Time sure flies by! Here we are with 2018 coming to a close! I have just returned from some quite extensive working trips where I had the privilege of working with so many wonderful clinicians and clients/patients. My work since beginning of October took me to Ontario, Canada, Ireland, Sweden, Denmark, New Zealand, Australia, Martinique and Guadalupe! The consistent message that I must share from ALL of these areas is that we have a continuous challenge in the world of postural care management as it relates to the seated position. This challenge is one that I have written about in previous blogs over the years - and that is regarding the lack of hip joint range of motion relative to the seated position. 90% of all the clients/patients that I have the privilege of working with and doing hands on assessments with, simply do NOT have the range of motion necessary to sit in the seating systems they are in. The consequence is a series of postural, respiratory , skin integrity and functional compromises with resultant shape deformation. Upon evaluation of these clients/patients there is a definite link between the favoured lying/sleep position and the presenting seated alignment.
In 2019 I will focus much more on this topic and look forward to communicating with fellow clinicians in the hope of improving our assessment and communication skills around this area of challenge.
Copied from Raz Design Website.
Sharon Sutherland of Seating Solutions LLC took the time to chat with Raz Design about all things related to seating and skin integrity. The following is an excerpt of our conversation with Sharon.
RD: Why isn’t more attention paid to the “other seat” (rehab shower commode chair)?
SS: Many clinicians have indicated that a possible reason for not paying as much attention to the “Other Seat” is because so much time is spent on prescribing the primary seating and mobility system. The decision around the rehab shower commode chair is unfortunately often a “box that gets checked” in order for the client to be discharged. This means that time is not spent analyzing the specific skin integrity and positioning needs of the client and translating these critical assessment findings into the parameters or features that are essential in the bathroom.
RD: What are the most important factors you consider when assessing a client for a rehab shower commode chair?
SS: Interestingly, many of the factors that are important to consider for this assessment are the exact same considerations that we make with regard to selecting the optimal seating and mobility equipment. For example;
- How many minutes or hours will the client spend on the toilet and in the shower/bathtub?
- Will the client need assistance carrying out these activities?
- What is the level of skin risk for this client on their seating surfaces and why?
- What are the key findings related to this client’s seated posture?
- Are there any postures needing accommodation?
- Are there any added stability issues from the seated position?
- What are the details of the bathroom layout?
- What is the client’s method of transfer: consider space, support needed and stability?
RD: What are some of the more overlooked assessment tools or guidelines when assessing skin integrity preservation in seating?
An excellent guideline that we sometimes forget to use is the “Prevention and Treatment of Pressure Ulcers: Clinical Practice Guideline,” click here to see: https://goo.gl/ovzFCF
Some very useful tools are, for example, calipers to measure the pelvic details and perhaps an interface pressure mapping system to look at the contact area and potential areas of pressure while trying the various rehab shower commode chairs available.
RD: What impact has pressure mapping had on your ability to assess a client?
SS: Here is a short list of what I have learned from interface pressure mapping in the selection of rehab shower commode chairs;
- Size, location and shape matters…when it comes to the relationship between the buttocks, (the bony structures/tissue) and the aperture;
- Seat material matters when it comes to load distribution, initially as well as over time;
- Back support matters when we are looking at positioning as well as load distribution;
- Utilizing tilt can be essential for both postural support as well as for weight shifting when bowel/bladder shower routines extend into the recommended skin integrity plan of care.
RD: Beyond the ITs and trochanters, what other anatomy should be considered of critical importance when discussing optimal seating and positioning?
- Femoral support
- Feet support
- Hip range of motion relative to sitting
- Lumbar/thoracic support
- Head support
- Upper extremity support
RD: Not all seating systems are made equally. What would you say separates the best seats from the rest?
- Quality and durability of the materials both inside the cover material as well as the cover material itself
- Ease of system adjustment as is often necessary on the spot
- Ease of care of the equipment for the client and/or their caregivers
- Durability and ease of use of the tilt mechanism where it applies
- Design compatible with the human form, which for me includes anthropometrics, skin integrity needs and positioning needs … or is the human just expected to fit?
