Clinically Speaking

Dynamic Seating: The Results Are In!

Dynamic seating has always been an area of interest for me. Before any specific product options were available, we were trying out different strategies at our seating and mobility clinic to provide some movement, absorb forces and protect equipment.

So just what is dynamic seating? It is movement that occurs within the seat and/or wheelchair frame in response to force from the client. Dynamic components absorb force, which in turn assists the client back to a starting position.

Dynamic seating can be used to meet a variety of client needs. Being curious about just who was using this technology and how, I decided to put together an informal survey. This survey asked 10 questions using Survey Monkey and was sent out via e-mail to the following listservs: Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) AT-Forum, RESNA Wheeled Mobility and Seating Special Interest Group, National Registry of Rehabilitation Technology Suppliers (NRRTS), and the American Occupational Therapy Association (AOTA) Technology Special Interest Section.

In total, 103 people completed the survey, though only 100 responses were ultimately visible, as this was the survey’s participant limit. The participant receiving the invitation e-mail had to click on the link to reach the actual survey in Survey Monkey. The survey began with a definition of dynamic seating, to ensure that the participant clearly understood what technology the survey was referring to.

The purpose of the survey was to get a sense of the number of professionals using dynamic seating, the goals of using this technology, and product limitations. Personally, I have seen great benefits from using this technology with the clients I work with and have often believed that dynamic seating is underutilized and/or not considered for certain clinical applications.

Here, we show the survey questions and the results.

1. Do you currently use dynamic seating?

 dynamic seating use

2. What is your role in the use of dynamic seating? Choose all that apply.

 role in the use of dynamic seating

3. What category of dynamic seating are you using most?

 category of dynamic seating in use

*Modular: One or more separate dynamic components added to a wheelchair.
**Integrated: Typically, a wheelchair with integrated dynamic movement in more than one area.

4. To what body areas do you most frequently apply dynamic movement? Rank in order of usage, with 1 being most frequent and 5 being least frequent. In descending order:

  1 2 3 4 5 Average Score
Trunk 35.63% 32.18% 20.69% 6.90% 4.60% 3.87
Lower Extremities 30.34% 24.72% 31.46% 8.99% 4.49% 3.67
Pelvis 23.26% 25.58% 16.28% 20.93% 13.95% 3.23
Head 7.87% 16.85% 24.72% 35.96% 14.61% 2.67
Upper Extremities 8.33% 4.76% 5.95% 22.62% 58.33% 1.82

5. For which client populations do you most frequently apply dynamic movement?

 apply dynamic movement

Note: This question included a comment section. Nine participants commented. Five participants indicated both selections. Participants also indicated use with clients who have severe dystonia, low tone and traumatic brain injury.

6. For which purpose do you most frequently apply dynamic movement? Rank in order, with 1 being most frequent and 10 being least frequent. (Note: “Score” indicates the average score of all responses.)

  1 2 3 4 5 6 7 8 9 10 Total Score
To increase sitting tolerance and compliance 33.33% 25.56% 16.67% 8.89% 8.89% 2.22% 1.11% 1.11% 1.11% 1.11% 90 8.34
To protect wheelchair andseating hardware from breakage 31.46% 14.61% 11.24% 13.48% 5.62% 5.62% 3.37% 2.25% 3.37% 8.99% 89 7.28
To decrease agitation 3.49% 19.77% 24.42% 13.95% 11.63% 8.14% 9.30% 5.81% 1.16% 2.33% 86 6.76
To increase function 10.98% 13.41% 10.98% 12.20% 10.98% 14.63% 13.41% 9.76% 1.22% 2.44% 82 6.30
To reduce active extension 15.91% 7.95% 6.82% 10.23% 11.36% 6.82% 9.09% 17.05% 7.95% 6.82% 88 5.69
To provide active range of motion 1.22% 9.76% 9.76% 20.73% 7.32% 7.32% 12.20% 10.98% 12.20% 8.54% 82 5.18
To increase strength and postural control 6.17% 7.41% 4.94% 7.41% 8.64% 12.35% 16.05% 9.88% 16.05% 11.11% 81 4.70
To reduce energy exertion 1.18% 3.53% 5.88% 2.35% 11.76% 16.47% 14.12% 18.82% 15.29% 10.59% 85 4.14
To provide vestibular input 1.27% 3.80% 10.13% 5.06% 15.19% 8.86% 7.59% 11.39% 7.59% 29.11% 79 4.08
To increase alertness 0.00% 1.27% 2.53% 6.33% 6.33% 13.92% 13.92% 10.13% 30.38% 15.19% 79 3.46

