DME

Blog posts of '2019' 'February'

What Happens After the Mat Assessment?

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What happens after the mat assessment? We have to use the results of the mat assessment and work as a team, utilising the skills of the therapist, the supplier, and the manufacturer to meet the clients’ seating needs. There are many roles and people involved in the seating evaluation process beyond the supplier and therapist including the client, family, teachers, nurses, etc… Today, we will focus on the role of the therapist. As a therapist becomes more experienced and comfortable with mat assessments they may start learning about specific products and the ways those products could work for their clients. Initially though, the role of the therapist is to be able to communicate to the supplier their findings from the mat assessment.

 

 
During the mat assessment the therapist should be assessing if their client is in a neutral posture, or if not, where the asymmetry is coming from. This doesn’t mean that you have to remember exactly how to name, for example, a pelvic rotation, but you want to be able to tell the supplier that the client’s pelvis sits further backward on the right side. Once we determine that there is a right hip rotation, then we need to assess if this hip rotation is reducible or non-reducible. You may have also heard this term referred to as fixed or flexible. If the asymmetry that we see can be reduced back towards neutral, it is flexible, or if it is “stuck” and non-reducible, then it is fixed. Knowing if the client has reducible or non-reducible asymmetries is important in determining the best products for the client. If someone has a reducible asymmetry, then we want to make sure products are selected to correct the asymmetry towards neutral. If the asymmetry is non-reducible, then we will have products to accommodate to this asymmetry and assist with prevention of furthering the asymmetry.

The other key questions we need to think about would include: What are the goals of the client? Let’s take for example a client that has scoliosis and is leaning to the right. We determine, based on our mat assessment, that this is a reducible asymmetry and that we can use positioning products to achieve an almost neutral seated posture. However, during our goal setting, the client explains the importance of being able to reach objects off the ground for maintaining his functional independence. How does this goal guide our practice? In this instance, with correcting his posture we may prevent him from leaning side to side to reach the ground. We need to be sure when we are choosing seating and positioning products that we remember MOBILITY is our ULTIMATE GOAL. The goals as the therapist may not match the same goals as the client. For this example, the therapist would need to consider both their positioning goals and the client’s functional goals.

We also need to remember that our clients change over time. Their goals change, their posture changes, and their needs will change. We want to remember that this equipment whether it is the wheelchair, or the seating on the wheelchair, will need to last a reasonable amount of time. Therefore, we need to keep in mind the long-term goals and anticipate any long-term changes that might occur.

Finally, before you choose your solution remember that you need to determine the cause before determining the solution. There will likely be problems that require more than one intervention, or different problems that may utilise the same intervention. Remember to keep the client’s goals and the ultimate goal of mobility in your mind as you work towards finding their seating solution.

Next week we will take a look at specifics behind the design of seating products and how we know what type of product to choose for our client when we are looking at all the options.
 
Rachel
 
 

It All Begins with the Mat Assessment

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We spoke last week about 24-hour positioning and its importance for the client, but how do we know what products to use and how to position our client? This all begins with the mat assessment. The mat assessment is where we will be able to determine any postural asymmetries, decreased range of motion, contractures, muscle tone, and so much more for the client’s seated position. Although the mat assessment typically will be utilised for the seated posture in the wheelchair, it can be beneficial for any surface the client may be on throughout their day. If you have never completed a mat assessment or are still new to the process – the most important piece of advice is to remember to breathe, get hands-on, and write down what you feel/see. Mat assessments can be scary when you first start, but ultimately it will provide you with the information you need to provide the best care to your client. So where do you begin?

Begin first by trying to find a hard surface for your client. Not every therapist will have access to a mat and that’s okay. It is important to try to find a firm surface so that you’re not getting false information back. The client’s safety and well-being are most important, so be sure to make sure your client is safe on the surface you choose.

 

 

You want to assess the client in both supine and sitting. The assessment in supine will allow you to not only assess the client without the effect of gravity, but it will also allow you to safely assess the client’s range of motion. I have included a few great resources below on mat assessments and a few helpful forms you can utilise. It is important to either have a form to fill out, or to write down what you see and feel as you go along. The last thing you want to do is finish the mat assessment and then forget what you have just done! Once the supine examination is over then you can complete the sitting examination.

For the sitting examination, be sure your client is safe at all times! You may have to provide support by sitting behind your client or having a second person for safety. The seated examination will give you feedback on the client’s position with gravity, position of their head and trunk, their balance, and so much more. Here is where you can really get hands on and determine how much support the client will need in their wheelchair. I like to use my hands as laterals, chest straps, or as whatever positioning items I am thinking of to mimic their effects. Remember to give your client proper foot support during the sitting examination.

 

 

If I can give one piece of advice when learning mat assessments is to PRACTICE! Practice on your family and friends. Practice on other therapists. Feel comfortable with your process before you try to just jump two feet into a complicated mat assessment. The best way we can learn is through practice. Take a look at these great resources below and as always feel free to email/call with any clinical questions! I am here to help you.

