The role of specialist seating in promoting health and wellbeing
Posture describes an overall body position. It is the way we hold ourselves or position our bodies, intentionally or unintentionally. It is influenced by a number of interconnected factors, including body shape and size, muscle tone, gravity, supporting surface, the task at hand, and even a person’s health. Optimum posture should encourage function, be energy efficient and not harm body systems.
People who have learning needs can often present with physical and sensory challenges resulting in difficulties managing their posture independently without support. Poor posture and trunk asymmetry can impair physiological function, including cardiac efficiency and endurance. It can encourage abnormal tone, including spasticity, and interfere with normal movement. It can cause fatigue, immobility and reduced function and independence – resulting in increased dependency and carer responsibilities. Poor posture can also increase the risk of pressure injury.
24-hour postural management
Failure to protect a person’s body shape or reduce the risk of pressure injury can result in many complications, such as pain, contractures and deformities, breathing difficulties and respiratory complications, poor digestion and constipation, infection, and even death. This is true of adults and children.
24-hour postural management is the use of any technique to minimise the complications listed above. It is a multi-disciplinary approach that has the potential to assist in enhancing and maximising an individual’s quality of life.
It is essential to consistently support posture and manage pressure throughout the day and night – in every setting such as home, school and work – in order to reduce the risk of secondary complications. A good lying posture at night is vital to reduce the risk of postural deformities developing, which may then affect the person’s ability to achieve a good sitting position. A good posture must be achieved during mealtimes to reduce the risk of aspiration or choking.
The average person in the United Kingdom spends 9.5 hours sitting every day. This does not include those who may be wheelchair users or those unable to change their position independently.
Specialist seating is a fundamental part of this 24 hour approach; ultimately it should improve the person’s quality of life.
Assessment and client involvement
Due to the variability among people, a universal sitting position is not practical. Therefore, a comprehensive individual assessment is imperative in the provision of specialist seating, which includes the person’s diagnosis, past medical history, social history and goals. Objective assessment should include the measuring of critical angles for sitting, such as hip and knee range of movement including hamstrings muscles length, and sitting ability and postural support needs.
When working with a client with learning needs, the client and their family, friends or carers should be involved throughout the assessment process, the selection and issue of equipment and the review, to ensure management plans are acceptable and appropriate for everyday life.
Always find out the best way to communicate with the person. Ask family, friends or carers for help. Key information about the person’s communication needs can also be found in their communication passport, traffic light assessment or health action plan, if they require these. Consider signs, objects of reference, photographs or communication aids when interacting with them.
It is important to recognise when someone with learning needs is in pain if they are unable to make this apparent verbally. Listen to those who know the person well and ask about any changes in their behaviour or interactions. Consider their facial expressions, gestures, body language or reduced appetite.
Children and adults can benefit from specialist seating, including those with a neurological impairment such as cerebral palsy, little or no active movement such as spinal cord injury, altered body shape and asymmetry such as scoliosis, movements that are difficult to control such as ataxia, impaired proprioception, or those with poor skin integrity or previous skin breakdown. Specialist seating must be introduced when a person is assessed as having postural problems or at an increased risk of pressure injury; this may mean introducing equipment when they are only babies. Lack of early intervention can result in irreversible damage and complications. Introduction of seating systems at an appropriate age is also considered to facilitate psychosocial and cognitive development.
In the paediatric setting, specialist seating should be adjustable to accommodate growing children, whilst facilitating learning, development and play. It should encourage stability and dynamic sitting balance to allow upper limb function. Improved head control is essential for orientation, socialisation and the development of cognitive and communication skills.
Most importantly, it should be comfortable and subsequently, it should increase compliance and consistent use. There is a correlation between compliance and comfort; regardless of the clinical benefits, though, the seating system may not be used if the user is not comfortable.
The aims of specialist seating
- Promote comfort, relaxation and safety.
- Prevent or reduce the occurrence of undesirable postural changes.
- Ensure maximum stability through a well-balanced position.
- Facilitate normal movement patterns or control abnormal movement patterns.
- Normalise tone or decrease its abnormal influence on the body.
- Ensure maximum body weight over largest possible surface area.
- Encourage pressure redistribution.
- Promote optimum functional ability.
- Encourage energy management.
- Enhance physiological functions such as cardiac, digestive and respiratory functions.
- Ensure the ability to transfer safely.
- Improve interaction and social inclusion.
- Improve quality of life.
Functions, components and accessories of specialist seating
- Pressure relieving properties of the supporting surface can reduce the risk of pressure injury, along with a regular change of position.
- Tilt-in-space can be utilised as part of a pressure care programme to redistribute pressure.
- Back angle recline can be effective in managing postural concerns such as hip dislocation or fracture.
- Adjustable seat dimensions, including width and depth, can maintain optimum pelvic position and weight distribution.
- Angle adjustable leg rests can assist with managing lower leg oedema; a negative angle can alleviate pain associated with reduced hamstrings muscles length.
- Lateral supports can accommodate or even correct abnormal spinal postures.
- Split seats can accommodate leg length discrepancies.
- Head supports can aid communication, vision, breathing, and eating and drinking for those with limited head control.
- Belts and harnesses can help maintain pelvic stability, and reduce abnormal tone and movements; it is imperative to complete a risk assessment prior to use to ensure safety and consider deprivation of liberty.
With appropriate assessment and set-up, specialist seating can encourage function by stabilising the pelvis to allow freedom of movement, improved head and trunk position for interaction and safe eating and drinking. It will also manage comfort and energy levels, and ultimately improve quality of life.
Rebecca Jones is Clinical Specialist at specialist seating provider Careflex