7. What are the greatest challenges you meet in applying dynamic seating? Choose all that apply.

 dynamic seating challenges

Note: This question included a comment section. Eight participants commented. Additional challenges included proper use, proper training, alignment of the dynamic component with the joint, decreased ability to integrate multiple joints, caregiver understanding/compliance, and weight.

8. Do you believe that dynamic seating is underutilized in our field?

 underutilization of dynamic seating

9. Do you believe our field needs more dynamic seating product options?

 need more dynamic seating

What They Said About Dynamic Seating

In summary, here’s how our survey participants responded.

Usage: About 87 percent of respondents currently use dynamic seating, with 85 percent recommending, 68 percent working with clients using dynamic seating, and 48 percent supplying dynamic seating. Additionally, 66 percent use modular dynamic seating components, while 34 percent use integrated systems.

Application by body area: Dynamic seating is being used most frequently at the trunk, followed by the lower extremities, pelvis, head, and upper extremities. This survey did not specify in which direction movement was applied. Posterior movement of the trunk often allows posterior movement of the pelvis, depending on the specific dynamic components.

Client Applications: Of survey participants, 79 percent most frequently use dynamic seating with clients who have increased tone and 21 percent with clients who need movement.

Goals and Purposes: Ten purposes or goals of dynamic seating were proposed, and survey participants were asked to rank these suggestions in order of which “purpose” was most frequently the “goal” of using dynamic seating with clients. Listed in descending frequency:

  • To increase sitting tolerance and compliance.
  • To protect wheelchair and seating hardware from breakage.
  • To decrease agitation.
  • To increase function.
  • To reduce active extension.
  • To provide active range of motion.
  • To increase strength and postural control.
  • To reduce energy exertion.
  • To provide vestibular input.
  • To increase alertness.

Products Challenges: The greatest challenges were as follows, in descending order of frequency:

  • Funding
  • Durability
  • The client returns to a “starting position,” but is no longer in the desired posture.
  • The client does not return to a “starting position”; the dynamic component remains activated.
  • The client cannot activate/move the dynamic component.
  • Dynamic movement appears to worsen frequency or force of extension.

Finally, 85 percent of our survey participants believe dynamic seating is currently underutilized, 75 percent believe we need more dynamic seating product options, and 20 percent believe that current options could be improved.

Clearly, while many people use dynamic seating with their clients, this technology segment as a whole is still underutilized. The majority of survey participants indicated that they are using modular options and believe we need both more product options and improvement of current options. Product limitations mentioned includefunding challenges, durability, loss of position, difficulties with providing the correct amount of resistance, and weight.

Survey participants are using dynamic seating primarily at the pelvis and knees and most often with clients who have increased tone. The goals of dynamic seating use are overwhelmingly to increase sitting tolerance/compliance and to protect the wheelchair from breakage. However, a large variety of applications was identified.

How do these results influence practice?

Feedback from the field can direct product development, improvement, and training in use. These new and improved products can better meet client need and may also broaden clinical applications.

Education is needed to increase awareness of dynamic seating and its potential applications, including clients who can benefit from this technology, areas of the body where dynamic components may be utilized, and the broad spectrum of goals that may be met through dynamic seating.

This article originally appeared in the February 2017 issue of Mobility Management.

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