Custom Molded Seating: When Off-the-Shelf Solutions Won’t Work

Q&A with Kelly Waugh, AssistiveTechnology Partners

Q: For what types of clients is custom molded seating a good option?

Kelly Waugh: Use custommolded seating when your strategy is to apply intimate surface contact to areas of the body that are contoured in order to:
• Accommodate moderate to severe deformity.
• Maximize support,and therefore stability, throughout trunk and lower body.
• Inhibit/block excessive abnormalmovement.
• Prevent postural collapse when the counterforces required to do so are large, or when area of body requiring support is contoured.
• Maximize pressure distribution for comfort and/or maintenance of skin integrity.
Based on the above objectives, custom molded seating can be a good option for individuals who display the following:
• Fixed deformity: Moderate to severe fixed deformity.
• Severe postural collapse of trunk: Minimal active movement or complete paralysis of trunk muscles (or extremely low muscle tone), which results in significant postural collapse in an upright position that cannot be controlled with linear supports or off-the-shelf generic contoured backrests.
• Excessive uncontrolled, abnormal movement that cannot be controlled without intimate surface contact.
• Skin breakdown from high peak pressures over bony prominences, especially when fixed deformity is present.

Q: Is custom molded seating particularly helpful for certain diagnoses or medical conditions?

KW: Custom molded seating is labor intensive and expensive; therefore, the bottom line is that it is indicated when you cannot achieve a client’s objectives using off-the-shelf products.
I have not found custom molded seating to be “particularly helpful” for any (particular) diagnoses… Indications for use depend more on thecharacteristics of the user — type of postural problems and functional goals of the individual. 
However, I will say that custom molded seating is not a good option for individuals who need to be able to move their trunk or buttocks in order to be comfortable, transfer, reach objects in their environment, etc. Because, usually, custom molded seating will limit active voluntary movement.

Q:What kind of learning curve is involved? How long does it take to get comfortable with this technology?

KW: There is a HUGE learning curve, and a significant risk of error and poor outcomes. It takes quite awhile to become skilled at creating a mold, and there is a lot involved in theprocess — clinical skill in determining and achieving desired postural alignment (often requiringassistance of a skilled clinician), as well as technical skill in creating the shape and utilizingthe specific manufacturer’s technology. Many errors can occur, which will result in poor outcomes.
For this reason, when I am considering custom molded seating for a client, my final decision has to take into consideration both the technology available to the RTS that I am working with (as some molding technologies work better for certain types of clients than others), as well as their skill and experience working with that technology. Even though I may think that custom molded seating is the best solution for a client, if I don’t think that I can get a good outcome based on the resources available, I will recommend something else.

About the Author

Kelly Waugh, MA, PT, ATP, is an assistive technology specialist with Assistive Technology Partners at the University of Colorado at Denver. Waugh has served as chair of the RESNA/ISO Wheelchair Seating Standards Working Group.

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