The mat examination is a critical component of a wheelchair seating assessment because it determines the seated angles and support surfaces required by the client. With time constraints, the mat exam is often skipped. However, if we disregard the mat exam, the seating system will likely fail to meet client’s needs and time may be wasted in the long run. So, kick off your shoes, and hop up on the table!
Symptoms & Causes
During the mat exam, the client is examined both in supine and sitting on the edge of the mat table. As you go through the exam in each position, it’s important to describe the client’s reflexes and muscle tone and their influence on body movements and posture. Be sure to note any range of motion limitations as well.
It is also important to look for causes, not just symptoms. For example, if you note a posterior pelvic tilt, try to determine why it is present. It may be that the client’s hamstrings are tight and pulling the pelvis forward, or the client is actively extending and pushing into this posture.
Starting in supine eliminates the forces of gravity, allowing assessment of available range which impacts the seated position. Here is a step-by-step for this exam:
- Place the client in supine on the table.
- Starting with the pelvis, can a neutral pelvic position be achieved?
- Determine also if a symmetrical spinal position can be achieved.
- Flex the hips and knees slowly until the pelvis moves out of neutral (typically into a posterior pelvic tilt). This determines the seat to back angle of the seating system.
- If the hips cannot be flexed to 90 degrees without movement of the pelvis, then a seated angle of greater than 90 degrees is indicated.
For the seated exam, you can use the following process:
- Sit the client on the edge of the mat table. Note that you may have to sit behind the client to provide adequate support.
- Once the client is seated on the edge of the mat table, take note of the following:
- Position of the head, neck, and trunk as well as active control
- Influence of tone and reflexes
- Amount of support is required.
- Using this assessment, determine what seat to back angle (or trunk to thigh angle) promotes an upright head (even if a head support is still required) and how much lateral and anterior trunk support will be required to facilitate a seated position.
The Mat Exam may feel a bit intimidating. Grab a colleague and practice on each other first! This will make the actual client examination easier.
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