Monday, November 25, 2019
Seating Assessments - The What, Where, When and Why
It still amazes me when I am involved with a complex seating assessment and the user advises that this is the first time they have had a MAT assessment done or they haven’t had this type of assessment since they were a child. As I heard this again last week from an active full time wheelchair user with significant non-reducible asymmetries, I decided to talk about the MAT component of the seating assessment this week!
Are you doing MAT assessments as part of a seating assessment? Are you a wheelchair user that has never heard of a MAT assessment? This week we will take you through a seating assessment and discuss the what, where, when and why of a MAT assessment.
This flowchart is part of the online workshop for spinal seating NSW – there is a link at the end of the blog to the online course
What is involved in a mobility and seating assessment? If someone’s mobility impairment requires them to complete all mobility and activities of daily living from the wheelchair they should have a seating assessment. The seating assessment will include the assessor discussing the mobility needs, documenting historical information in relation to the impairment, looking at and measuring any existing wheelchair and seating, looking at the home environment, discussing goals, discussing other environments, the MAT and taking measurements.
Seating assessments are usually completed by Occupational Therapists or Physiotherapists. For some funding systems you need to see a therapist who has met the funder’s minimum requirements through a competency pathway, others may state an OT or PT, in which case you should look for a therapist who is experienced in Wheelchair and seating prescription.
A seating assessment should identify postural and functional goals and then taking a biomechanical approach, identify how to support the posture to meet the user’s goals. Both the therapist and the user should wear loose, comfortable clothing that will not restrict movement. For best outcome, a seating assessment should be done prior to the identification of potential trial equipment. The trial parameters will be identified at this assessment and then appropriate seating. (IMAGE A)
What is a MAT?
MAT is an acronym for Mechanical Assessment Tool. When completed in full it has 3 parts to it, the first part is the seated evaluation where the therapist will identify the posture whilst sitting in the existing chair. This part of the assessment can assist in identification of any postural issues currently being experienced in the existing system. The therapist will potentially feel your hip bones to ascertain how symmetrical you are sitting as well as making notes about how you are sitting and about your current equipment. It is good to articulate what is liked and not liked about your current equipment during this process. The therapist wants to determine what’s working and what could be improved so it’s good to talk about any difficulties being experienced with the current wheelchair or seating. Any places or tasks are identified that could be completed but are limited due to the existing seating or mobility device.
The next part of the assessment requires a supine evaluation (Supine means lying on back). This is around identifying the amount of movement in hip, knee and ankle joints. Essentially, they are looking at the capacity the body has to be in a seated position. The assessor will passively move legs into positions required for sitting and feel for tone and how much range of movement there is. It doesn’t matter if you can’t move your legs, the therapist will do it for you. They may measure this movement using a special ruler called a goniometer (Image 5, of goniometer ) or they may just take note of the movement range.
The 3rd part of the assessment is the simulation or the unsupported sitting component. This involves mocking up the ideal seated position based on the information from the first two parts of the assessment and taking measurements in this position for any new seating that may be required. This assessment is more crucial for people that are unable to sit without support as this will determine what and how much support the seating in the wheelchair needs to provide. The measurements are taken once the positioning has been determined to ensure the sizing will appropriately support needs. (Image 6 MEASURMENTS IMAGE)
When is a MAT done?
A MAT will usually be done prior to trialling a new wheelchair or seating system. It may also be done as part of a review of existing equipment to assist in determining if that equipment is still meeting needs. A MAT can assist in determining if there have been any physical changes in posture or range from the last time the seating or mobility base was prescribed. Completion of a MAT will assist in identification of the correct supports so it should be completed prior to the identification of a trial wheelchair.
Where is a MAT done?
A MAT assessment should be done on a plinth (Treatment bed) this surface is firm so enables the therapist to determine the movements fluidity and range without the impact of a soft surface hiding the movements. This is why seating clinics will often get clients to attend an assessment at their facility prior to setting up a trial at home. Some modifications to the MAT process may be necessary if completing in a person’s home or community setting without access to a plinth; If the seating assessment is completed in the community the therapist may bring a massage table. If done on an air alternating mattress, consider putting it to transfer mode or deflating it. If appropriate the assessment can sometimes be carried out on the floor.
Why is a MAT done?
By biomechanical design, people are not built for sitting, our skeletal system would have very different shaped sitting bones if so. A MAT is completed to assist in understanding the capacity of a person’s seated position. If postural tendencies and reductions in range are not considered they can have a negative impact on positioning, pressure risk and function. By working out what position is optimal, the required supports can be identified to support that position and then replicated with a trial of potential equipment.
To effectively identify seating requirements, points of control and required supports, it is best practice to perform a MAT as part of the seating assessment.
If you are a therapist and work with users to identify mobility and seating equipment, then keep your MAT skills up to date! There is an online course you can do here: https://www.aci.health.nsw.gov.au/networks/spinal-cord-injury/spinal-seating/module-3/the-mechanical-assessment-tool-mat
We offer several hands-on workshops and education opportunities to assist in learning more about MAT or building confidence in skills to complete this assessment.
Contact firstname.lastname@example.org to find out more information. Our education team is also happy to discuss any learning opportunities or clinical dilemmas.