RD: Seating systems are becoming increasingly complex. How do you match the needs and requirements of each client with the available options?
SS: The hands-on assessment is really the key to determining everything. With a detailed assessment, I can easily translate the assessment findings to key product parameters/features, which I have deemed to be essential for the client. With this information, I then try the proposed equipment with the essential features with that client. Once this is done, I am in a position to feel confident with my prescription. As well, I have the necessary information to submit for funding or reimbursement.
RD: You’ll be speaking at ISS 2017 this year. What are the most important things you want clinicians to take away from your presentation?
SS: I would love for clinicians to take away the message that says the hands-on assessment is critical: the information we are probably collecting anyway, related to other positioning and mobility, can be also used to determine the minimal essential features that are necessary in the rehab shower commode chair. Don’t forget to use tools (such as pressure mapping) that you might already have access to in seating clinic when making decisions for the bathroom. Remember, the client who you have deemed to be high risk for skin integrity issues will have those same/similar needs everywhere they sit or lie down.
Author: Chris Palmer
Blog published on Respecta.fi following training that Sharon participated in in Finland in December 2016.
Ratkaisu terveelliseen istumiseen löytyy kurkistamalla oireiden taakse
26. tammikuu 2017 - adminJos voisin kehittää jotain istumisen, asennon ja liikkumisen saralla, haluaisin opettaa kaikille erityistä istumisen ratkaisua tarvitsevien kanssa työskenteleville ammattilaisille kuinka istuma-asento tutkitaan ja arvioidaan käsin ja miksi se on tärkeää, sanoo Sharon Sutherland. Hän on istumiseen, istumisasentoon ja liikkumiseen erikoistunut fysioterapeutti, Seating Solutions LLC:n omistaja ja suosittu luennoitsija terveydenhuollon organisaatioissa ympäri maailmaa. Sharon Sutherland on työskennellyt tällä rajatulla erikoisalalla 28 vuotta, ja on tyytyväinen siitä, että istumisesta ja istuma-asennosta keskustellaan ja tiedetään entistä enemmän terveydenhuollon ammattilaisten keskuudessa. “Me istumisen ja liikkumisen apuvälineitä tarvitsevien potilaiden kanssa työskentelevät ammattilaiset reagoimme usein oireisiin, kuten liukumiseen, kallistumiseen tai ruuansulatusvaivoihin, niiden takana olevien syiden sijaan. On tietenkin järkevää reagoida oireisiin, mutta uskon, että oireiden takana olevien syiden ymmärtäminen johtaa parempiin tuloksiin pitkällä aikavälillä”, sanoo Sharon Sutherland. Kädet kertovat enemmän kuin pelkät silmät Sharon Sutherland on käsin tehdyn tutkimuksen ja arvioinnin suuri puolestapuhuja. Työskennellessään lukuisten ammattilaisten ja potilaiden kanssa monissa eri maissa hän on havainnut, että istumista ja asentoa ei tutkita perusteellisesti. Tämä voi johtaa arvokkaan tiedon ja havaintojen ohittamiseen mahdollisesti elämää mullistavin seurauksin. ”Käsin tehty arviointi on kriittinen osa prosessia. Omassa työssäni se auttaa minua ymmärtämään asiakkaan istumiseen liittyviä, näkyviä oireita ja niiden takana olevia juurisyitä. Haluaisinkin auttaa kaikkia ammattilaisia, jotka kirjoittavat lähetteitä asiakkailleen istumisen, asennon ja liikkumisen apuvälineisiin, ymmärtämään miksi käsin tehty arviointi on tärkeää ja miten se tehdään kunnolla”, sanoo Sharon Sutherland. Kunnioita lanteitaIstuminen on jokapäiväinen toiminto, johon emme kiinnitä sen kummempaa huomiota. Todellisuudessa se vaatii paljon työtä, jopa silloin kun hermo-ohjaus toimii normaalisti. Huono istuma-asento aiheuttaa erilaisia haasteita ja ongelmia. “Monesti istumisen arvioinnissa havaittua lantion liikerataa ja lantion/selkärangan linjausta katsotaan läpi sormien. Kun linjaus on hyvä, alimmat kylkiluut ja suoliluunharjat (ASIS) muodostavat suorakaiteen. Hälytyskellojen pitäisi soida, jos suhde on kolmiomainen. Toiselle sivulle kallistunut asento liittyy usein takareisien kireyteen ja lantion