ISS 2012: Seating & Mobility Professionals Unite

VANCOUVER, B.C. - While the annual International Seating Symposium (ISS) is seating & mobility's premier educational event for clinicians and complex rehab technology providers, there's no denying that catching up with old friends and making new ones is a rewarding and valuable part of the overall experience. Connecting and reconnecting with colleagues over drinks or dinner can be every bit as important as time spent in educational courses, in business meetings or in the exhibit hall.

Several presenters at this year's ISS - which took place once again at the waterfront Westin Bayshore in March - focused on how important eating and drinking are to human beings, not just for necessary nutrients and hydration, but also for their social well being and inclusion.

While that may not sound like a topic directly linked to seating & mobility, the speakers quickly proved that it is - and like so many of the event's other speakers, they had the audience thinking about how seating & mobility touches so many other aspects of consumers' daily lives.

A Common Challenge, A Devastating Impact

Though pre-symposium workshops began Tuesday, March 6, the ISS kicked off officially the morning of March 7, with keynote speaker John Patrick, M.D., professor, history of science, medicine & faith, Augustin College in Ottawa, Ontario.

Patrick spoke on "Ethics: Caring for Individuals with Disability: The Tyranny of the Measurable & What Individuals with Disability Teach Us About Meaning." He discussed the high prevalence of malnourishment in children with spastic quadriplegia, and commonly seen results: low body weight, frequently feeling cold, depression.

Patrick also mentioned the high physical and emotional toll on parents and caregivers who spend hours each day feeding their children, only to see them remain malnourished due to problems with eating and swallowing. Enteral nutrition, Patrick added, is not necessarily an easy solution. Introducing the idea as an alternative to feeding by mouth can make caregivers feel that they've failed to care adequately for their children, despite often heroic efforts. Janice Duivestein, MRSc, OT/PT, feeding team leader and neuromotor program manager at Vancouver's Sunny Hill Health Centre for Children, delivered the next morning's first plenary session: "Sit, Eat, Thrive: Making the Connection Between Posture & Mealtimes."

Duivestein led off with some startling statistics: that dysphagia - difficulty swallowing - is experienced by 11-23 percent of adults. The risk for dysphagia increases for people over the age of 50 and for people with neurological illness or injury.

Among clients seen by seating & mobility professionals, the rates for dysphagia are even higher, Duivestein said. Some 40-50 percent of people who've had a stroke, approximately 70 percent of traumatic brain injury patients, and up to 80 percent of children with cerebral palsy also experience dysphagia.

In addition to obvious physical consequences, such as malnutrition, low energy, vitamin deficiencies, dehydration and muscle weakness, Duivestein pointed out that difficulties in eating and drinking can lead to social isolation and reduced participation in social activities, anxiety, stress for caregivers and depression.

Seating & mobility professionals are in a good position to intervene, however. Duivestein pointed out that using tilt, improving the stability and balance of the head and trunk, and changing head positioning can help improve many clients' abilities to eat and drink by mouth, thereby improving not only their physical health, but their social interaction, as well.

Putting the Pieces Together

There were plenty of other educational sessions that seemed to complement each other, like pieces of a puzzle coming together. The paper presentation given by Laura C. Titus, BScOT, University of Western Ontario, was called "Power Tilt Use for Pressure Management from the User's Perspective." Titus's research explored barriers that keep wheelchair users from using tilt or from tilting back far enough. Among the responses gleaned from clients, Titus said, was that they equate full tilt to lying down.

"Would you lie down in a restaurant?" one client asked, in explaining why he doesn't fully tilt.

Another observation: That tilting back past 30-35 degrees required use of a headrest, which many clients disliked. Asked what a headrest on a wheelchair would suggest, one client said, "I guess maybe that you are weaker or more vulnerable."

The next paper presentation was by Stephanie Tanguay, OT, clinical education specialist, Motion Concepts, and Lois Brown, MPT, ATP, clinical education specialist, Invacare Corp. They spoke on "Power Positioning System Use: Results of a Consumer Survey."

Brown and Tanguay worked with clinical colleagues to gather responses to a consumer survey that asked, for instance, "Did your therapist ask you to demonstrate a weight shift?" Yes, said 80 percent of clients - though they also said that most pressure sore prevention information was relayed verbally rather than in writing, and about 73.6 percent reported tilting or reclining as far back as their systems allowed.

Asked if they'd ever had a pressure sore despite using power tilt/recline, 61 percent of clients surveyed said yes.

An Industry, Intersecting

The coming together of professionals and ideas, as always, was a huge part of this year's ISS. On the opening morning of the event, O'Donnell reported nearly 700 attendees pre-registered, with more than 200 exhibitors participating. People from 27 countries besides Canada and the United States made the trip to Vancouver, and attendees included PTs, OTs, physicians, rehabilitation engineers, nurses and speech pathologists.

Keynote speaker Patrick had opened the event by saying, "Disability is a troubling word." For a week in Vancouver, seating & mobility professionals examined their own understanding of that word and what impact their work could have on it.

The industry takes up that question again in Nashville in March 2013. That's when the 29th ISS takes place with the theme "Building the Future." In fact, the call for papers is currently on (

About the Author

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

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