by Margaret Vence, PT
As a therapist new to the pediatric physical therapy world, it has been valuable to observe seasoned therapist practicing in the field and to attend continuing education courses to learn all the intricacies to maximize function for our pediatric clients. Recently, I was able to attend a course offered by Monroe custom seating from Ottobock. The course highlighted best practices for seating and positioning and honed in on a few best practice takeaway points.
The first takeaway was to ensure the therapist and Assistive Technology Professional (ATP) have observed and assessed the patient’s posture and pelvic alignment. An oblique or rotated pelvis can lead to trunk instability, and fatigue. This can further lead to decrease in the patient’s functional reach, poor positioning for eating and drinking and a decreased visual field and associated decline in social interaction. Proper pelvic alignment is the foundation to maximize upper extremity and trunk function.
A second takeaway point was the importance of 24 hour positioning. Many of our patients are in their wheelchairs and a seated position the majority of the day. Gravity does not go away when they lie down to go to sleep or change positions. The body will tend to favor the posture that has been assumed during the extended sitting timeframe. For example, if the patient is a tummy sleeper, this position will tend to replicate an anterior pelvic tilt positioning that maybe assumed in sitting. To combat this, the therapist can educate the family on alternate sleeping postures. It is important to educate the family, caregiver and patient of optimal positioning when the patient is out of the chair to assist in improving range of motion, trunk and pelvic alignment throughout the day.
A third takeaway challenged the clinicians to think of an appropriate outcome measure to use when prescribing a seating solution. An outcome measure can assist in establishing goals so that the clinician and patient can determine if and when there is progress and assist with documenting favorable change. An outcome measure that is useful for this group of patients include the FIST (Function In Sitting Test) which assesses seated balance. Another measure that can be useful for this group of patients is monitoring pulse oximetry prior before and after custom seating.
When clinicians are able to transition clinical findings into patient specific goals and prescribe appropriate seating product parameters, this will allow the patient to optimize his or her function, comfort and safety.