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OBJECTIVES
After reading this chapter, the reader will be able to:
List the fundamental components of "seating"
Recognize the features of an ultralight manual wheelchair, compare frame styles, and understand configuration options
Understand the different power mobility options for base and seat selections
Discuss the benefits and challenges for use of power mobility
Discuss common theories of cushion design for skin protection and postural support
Discuss the interaction between components of the seating system
Describe the required components of a postural examination for seating purposes
Discuss the influence of seated posture on dynamic function
Justify the need for selected/prescribed seating system components
Be able to defend time spent in seating planning and intervention as therapeutic time for the client
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Seating is the foundation for optimal outcomes in the spinal cord-injured population, especially for those who use wheelchairs for full-time mobility. There is an intimate and obligatory relationship between the posture of a paralyzed body and the support provided from the seating system. Postural alignment directly impacts respiration, swallowing, speech, skin, and musculoskeletal health and function. Posture may also affect the body image of an individual and feelings of self-worth and therefore participation in the community after spinal cord injury (SCI). The multi-factorial influence of posture on health outcomes makes seating a premier concern for early intervention and constant vigilant monitoring throughout the injured person's lifetime.
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Understanding the interactions of the seating system and the resulting postural alignment requires careful integration of information from the physical therapy examination and an understanding of the potential, as well as the constraints, of the equipment. Specifying an orthotic seating system is a specialty skill. It provides therapeutic benefits for the client. The therapist must evaluate the impact of selected parameters of a seating system and any adjustments made and must understand the effect on the client/user. Seating requires critical thinking, analysis, and integration of knowledge by the therapist. The actual mechanics of seating system configuration changes may be delegated to qualified support personnel, but the evaluation, specification, and fitting should never be relegated to anyone other than a skilled seating therapist (i.e., physical or occupational therapist).
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In this chapter, the concepts of the evaluation for and prescription of a therapeutic system will be described, and a strategy for defining the specifications will be developed for a client. However, an exhaustive review of all available products is beyond the scope of this text and the fact is that specific device-related information would soon be outdated. More importantly, seating for the client with SCI needs to be individualized based on examinations, assessments, and interventions. There is no such thing as the "best wheelchair" or the "best cushion," although there may well be an optimal wheelchair configuration or cushion for the individual in question. Upon completion of this chapter, the reader will understand seating system selection and configuration for the client with SCI ...