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March 2017

Critical considerations when selecting rehab shower commode chairs

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;
  1. How many minutes or hours will the client spend on the toilet and in the shower/bathtub?
  2. Will the client need assistance carrying out these activities?
  3. What is the level of skin risk for this client on their seating surfaces and why?
  4. What are the key findings related to this client’s seated posture?
  5. Are there any postures needing accommodation?
  6. Are there any added stability issues from the seated position?
  7. What are the details of the bathroom layout?
  8. 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?
SS: 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;
  1. Size, location and shape matters…when it comes to the relationship between the buttocks, (the bony structures/tissue) and the aperture;
  2. Seat material matters when it comes to load distribution, initially as well as over time;
  3. Back support matters when we are looking at positioning as well as load distribution;
  4. 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?
SS:
  1. Femoral support
  2. Feet support
  3. Hip range of motion relative to sitting
  4. Lumbar/thoracic support
  5. Head support
  6. Upper extremity support
 
RD: Not all seating systems are made equally. What would you say separates the best seats from the rest?
SS:
  1. Quality and durability of the materials both inside the cover material as well as the cover material itself
  2. Ease of system adjustment as is often necessary on the spot
  3. Ease of care of the equipment for the client and/or their caregivers
  4. Durability and ease of use of the tilt mechanism where it applies
  5. 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 created by Respecta, Finland following a training by Sharon in December 2016

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

Look behind the symptoms to create a healthy seating position
 
If I 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.
 
Hands on assessment
 
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.
 
Respect the hip
 
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 should ring!
 
“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.
 
How 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.”
 
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