Tuesday, October 29, 2019
Restraint or Enabler...Part of the prescription or an afterthought?
Over the past decade the debate has continued around the world…is a pelvic belt a restraint and therefore classified as a restrictive practice? Or is it part of the seating solution supporting functional postural positioning? This week we will look at the definitions of restrictive practice, restraint and the functions of pelvic belts.
Within the clinical reasoning process of a seating assessment, we need to identify points of control. If we consider the movements of the pelvis in the coronal plane we know that a neutral or a slight Anterior Pelvic Tilt (APT) is a more functional position than Posterior Pelvic Tilt (PPT). When a belt is applied to assist in maintaining a neutral position, we refer to this as a postural support, therapeutic support, (note the word support) or an enabler because by providing support we are enabling function.
With the pelvis as the foundation think about how we can successfully increase distal ability…by providing proximal stability! It is also important to understand these types of supports and postural needs so that this can be appropriately explained to our clients. They can then make an informed choice around their equipment options.
Pelvic positioning belts are often seen as being a safety belt, this is likely due to the use of seat belts in motor vehicles. In a motor vehicle the belt is a restraint, its sole purpose is to restrain someone in the seat in an accident. If a wheelchair is being used as a seat in a motor vehicle for travel the positioning belt does not negate the requirement of a seat belt in the vehicle. They each have a different purpose!
“Restrictive practices are defined as any type of support or practice that limits the rights or freedom of movement for a person with a disability”. There are 6 types of restrictive practices recognised:
We will now focus on the two areas of restrictive practice that are often referred to with the application of pelvic belts – physical and mechanical.
• A physical restraint is the use or action of physical force to prevent, restrict or subdue movement of a person’s body, or part of their body, for the primary purpose of influencing their behaviour. (https://www.ndiscommission.gov.au/regulated-restrictive-practices)
• This is when something is put on a person to stop or make it harder for the person to move or to control their behaviour.
• Sometimes a device is put on a person to help them to move or to stay healthy. This is called a ‘Therapeutic Device’. This type of device is OK as it can help reduce pain, improve health or help the person do an activity.
It is OK to use a therapeutic device when a health professional like a doctor or occupational therapist has approved it. The person with disability also needs to say it is OK. (Voluntary Code of Practice for the Elimination of Restrictive Practices – Disability Services Commission / WA Government)
Both definitions relate to behaviour and if being used in this way they meet the definition of restrictive practice. So, when is a pelvic belt a restraint and when is it an enabler…?
Ask yourself the following question:
We know that there are facilities out there that have very stringent restrictive practice policies that continue to impact on the prescription of a therapeutic support. It is still crucial that if you have identified the need for a positioning support, that you own it! Don’t include the recommendation based on being told that the facility has a restrictive policy and will not allow belts. Best practice indicates that you still make the recommendation and document the reasons how it will enhance function.
If you want more information on positioning supports, we offer educational workshops on seating and positioning and are always available to help you. Feel free to contact me at email@example.com.
Clinical Education Specialist
Tracee-lee Maginnity joined Permobil Australia/New Zealand in July 2019, as a clinical education specialist. She graduated Auckland University of Technology with a BHSc (Occupational Therapy) in 2003 and has since worked in various roles related to seating and mobility including assessing, prescribing and educating.
Tracee-lee is passionate about maximising functional outcomes with end users and the importance of education within the industry.