In Complex Rehab, One Word Is Full of Possibilities
- By Laurie Watanabe
- Nov 01, 2016
ACTIVE PEOPLE: SOLARSEVEN/ISTOCK.COM
It’s ironic that an industry called seating and wheeled mobility
has at times been static when designing systems for clients with
complex needs. In the past, the strategy was often to position
them in their wheelchairs and then make sure they stayed in
exactly the same place all the time.
That scenario required wheelchair users to do something ablebodied
people were not expected to do: Stay still. Yes, there were
weight shifts — intermittent tilting and reclining, or push-ups to
relieve pressure. But in between, wheelchair users were set into
prescribed, largely static positions that were expected to suffice
for hours every day.
The human body and mind aren’t meant to remain placid, and
complex rehab’s buzziest term right now might be dynamic, meant
to describe seating or mobility that moves or changes much more
frequently, quickly and functionally than in the past.
But within that single word are several different interpretations,
because fittingly, there is more than one way to move.
Currently, the word dynamic is applied to complex rehab in a few
- Dynamic seating: Seating systems and components often
described as moving with the client, typically when the client
experiences spasticity or high muscle tone and pushes against
seating components. A client might lean or push against
positioning components, such as a harness, intentionally, such
as when leaning forward to reach something on a table. Can
also include seating systems that can be very easily, quickly and
repeatedly adjusted to fit clients’ needs.
- Dynamic feedback: Systems designed to provide movement
in response to the client’s movement, which can aid with
proprioception and balance, and can help to reassure clients
with sensory issues.
- Dynamic wheeled mobility: Wheelchairs that can change
aspects of their configuration very quickly and repeatedly in response to changes in environment or a client’s functional
The different interpretations have a couple of things in
common. Wheelchairs or seating systems with dynamic features
must still optimally carry out their primary positioning and
mobility functions; those goals can’t be sacrificed for the sake
of the dynamic components. And ideally, dynamic features will
work in concert with the rest of the system to provide a whole
experience greater than the sum of its components.
As Steve Mitchell, OTR/L, ATP, says of the different types
of dynamic technology now available, “What they [all] have in
common are improving function.”
Check out these “dynamic dynamos,” complex rehab components
and systems that feature different dynamic functions,
all in the name of better accommodating clients with complex
Swing-Away Lateral Bracket
What makes it dynamic: Includes
a unique telescoping feature that
allows the pad to be locked at varying
depths without requiring the use of additional links.
How the wheelchair client benefits: The telescoping feature
provides additional lateral pad pressure prevention. A complication
frequently seen with non-adjustable lateral pads is the increased pressure
that develops between the user’s trunk and the lateral pad. For clients
who pose a significant risk for skin breakdown, especially as a result of
an aggressive seating posture (e.g., hypertonicity, repetitive or writhing
motions), the telescoping function will allow slight pad adjustments to
be made on a routine basis. Adjustments can be made while the client is
seated in the wheelchair, bringing the pad toward the posterior aspect of
the client’s trunk, repositioning in neutral and/or advancing the pad to
the anterior trunk — all by adjusting the depth of the telescoping base.
This adjustment allows for a shift in pressure application and the prevention
of pressure injuries or skin breakdowns under the laterals.
USA’s Easy Fit
What makes it dynamic: Adjustable micro-modular
seating is infinitely adjustable
and flexes to accommodate the
client while maintaining the
client’s position. Matrix Seating
also flexes with the wheelchair
movement resulting in shock
absorption and reducing sheer
How the wheelchair client
benefits: The adjustable micro-modular custom mold can be added to
or reduced, as the user’s size requires. For example, Matrix Seating can
be easily grown to accommodate weight gain and body shape changes.
Matrix Seating adjustability can enable incremental changes to positioning
in order to provide orthotic spinal correction.
Symmetric Designs’ Axion
it dynamic: Enables headrest pads and head
positioning devices to rotate with
the user’s head, transforming
headrests into dynamic positioning
How the wheelchair client benefits: When
the Axion is implemented with the user’s head
support, it allows the head support device
to rotate, resulting in reduced shear forces,
increased peripheral vision and users can now
have their head supported while still having
freedom to move their head horizontally.
What makes it dynamic: Features Active Standing
Technology that enables
a user or caregiver to
facilitate motion with the
arms that is reciprocated
in the legs.
How the wheelchair
client benefits: Simulates the motion of
which provides increased
range of motion at the
ankles and hips while also weight bearing. Adjustable resistance cylinders
can also be engaged to provide additional possibilities for cardiovascular
conditioning. Users complete a self or assisted transfer in a seated
position and use the hydraulic or optional electric lift to stand. Sit-tostand
provides a gradual transition to standing and allows those with
tightness the ability to progress toward full extension.
What makes it dynamic: Bodypoint
dynamic posture supports include proprietary
materials to control the amount of
stretch and provide comfortable movement.
The manufacturer tests to ANSI/RESNA
WC-3: S3 2013 Standard for Postural
Support Devices to ensure product safety
and performance. The dynamic PivotFit
provides a body-contouring shape with
curve-hugging Laminar Pads. This support
is used for shoulder retraction and/or trunk
rotation. The carefully engineered swivel
buckle equalizes tension to allow for precise
pad placement for an individualized fit.
How the wheelchair client benefits: Jordan (pictured) gained stability and head
control using the dynamic PivotFit. Now
he operates a head array mouse system for
computer use in school and for fun.
This article originally appeared in the November 2016 issue of Mobility Management.
Laurie Watanabe is the editor of Mobility Management. She can be reached at firstname.lastname@example.org.