These challenges that we see in seating often are not seen in isolation. We see combinations of them. How do we prioritize them during a wheelchair evaluation?
Answer
It really comes down to what is flexible and what is fixed. For example, if someone has a combination of posterior pelvic tilt and rotation, we are going to look at solutions that address both. An anti-thrust seat, whether it is part of a linear seat or built into a molded seat, has a curb to block the IT's. That can help prevent both posterior pelvic tilt and rotation. We also know that the position or the angle of the pelvic belt is important in limiting posterior pelvic tilt. We would choose probably a 60 degree angle to limit that posterior pelvic tilt but we would make sure it pulled down on the forward side if we were also dealing with rotation. It is keeping in mind all the challenges that we are seeing and trying to create solutions that address all of those. It is very important today to look at how we match individual seating challenges to strategies such as angles of pelvic belts, cushions that are anti-thrust shaped, etc.
Michelle Lange, OTR, ABDA, ATP/SMS
Michelle is an occupational therapist with 25 years of experience and former Clinical Director of The Assistive Technology Clinics of The Children’s Hospital of Denver. She is a well-respected lecturer, both nationally and internationally and has authored 7 book chapters and over 175 articles. She is the editor of Fundamentals in Assistive Technology, 4th ed. Michelle is on the teaching faculty of RESNA and the University of Pittsburgh. She is on the RERC on Wheeled Mobility Advisory Board. Michelle is a credentialed ATP, credentialed SMS and is a Senior Disability Analyst of the ABDA.
Related Courses
1https://www.physicaltherapy.com/pt-ceus/course/wheelchair-positioning-postural-care-3596Wheelchair Positioning: Postural CareThe goals of wheelchair seating include managing posture and pressure as well as providing stability for function. Postural care addresses positioning outside of the wheelchair, particularly during sleep, and can be used to improve the quality and duration of sleep, promote health and maintain safety during sleep, as well as to minimize, prevent and even reverse orthopedic changes.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyPhysicalTherapy.comwww.physicaltherapy.comWheelchair Positioning: Postural CareThe goals of wheelchair seating include managing posture and pressure as well as providing stability for function. Postural care addresses positioning outside of the wheelchair, particularly during sleep, and can be used to improve the quality and duration of sleep, promote health and maintain safety during sleep, as well as to minimize, prevent and even reverse orthopedic changes.3596OnlinePT60M
The goals of wheelchair seating include managing posture and pressure as well as providing stability for function. Postural care addresses positioning outside of the wheelchair, particularly during sleep, and can be used to improve the quality and duration of sleep, promote health and maintain safety during sleep, as well as to minimize, prevent and even reverse orthopedic changes.
2https://www.physicaltherapy.com/pt-ceus/course/dynamic-seating-3093Dynamic SeatingDynamic seating has four primary functions – to allow movement, to diffuse force, to protect the client, and to protect the seating system and mounting hardware. This course will take a look at the product options, discuss clinical indicators and contra-indicators for dynamic components and present case studies to illustrate these points.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyPhysicalTherapy.comwww.physicaltherapy.comDynamic SeatingDynamic seating has four primary functions – to allow movement, to diffuse force, to protect the client, and to protect the seating system and mounting hardware. This course will take a look at the product options, discuss clinical indicators and contra-indicators for dynamic components and present case studies to illustrate these points.3093OnlinePT60M
Dynamic seating has four primary functions – to allow movement, to diffuse force, to protect the client, and to protect the seating system and mounting hardware. This course will take a look at the product options, discuss clinical indicators and contra-indicators for dynamic components and present case studies to illustrate these points.
3https://www.physicaltherapy.com/pt-ceus/course/positioning-the-head-3098Positioning the HeadThis course will discuss various strategies to optimize head position. First, we will explore strategies beyond the head support, including specific positioning interventions and addressing visual issues. Second, we will explore posterior head supports in depth, matching specific features to client needs. Third, we will explore other options which may be required if posterior support alone is inadequate, including anterior head support.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyPhysicalTherapy.comwww.physicaltherapy.comPositioning the HeadThis course will discuss various strategies to optimize head position. First, we will explore strategies beyond the head support, including specific positioning interventions and addressing visual issues. Second, we will explore posterior head supports in depth, matching specific features to client needs. Third, we will explore other options which may be required if posterior support alone is inadequate, including anterior head support.3098OnlinePT120M
This course will discuss various strategies to optimize head position. First, we will explore strategies beyond the head support, including specific positioning interventions and addressing visual issues. Second, we will explore posterior head supports in depth, matching specific features to client needs. Third, we will explore other options which may be required if posterior support alone is inadequate, including anterior head support.
4https://www.physicaltherapy.com/pt-ceus/course/wheelchair-mobility-optimizing-driving-in-3622Wheelchair Mobility: Optimizing Driving in Power WheelchairsPower wheelchair evaluation determines appropriateness for power wheelchair use and then determines the optimal power wheelchair base, power seating, driving method and other needed components. Optimizing power wheelchair driving is critical to improve outcomes and includes choosing the best drive wheel configuration, utilizing tracking technologies, and programming.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyPhysicalTherapy.comwww.physicaltherapy.comWheelchair Mobility: Optimizing Driving in Power WheelchairsPower wheelchair evaluation determines appropriateness for power wheelchair use and then determines the optimal power wheelchair base, power seating, driving method and other needed components. Optimizing power wheelchair driving is critical to improve outcomes and includes choosing the best drive wheel configuration, utilizing tracking technologies, and programming.3622OnlinePT60M
Power wheelchair evaluation determines appropriateness for power wheelchair use and then determines the optimal power wheelchair base, power seating, driving method and other needed components. Optimizing power wheelchair driving is critical to improve outcomes and includes choosing the best drive wheel configuration, utilizing tracking technologies, and programming.
5https://www.physicaltherapy.com/pt-ceus/course/positioning-the-pelvis-3157Positioning the PelvisThe position of the pelvis very much determines the position of the trunk and lower extremities and so achieving and maintaining the optimal position is critical. This course will present common pelvic asymmetries with suggested strategies to address each challenge. Providing as neutral a pelvic position as possible improves overall posture, stability and function.auditory, textual, visual129USDSubscriptionUnlimited COURSE Access for $129/yearOnlineOnlyPhysicalTherapy.comwww.physicaltherapy.comPositioning the PelvisThe position of the pelvis very much determines the position of the trunk and lower extremities and so achieving and maintaining the optimal position is critical. This course will present common pelvic asymmetries with suggested strategies to address each challenge. Providing as neutral a pelvic position as possible improves overall posture, stability and function.3157OnlinePT60M
The position of the pelvis very much determines the position of the trunk and lower extremities and so achieving and maintaining the optimal position is critical. This course will present common pelvic asymmetries with suggested strategies to address each challenge. Providing as neutral a pelvic position as possible improves overall posture, stability and function.
