The Power of the Pen: How Journaling Can Help to Create Optimal Positioning

hand writing in journal


While Complex Rehab Technology is indeed complex, two of the most powerful tools in the quest for creating the optimally functional seating system might be a pen and a notebook.

In the hands of your client, a family member or caregiver, that notebook can gather the kind of information that’s difficult to capture during relatively brief clinic appointments.

Positioning at Home

Gabriel Romero is VP of Sales & Marketing for Stealth Products. In addition to all the high-tech electronics and space-age materials that Stealth Products uses, Romero is a big believer in the powers of observation… including observations that aren’t necessarily possible when you’re seeing a client for just an hour at a time.

“You can’t expect that what [the family] sees all the time is also going to happen at a 9 a.m. clinic visit, when [clients] are well rested,” Romero pointed out. Instead, positioning difficulties “happen at 2 p.m. Or it’s an environment that triggers it: Maybe [positioning problems] happen more when they go outdoors and they start to bounce around in gravel and dirt, and their positioning gets lost.”

That’s the type of information that clinicians and suppliers aren’t able to see.

“That’s why it’s so important to journal,” Romero said. “The more a family member journals when they get new equipment or when something’s changed… just journal for a month. You’ll start to see critical things in a month’s time.”

While taking detailed notes can be helpful at any time, Romero especially appreciates those notes when the seating team is trying a new regimen. “We used to tell people all the time when we were trying aggressive positioning: Look for redness. That redness doesn’t happen years afterwards; it starts to happen quickly, depending on the position. That’s a key thing.”

Romero advises family members and caregivers to note any changes in behavior, no matter how subtle. Is the client seemingly trying to avoid making contact with an armrest, for example? Does a non-verbal wheelchair user suddenly seem reluctant to be in the wheelchair?

“If you see something different, if you see discomfort, if you notice excessive sweating — it’ll show you that something’s going on here and maybe some adjustments need to happen,” Romero said. “Something could be different with the cushion, something could be different with the back.”

Caregivers and family members are usually keenly aware of what’s routine behavior and what’s not — and when something different happens, Romero suggests they write it down so they can share notes — good and bad — with the seating team.

“It takes a village,” he said, “and the more that the village is prepared with information, the more we can talk about what’s being experienced. A parent or spouse or loved one is always with them, and they know. They’ll know pretty quickly.”

This article originally appeared in the Seating & Positioning Handbook 2021-2022 issue of Mobility Management.

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at

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