This article is sponsored by Stealth Products. In this Voices interview, Mobility Management sits down with Filipe Correia, Latin America and Europe Business Development Manager at Stealth Products, to explore global perspectives on seating and postural support. Drawing on his experience across European markets, Correia discusses the clinical and cultural differences that shape priorities in posture, variation, and movement. From static seating challenges to multi-segmented systems and fatigue management, he highlights key insights U.S. clinicians can learn from international approaches, and how seating strategies are evolving to support long-term outcomes around the world.
Mobility Management: At a high level, what does the European mobility landscape look like today?
Filipe Correia: In Europe, the mobility landscape varies widely from country to country. Each country has its own reimbursement system, product standards, and clinical practices, which makes the landscape much more fragmented compared to the U.S. While the U.S. has state-level differences, it still operates under a single federal system with Medicare and Medicaid. In Europe, there’s no such unifying umbrella.
Take Portugal and Germany, for example. In Portugal, there’s no formal product catalog dictating reimbursement. Products must still be registered with the appropriate government agencies, but clinicians have significant discretion. They manage a yearly budget and can prescribe anything from diapers to a 50,000-euro power chair, as long as they justify the clinical need.
In contrast, countries like France and Spain follow a much stricter model. They maintain a defined catalog of approved products, with fixed reimbursement rates. That approach gives less flexibility to clinicians but offers a clearer structure. It’s not necessarily better or worse, it’s just different.
Across Europe, with 30 to 40 countries all managing mobility care in their own ways, the result is a highly diverse and complex environment for both clinicians and suppliers.
How does the approach to seating and postural support in Europe compare to what you’ve seen in the U.S.?
The core principles and clinical goals are the same on both sides of the Atlantic. Whether you’re in Europe or the U.S., when a person needs seating and postural support, the objective is to improve function and quality of life. So at a fundamental level, we’re all aiming for the same outcomes.
What differs is the structure of the system and how those goals are achieved. In the U.S., one of the things I admire is the role of the ATP or the Assistive Technology Professional. That role doesn’t really exist in most European countries. Instead, you typically have large rehab clinics with clinical teams doing the assessments, and then dealers who are responsible for delivering the product. But in some countries, there’s a real disconnect between the clinical side and the dealer side.
That lack of coordination can create problems. In certain cases, you may have a salesperson making decisions on something as complex as a power chair assessment instead of a clinician. That’s where the U.S. model has an advantage. The ATP serves as a bridge between clinical expertise and product knowledge, ensuring that the solution is both appropriate and technically sound.
So again, the goals are aligned globally, but the path to get there is often quite different depending on the system in place.
And how do those differences influence how clinicians and manufacturers prioritize postural variation?
Postural variation is a really important topic, and it often doesn’t get the attention it deserves, especially for certain groups of users. When you look at the product options available today, there are several ways to support postural changes throughout the day. You’ve got tilt, recline, and dynamic systems like dynamic headrests, backs, or footrests. But many of these features are typically designed with high-tone clients in mind, especially those who exhibit a lot of extension or spasticity.
But what about low-tone clients? They need postural variation just as much. Changing position throughout the day helps with comfort, head control, endurance, and overall function. It’s not just about managing tone, it’s about enabling someone to stay in their chair longer, in a more comfortable and effective way.
For me, postural variation means giving someone the ability to shift and move naturally throughout the day, the same way I do. I sit at a desk for six or more hours a day and probably change positions a thousand times without even thinking about it. But then we ask someone in a wheelchair to do those same activities—stay alert, attend meetings, interact with people—all while staying in the same position the entire time. That’s unrealistic. It leads to fatigue, discomfort, and eventually resistance to the seating system itself.
Tilt can help, but it’s often misunderstood. We tend to use tilt as a long-term solution—tilting someone back 45 degrees for hours at a time. That’s not ideal. When someone is tilted that far back, they’re looking at the ceiling, they lose function, and their body starts to compensate in ways that can be harmful. In places like Scandinavia, they don’t even call it tilt, they refer to it as a multi-position chair, which better reflects the intent: short bursts of positioning for rest, then a return to upright.
Recline also allows for variation, but it comes with trade-offs. Reclining changes the seat-to-back angle and often leads to the client sliding forward. That means someone has to reposition them repeatedly throughout the day, which is time-consuming and not sustainable for caregivers or family members.
