For many of the clients who we see in therapy, posture and mobility are paramount goals. Fortunately, a good majority of patients learn to modify their posture and improve their gait easily.
But many individuals with lifelong disabilities rely on wheeled mobility and appropriate seating to enhance their level of independence. These complex clients rely on the expertise and knowledge of their rehab team to recommend and order appropriate equipment that fits well and meets the needs of their lifestyle.
What Should Therapists Know About Seating & Mobility?
As a therapist, it’s important for you to provide appropriate seating and mobility evaluation and assessment to determine whether the equipment is fitting appropriate. You should also be able to competently discuss issues regarding equipment for complex clients with their physicians as well as local rehab technology suppliers and assistive technology professionals.
Errors made when assessing your clients’ needs and in measuring and recommending equipment can not only be costly, but can also have a detrimental impact on your clients’ quality of life. Plus, in many cases, the equipment in question is expensive and may not be easily returned or exchanged once it is issued to the client.
Common consequences associated with improper seating and mobility assessments include:
- Pressure sores, which could require medical intervention or even surgery and lead to time lost from work or school due to recovery. The rehabilitation and lost wages costs of pressure sores are high. The average cost of inpatient care for a patient with a pressure ulcer is nearly double that of a patient without one.1
- Contractures, which are permanent musculoskeletal deformities that may require bracing or surgery to correct, leading to time away from work or school for recovery. As with pressure sores, both rehab and lost wages costs are high.
5 Considerations for Therapists When Evaluating Seating
When recommending seating or positioning and wheeled mobility, keep these considerations in mind:
- Start with the pelvis! Once the pelvis is positioned securely and in its best resting position, the spine, head, and extremities will align.
- Consider all aspects of the person’s daily routine. What activities does the person participate in from the time they wake up until they go back to bed? Which of these can be done independently and which require assistance? What environments does the person spend their time in? How long are they there? These might include their home (both the inside and the outside), their community, their school or work, and recreational activities they participate in.
- How will this person travel with the recommended equipment? Do they require a vehicle, adapted or otherwise? Are they using local public or commuter transportation? Will they be taking longer trips that require a train or a plane?
- Who will train and practice with the client and their family or caregivers until they are expert users?
- Who will service the equipment if repairs are needed?
You can learn more about assessing complex clients for seating and mobility needs as well as how to order appropriate equipment in the following MedBridge courses, presented by myself and Ann Jackson, PT, DPT:
- Paul, M. (2018). Costs associated with pressure wounds in the U.S. inpatient hospital population. Innovation in Aging, 2(Suppl 1), 920–921.