liikerajoitukseen”, kertoo Sharon Sutherland. Kuinka kliiniset löydökset muunnetaan tuoteominaisuuksiksi? Sharon Sutherlandin tavoitteena on tunnistaa syyt asennon takana ja luoda asiakkaalle kokonaan uusi ratkaisu pikemminkin kuin paikkailla ja korjailla nykyistä. Hän neuvoo ottamaan tuotespesialistin mukaan prosessiin mahdollisimman pian. “Tuotespesialisti voi tuoda keskusteluun toisen näkökulman ja auttaa keskittymään olennaiseen. Tiimityöllä kliiniset löydökset on helpompi muuttaa tuoteparametreiksi, mikä tekee sopivien koekäyttötuotteiden valinnasta helpompaa”, sanoo Sharon Sutherland. Millainen sitten on hyvä istumisen ratkaisu paljon tukea tarvitsevalle asiakkaalle? “Hyvä istumisen ratkaisu täyttää potilaan tarpeet painon jakamisessa, asennon hallinnassa ja tuessa, ilmanvaihdossa ja iskunvaimennuksessa”, summaa Sharon Sutherland. www.seatingsolutionsllc.com
English translation: Interview of Sharon Sutherland, PT with Respecta, Finland
behind the symptoms to create a healthy seating position
could make one difference in this world of seating, positioning and mobility it
would be to help all clinicians understand how to do a thorough hands-on
assessment and why it is important, says Sharon Sutherland, physical therapist
sspecialized in the field of seating, positioning and mobility. She is
the owner of Seating Solutions LLC, and a popular teacher and lecturer in
healthcare organizations internationally.
Sharon Sutherland has been practicing this
very specialized area in physical therapy for 28 years, and welcomes the fact
that seating and positioning is globally becoming more of a discussion which
brings increased awareness among healthcare professionals.
“I think that we as health care
professionals who have the privilege of working with patients who need
specialized seating, positioning and mobility often react the symptoms – like
sliding, leaning or digestion problems – that the patient presents with as
opposed to really understanding the causes behind the symptoms. It is very
reasonable to react to the symptoms, however I believe that understanding the
causes behind the symptoms can provide us with greater opportunity for creating
more successful long term outcomes”, says Sharon Sutherland.
Sharon Sutherland is a big believer and
spokesperson for hands on examination. Travelling across many countries working
with clinicians and patients, she has observed, that sometimes the hands on
evaluation is not thoroughly completed as it relates specifically to seating
and positioning. There are numerous reasons to this, but it can lead to missing
some very valuable findings with potential life changing consequences.
“The hands on evaluation is a critical part of the process, and for me
personally it helps me understand the presenting symptoms as well as the underlying causes of the clients postural presentation and related
challenges. If I could make one difference in this
world of seating, positioning and mobility it would be to help all clinicians
who are faced with the task of prescribing seating, positioning and mobility
solutions for clients with more complex needs understand why it's
important and how to do a thorough hands
on assessment”, says Sharon Sutherland.
Sitting is an everyday function that we
don’t always pay much attention to, but this action is a lot of work, even with
intact neuromuscular control. When the optimal sitting position is not discovered,
this causes different challenges and symptoms, and this is when alarm bells
“The most common assessment finding related
to sitting that I see being overlooked, is the relationship between hip range
of motion and pelvic/spine alignment. Alarm bells ring for me, when I see a
patient in their seating system with a triangular relationship between their
ribs and pelvis but when in supine, they present with a much more rectangular
relationship between lower ribs and ASIS’s. This is often related to limited
hip and or hamstring issues for example that have not been respected by their
seating system”, says Sharon Sutherland.
to transfer clinical findings into goals and potential product parameters?