So yes, we have some tools for postural variation, but we’re not always using them in the right way, or for the right reasons. Ideally, postural variation should let users shift naturally throughout the day to either be more functional or to rest, just like anyone would in an office chair. But it needs to happen without compromising their position, pelvic alignment, or stability, and without requiring constant manual repositioning. That’s the real goal.
How are the fundamental principles of seating systems taught or implemented differently in Europe compared to the U.S.?
It really depends on the country. Like I mentioned earlier, in some parts of Europe, the system relies heavily on what the dealer does with the client. That creates a risk, because if the dealer isn’t well-trained in the science of seating, biomechanics, and postural alignment, it can lead to issues in product selection and setup.
That’s where the U.S. has a big advantage. You have ATPs (Assistive Technology Professionals) who are incredibly well-trained and act as a bridge between the manufacturer, the dealer, and the clinician. They understand the clinical side and the technical side, which helps ensure that the client gets the right solution.
In that sense, I’d say the U.S. has a much stronger structure in place to ensure that seating goals are met and applied consistently. In Europe, some countries lack that kind of defined role, and that can make it harder to implement these fundamental principles at scale.
What key insights from your experience in the European mobility market would you share with American providers that they might not have considered?
That’s a tough one, mainly because comparing Europe to the U.S. isn’t always fair. There are so many different systems across European countries. Some offer great examples worth emulating, while others don’t translate as well.
That said, one positive thing I’ve seen here in Europe is a strong connection between manufacturers, clinicians, and dealers, at least in certain countries. That relationship can be very collaborative, with all parties working together closely to support the client. In the U.S., from what I’ve seen, there’s sometimes a bit of disconnect between those same groups. I don’t mean that as a criticism, just an observation.
Having someone like an ATP in the U.S. is a big asset, but it’s also important that the clinician, the dealer, and the manufacturer are all aligned. In parts of Europe, manufacturers are often directly involved in assessments and fittings, which really strengthens that collaborative model.
Another thing worth noting is the reimbursement structure. In some European countries, the system is quite supportive, almost surprisingly so. For example, if a child has divorced parents, the reimbursement system may cover equipment like strollers, wheelchairs, or beds for both households. It’s built around the idea that the child deserves consistent support, no matter where they are.
So if there’s one piece of insight I’d share, it’s that streamlining reimbursement in the U.S. could really help strengthen those critical connections between the key players, and ultimately lead to better outcomes for clients.
Are there different strategies or technologies in Europe that you’ve found especially effective for addressing fatigue and postural muscle support?
I think the way people understand and address postural fatigue is pretty consistent across regions. That said, I don’t think we’ve fully tapped into everything we can do to manage it. Traditionally, the strategy in both Europe and the U.S. has been to position the client with strong support and try to maintain that position as long as possible, hoping it reduces fatigue. We’ve relied on tools like tilt, recline, lumbar supports, positioning belts, and anterior harnesses to stabilize the trunk and pelvis. These tools have their place, but the overall approach is pretty static.
What’s become clear to me is that more isn’t always better. One of the earliest lessons I learned in my career is that less is more when it comes to seating systems. The more components we add, the more we risk interfering with the client’s function, and the more likely we are to create discomfort or frustration. It’s not always economical either.
That’s why we launched a system called EPIC, which has been a game-changer. It allows for postural variation throughout the day without compromising pelvic stability, something that’s been missing in most traditional seating strategies. In Italy, for example, EPIC has been in use for the last two years, and it’s been transformative. It doesn’t matter whether the client has high tone or low tone; it gives them the ability to move naturally during the day, which is critical.
This ties back to a point I made earlier: rigid reimbursement systems can really limit innovation. When you introduce something new that doesn’t neatly fit into an existing category, it’s hard to get it approved or reimbursed. But in countries like Portugal, the UK, Italy, and France, we’re seeing more openness to these types of systems, and the benefits are clear.
Clinicians will understand this: what we’re really trying to avoid is prolonged isometric contraction. That’s when a muscle is contracted and held in a fixed position without movement. It’s like holding your arm out while gripping your phone—light at first, but after five minutes, it feels heavy. That’s the same fatigue we’re asking wheelchair users to endure when they sit in the same position for hours without any variation.
Postural variation gives their muscles a break. It allows for micro-movements that release that contraction and reduce fatigue, without sacrificing stability. When done right, it improves upper trunk control, head positioning, and functional ability with the arms, all of which directly impact quality of life.
