The Physio's Guide to Optimal Patient Seating

In this article we will take a look a some general information on the management of older aged residents with seating and wheelchair needs. Firstly, appropriate seating and wheelchairs are crucial to provide residents with optimal comfort and freedom to move.

Key issues for consideration are:

·       Resident Comfort

·       Correct positioning and Posture

·       Pressure reduction for areas like the buttocks and sacrum

·       How the resident is going to move or be moved about

It’s important to think about which type of chair the resident may need, be it a Standard Wheelchair, Tub Chair, or Arm Chair.  When it comes to these types of chairs, make sure you ask yourself these important questions.

 
Armchairs:

1.     Does the resident have easy access to a variety of venues and social events?

2.     If the resident is ambulant does the chair allow them to stand with ease?

3.     Do staff need to assist the resident to stand?

4.     If staff need to use a stand hoist, can it effectively approach the chair?

5.     Would an electric chair raise assist the resident and staff?

6.     Can the resident’s feet rest comfortably on the floor?

7.     Does the resident need to elevate their feet regularly?

8.     Would an electric recliner/ raise chair better meet the resident’s needs?

9.     Does the resident need a cushion?

 

Wheelchairs:

1.     Does the resident wish to self-propel the wheelchair?

2.     Is the resident at a high risk of pressure areas?

3.     Would a tilt in space wheelchair be appropriate?

4.     Do the legs need to be elevated?

5.     Is the chair easy to push and maneuver?

6.     Will the resident be taken outside in the wheelchair?

7.     Does the resident have any major postural concerns e.g deformity or contractures, leaning to one side or bending forward, asymmetry.

 

A basic physiotherapy assessment of someone’s needs for customized seating will include an assessment of:

·       Pain

·       Contracture

·       Posture

·       Pressure issues

·       Mobility levels

·       Quality of life issues

Care Plans for residents should incorporate the following:

·       The chair or wheelchair the resident sits in when out of the bed

·       Whether the resident has a specially prescribed cushion to sit on

·       Whether the resident should be assisted to stand up, walk or self-propel a wheelchair

·       When and for how long the title-in-space mechanisms should be used

·       Whether leg rests should be elevated and for how long

Common mistakes:

1.     Not putting on brakes when the resident is stationary or only putting on one brake

2.     Not positioning the resident so buttocks are well back and central

3.     Not using specially prescribed cushions

4.     Not keeping equipment in good working order e.g not repairing faults or broken parts, not keeping tires properly inflated.

When it comes to correct seating for older people, knowing the in’s and outs can allow everyone to rest easy.