Complex Problem-Solving at Its Best

Q: As a clinician, what are your general goals for your seating & mobility clients? Can you give examples of what you hope a “holistic” seating & mobility solution can accomplish for your client every day?

Lois Brown: Creating a “wheeled seating & mobility system” requires a paradigm shift in how we prescribe and evaluate the eff ectiveness and efficiency of that proposed solution.

Often we prescribe the mobility device, followed by the seat cushion and back without evaluating the effect that contours and back adjustments have on propulsion efficiency, functional mobility and the client’s goals. Or we provide an ultralight chair with a heavy and high cushion that aff ects propulsion efficiency.

But what do they want to be able to do from the chair? For example, the client needs contours and heights that fully support the spine, but allow for trunk rotation and upper-extremity reach without obstruction.

We often use the term “Everything is give and take” in what some components allow, and others you have to sacrifice. Our job is to push that line and accomplish as much as we can for the individual.

Q: How do you keep these goals in mind as you work?

LB: For me, the most important part of the wheeled seating& mobility evaluation process is the time during the history and intake, where you are asking and “listening” to the client’s goals, challenges in their current equipment, their everyday functional tasks and responsibilities, whether it be work, child care, information on all the environments in which they need to function and their modes (not mode) of transportation they may use.

All the while we need to match the seating to their postures, not just for aesthetics and current postural needs, but to prevent secondary injury or progression depending on diagnosis. This is complex problem solving at its best.

Editor’s Note: Next issue, Lois talks in more detail about the benefits to be had when seating & mobility systems are treated as holistic solutions rather than separate parts in our feature story Backs & Cushions: All Together Now!

This article originally appeared in the January 2012 issue of Mobility Management.

About the Author

Lois Brown, MPT, ATP, is the rehab clinical education specialist for Invacare Corp., Elyria, Ohio. She is a frequent presenter on seating & mobility topics at industry events.

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