How is the multi-segmented approach to seating and its impact on head positioning applied across different health care systems?
That’s a really interesting question. For a long time, head positioning was treated as the last piece of the puzzle in a seating system. The approach was reactive: if a client had low tone and their head dropped forward, we’d just jump to fixing it with a headrest or support, without first asking, “Where is this coming from?” We weren’t always taking a holistic view of the body.
But when we started applying a segmental approach to the spine, we realized how everything is connected. If I allow the pelvis to fall into posterior tilt, it will affect the lumbar spine. That, in turn, influences the thoracic spine, which then impacts the cervical spine, and ultimately, head position. So if you’re only looking at the head and trying to hold it up without addressing what’s happening lower down, you’re missing the real issue.
Historically, the mindset in many systems, especially where movement is feared, has been to block movement entirely. That’s why we’ve seen so many belts, harnesses, and rigid supports built into seating systems. But here’s the thing: movement is life. We use movement in therapy, in treatment, in everything we do. If you don’t allow movement in a sitting system, you’re almost guaranteed to see problems with head control over time, either due to fatigue, discomfort, or compensatory postures.
Let’s not forget: the head is the heaviest part of the body in terms of leverage. If the body isn’t balanced and supported, it becomes incredibly hard to hold the head upright. I often refer to a study that really illustrates this point. The average head weighs about 10 to 12 pounds, and that’s the amount of force the neck has to manage when the head is in a neutral, upright position.
But once the head begins to fall forward—even just 15 degrees of forward flexion—the force on the neck increases dramatically, up to 27 pounds. If the head goes to 30 degrees of flexion, it jumps to 40 pounds of force. Think about that: 40 pounds of strain distributed across seven small cervical vertebrae. That’s enormous.
So again, if you’re forcing someone to stay static in their chair all day, you’re causing a chain reaction through the spine that can lead to serious problems with head control. This is why postural variation and segmental support are so important. They give the body the balance it needs, so the head doesn’t have to compensate for everything else.
How is movement within seating systems viewed from a European clinical or engineering standpoint, especially in terms of long-term outcomes and funding priorities?
Movement is still something that makes a lot of people nervous, starting with the manufacturers. If a client moves a lot in their seating system, the product has to be strong enough to handle that movement without breaking, twisting, or failing. At the same time, it still has to provide proper support and allow that movement to happen safely and effectively.
So far, most manufacturers have responded by simply trying to make their products stronger and more rigid to resist movement. Instead of designing systems that move with the client, they’re focused on creating products that can withstand movement. But that doesn’t address the real need.
There’s also an imbalance in the types of products available. Most seating systems that allow for movement or postural variation are designed for high tone clients—those who extend a lot or have spasticity. But low tone clients also need postural variation throughout the day, and unfortunately, many of the current systems don’t support that.
That’s why there’s still a long way to go in how manufacturers approach movement and postural variation. The EPIC system, like I mentioned earlier, is a first step in the right direction. It’s an exciting innovation that’s already changing the way we think about dynamic seating by embracing movement rather than resisting it, and doing so in a way that supports a broader range of diagnoses. It’s reshaping how we approach long-term outcomes in seating across Europe and beyond.
What are some of the most promising or innovative postural variation solutions you’ve seen in Europe, and how do they compare to what’s currently being adopted in the U.S.?
I’ve mentioned the EPIC system a few times throughout our conversation. It was originally designed by a brilliant Belgian physiotherapist named Barb Haven, who was focused on segmenting the trunk in a way that supports postural variation without compromising pelvic stability. The goal was to allow the client to move more freely while actually increasing their functional ability.
This system is now manufactured in the U.S. by Stealth Products and is being sold worldwide. So if we’re talking about a truly innovative postural variation solution that’s gaining traction both in Europe and the U.S., it’s the EPIC. It’s really the first system that delivers on the promise of postural variation in a meaningful, scalable way.
Everything else we’ve seen is either built with high-tone clients in mind or designed to manage unwanted movement, not to encourage healthy variation. So for now, the EPIC stands out as the first true postural variation system that’s being used across markets, and hopefully, it becomes the standard going forward. It’s just an incredible innovation.
Editor’s note: This interview has been edited for length and clarity.
Stealth Products is a manufacturer of durable medical equipment and specializes in products that improve the users’ lives. We stand on innovation and quality in our products and look forward to a bright future moving forward. To learn more, visit www.stealthproducts.com.
The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact [email protected]