintains a midline postural position. If the client has flexible or partially flexible posture it may be possible to correct or partially correct their posture. If the client has fixed posture then their posture must be accommodated in the chair. This can be achieved by the use of lateral supports or by using the armrests to maintain or attain a midline position. There are a variety of accessories available on the Seating Matters chairs to support and meet the needs of varying postures. E.g. waterfall back, fibrelux back, lateral supports, triangular wedge, padded arm covers etc. 6. Support the Head Correct positioning of the head is vital for aiding effective respiration, swallowing and communication. Where possible the patient’s head should be balanced, and aligned above the hips. If head control is absent or poor this can be achieved by the use of head supports and pillows. The Seating Matters Phoenix supports the most complex upper body and head positions with its height adjustable back and integral head and shoulder supports. There are a variety of accessories available on the Seating Matters chairs to meet the needs of varying head positions, such as a horseshoe pillow, a concave pillow and a standard head pillow. 7. Support the Arms Although the arms only take 3% of the body weight, supporting the arms is essential to encouraging a midline position and to increase functional independence. Ensure the arms of the chair are at the correct height and are fitted closed to the trunk to support a midline posture. The arms of a chair help to provide lateral support and stability and without this support patients may use their arms to ‘fix’ themselves in their chair to provide the stability they need. This reduces the ability for them to use their arms for functional tasks and therefore limits their independence. The arms on the Seating Matters Phoenix and Sorrento are width adjustable and height adjustable. 8. Use of Tilt in Space Tilt in space should be used to facilitate a change of position and pressure redistribution in patients with limited or no mobility. Tilt may also be used to alleviate kyphotic/flexed postures and is helpful in providing a comfortable position for resting when fatigue sets in. Tilt in space is important as regular weight redistribution minimises pressure on the weight bearing areas such as the sacrum and IT’s. It can facilitate improved posture, visual field, respiration, swallowing and comfort. 30 degree tilt in space facilitates a good functional position, which improves the clients’ ability to breathe, swallow and communicate. If the client has a history of Pressure Ulcers (PUs) or at high risk of developing PUs then the use of 45 degree tilt is advised to effectively manage this high pressure risk. The NICE Guidelines state that clients require 2 hourly weight shifts when sitting continuously. This can be achieved by the use of tilt in space. The Seating Matters Phoenix and Sorrento are the only chairs available with 45 degree angle tilt in space as an option. 9. Accommodate Tight Hamstrings Tight hamstrings are commonly overlooked in seating and are a major cause of why patients might be sliding from a chair, which contributes to the risk of pressure ulcer development. Always check hamstring range and set the leg rest to accommodate tight hamstrings. Do not elevate the leg rest if hamstrings are tight. All the Seating Matters chairs are designed to accommodate tight hamstrings. A negative angle calf pad is available on The Seating Matters Phoenix™ and Sorrento™ to accommodate contractures. 10. Appropriate Cushion All Seating Matters chairs use Dartex, a multi-stretch breathable material, on all patient contact surfaces as standard. All patient contact surfaces should allow for immersion and envelopment as this will facilitate maximum pressure management in seating, Dartex achieves this. The cushion is removable to allow a patient to use an alternative cushion which they may have had previous success with if they so wish. Please ensure the chair is adjusted to accommodate the new dimensions ensuring the body is full loaded in the chair. Where possible ensure that there is nothing between the patient and the cushion. The use of slings or incontinence pads will prevent immersion into the cushion and increase the risk of shear and friction. Remember we have free resources on hand to help you in prescribing correct seating for your patient or loved one. We provide free Seating Assessments carried out by our local Seating Specialists, Mary Hickey and Linda Watters. They have over 45 years combined experience in the Healthcare Sector in Ireland and are both extremely passionate about Seating Matters. Download The Four Principles of Pressure Management in Seating here. The Clinician’s Seating Handbook – A reference guide to clinical seating provision written by Martina Tierney OT. Get your free copy containing practical tips for conducting Seating Assessments, an overview of our clinical research study and results as well as a guide to seating patients with a bariatric condition, request your free copy here. Perhaps your team would benefit from a free Lunch & Learn training session to get hands on practical experience and demonstration of the features and functions of the Seating Matters chairs. Find out more here.