Her plan for each client is to identify the causes behind the postural
presentation in existing equipment and create solutions rather than reaching
for the band-aids. She advises to involve a product specialist in the process
as soon as possible.
“I think a team approach in finding the
right product is great! Product specialists can bring another perspective to the
table as well as they can sometimes help with keeping us focused on what's
important to glean from the assessment. Together we can translate the
assessment findings into product parameters which will then make it easier to
select the most suitable products for the patient to trial before final
decisions are made”, says Sharon Sutherland.
“I believe for a seating product to be a
good solution it must meet the needs of the patient in the areas of pressure
redistribution, shear management, postural management and support, microclimatic
management and impact dampening.”
I cannot believe it is almost November and the holiday season. I have been traveling extensively doing clinical presentations and hands on evaluations with clients all over the US over the past few months. Its been a great Fall so far - or as we say in Ireland .... a beautiful Autumn:)
2016 is fast approaching and I find my calendar becoming solidly booked until June. This is simply a reflection of how many people are in need of seating, mobility and standing evaluations and training. The clients and clinicians I meet everyday worldwide in my travels are fantastic. I feel privileged to work with each and every one.
The number one challenge that everyone faces it seems is diminishing funding... this means that as clinicians we have to get better and better at our evaluations and documentation. If what we are prescribing/recommending is not deemed to be the minimal essential equipment that our clients need we find ourselves appealing and redoing all the paperwork.. This costs time and money and most importantly it costs our clients time while they wait for appropriate equipment. In the interim, they are often stuck with nothing or with equipment that is inappropriate and even causing physical and functional deterioration. If you are reading this- what are your thoughts and experiences?
Do you think about the relationship between hip limitations and seating? In the past 4 years, I have been paying close attention to this. Approximately 80% of all the clients ( not age specific) I have had the privilege of assessing for wheelchair seating during this time have not had the range of motion necessary to sit successfully in the wheelchair seating systems they were presenting in (On average I see between 15-20 clients per month). Their presenting symptoms varied from sacral sitting and compensating kyphosis with hyper extended cervical spine to extreme pelvic obliquity, pelvic rotation and compensating scoliosis with very compromised respiratory and disgestive function. Upon assessment out of the chair on a mat table or plinth in supine, it is revealed that their hip range of motion relative to their pelvis is very compromised on one or both sides... This leaves a dilemma when it comes to effective seating solutions.... I believe we need to consider carefully our options... Have the client "fit the chair/seating system" or have the chair/seating system fit the client"..... What are your thoughts? - what are our options? Are you seeing this when you do your full "out of chair" seating assessments? Do you stumble upon this with your clients who present with more complex seating needs? Would you like to discuss this?
How many of you focus on Seating for the Elderly ? I am a big believer that this population truly needs correctly prescribed seat cushions, back supports and wheeled mobility bases. Think about - Propulsion, Transfers, Eating, Respiratory complications, Skin Integrity challenges- just to name a few of the considerations. I provide consultation/advice, clinical training, staff training, clinical assessments in this area of specialty. Please share with me your thoughts!
So hard to believe that summer is over and fall is upon us! Its been a really crazy - busy FUN summer between work travel and personal travel. I am sure some of you have heard..... I got married in August to this wonderful man " Scott Sutherland" I am now in the midst of figuring out this name change jungle!!! I will keep you all posted on that progress!
In October I will have at least 10 speaking engagements which will include hands on evaluations and a lot of fun interaction with various audiences in the field of complex rehab! This will be followed with a trip to my homeland in early November where I have the pleasure of speaking at the European Seating Symposium in Dublin:) Of course this will include a quick visit with my family who live in Ireland... I cant wait... !