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?
2. What is your role in the use of dynamic seating? Choose all that apply.
3. What category of dynamic seating are you using most?
*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?
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.
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?
9. Do you believe our field needs more
dynamic seating product options?
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.