Rachel

 

Resources:

Spinal Seating Modules
https://www.aci.health.nsw.gov.au/networks/spinal-cord-injury/spinal-seating/module-3

Mat Assessment Guide
https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0005/312791/RD5.2_Seating_MAT_Assessment_Guide.pdf

Permobil Seating and Positioning Guide
http://hub.permobil.com/wheelchair-seating-and-positioning-guide

24 Hour Positioning:

Should I be thinking about this for my client?

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Before we can answer this question, we first need to make sure we understand what 24-hour positioning is. I briefly discussed this last week as 24-hour positioning will be one of the main 3 themes you hear about this year throughout our weekly blog posts.

Let’s think about a circle, clock, or a pie. Now, let’s break this clock up into 24 hours instead of the typical 12. Think about how much time you spent on each surface you sat, stood, or laid down on. How many hours were you sitting at your desk? How many hours were you laying in your bed over the last 24 hours?

Now let’s think about this clock for your client. How many hours does your client spend on the bed each day? What about their wheelchair or their favourite sofa? Maybe their clock would like this this:

 

 

What does this mean and why does it matter to us? It is important for us as a therapist and every team member involved in the procurement of complex rehab technology to be involved in the appropriate selection of this equipment.

Many if not most of our clients have decreased or limited mobility and/or sensation. This means that they are at a risk of skin breakdown. It also means that they may not be able to maintain a neutral posture, and without proper positioning the client may end up with postural asymmetries. These asymmetries such as scoliosis and pelvic obliquities can put the client at further risk of skin breakdown but can also affect their functional independence. Let’s think about an example. Imagine that you never had a back to your chair that you sat in at work. Would you sit up straight throughout your day or do you slowly allow your spine to curve and end up with some thoracic kyphosis?

 

 

For me, I constantly find myself “slouching” or going into a thoracic kyphosis throughout my day. Now, what happens if I didn’t have strong enough muscles in my trunk to fix my posture? I would be stuck in that “slouching” position for hours of my day and eventually over time my muscles would get tighter and that “slouching” position would be my new normal position. The cycle would continue to progress until perhaps my posture was bad enough to start causing me pain and a cascade of other impairments. This is what can happen to our clients if they are not properly positioned throughout their entire 24-hour day and it is not just with sitting. We can think about how even the positioning in bed can potentially have more of an impact than the wheelchair that the client is only sitting in. What if the client is in their bed for 8-12 hours a day and only 4-5 hours a day are spent in their wheelchair? Have we thought about how they are positioned in their bed? My favourite example to think about for bed positioning is the neck and head. Many times, our clients will have 3-4 pillows under their head for comfort, but what happens to the position of their neck? Now, some of the clients may need this positioning for medical management, but if the client is safe to have less pillows, we want to keep the neck closer to neutral. I see numerous clients that have pain in their neck and forward head position limiting both their vision and functional independence, but perhaps it is not just the position in the wheelchair that is the issue. Perhaps instead it is that the client needs changes to their positioning in the bed first.

We will continue to explore the topic of 24-hour positioning, but I hope you finish this blog today with the idea that positioning on every surface matters. It is crucial for us as part of the team to consider every surface that our client is on throughout their day and how their position on that surface can impact not just their positioning, but also their well-being, participation, and independence.

Rachel

 

 

 

Happy New Year!
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Permobil is excited for 2019 and we have BIG plans this year to keep bringing you the most up to date and top information, products, and service!

In order to provide the best blogs and education for this year, we decided to return to the root of why we are all here: The end-user. To accomplish this, we chose a few topics that affect our end-users daily. We will then use these topics, or themes, throughout the blog posts this year. It is important to remember that whether we are discussing specific products, features of wheelchairs, or general concepts, that everything points back to the end-user.
 
The blogs for 2019 will primarily focus on 3 main themes: Shoulder preservation, independent access, and 24-hour positioning.

 

 

Shoulder Preservation
Shoulder Preservation is extremely important as many end-users require their upper extremities for their mobility in addition to everything that we ask of our shoulders every day. This places the shoulders at a high risk for injury. Often, we think about this only with manual wheelchair propellers, but many power wheelchair users experience shoulder pain as well due to the increased requirement for overhead activities. This year we will focus on shoulder preservation by talking about the shoulder anatomy and physiology, the products on the market to assist with shoulder preservation, and how simple changes can make a big difference when it comes to the shoulder.
 
Independent Access
Independent access can vary from talking about our community that we live in, our home and its accessibility, or the equipment that the end-user utilises. No matter what the discussion is about though, the key is that every person has the right to the same technical standards. This year we will focus on what independent access truly means, the equipment and technology that is helping to allow for this, and how we can continue to design and develop ways to further allow independent access to everyone at the same standard that many of us live in our everyday lives.
 
24-Hour Positioning
Think about a clock and how you spend your time. If we think of this clock as 24 hours and separate it into sections of time for our clients, how much of this time is spent on different surfaces? Is the end-user always in their wheelchair? Or, are they on several different surfaces throughout those 24 hours? Many times, the wheelchair is perfectly fit to the end-user and provides the end-user with positioning to maintain a proper neutral posture. The problem is that this is not the only surface the end-user is sitting on throughout their day. What about the child that is using a power wheelchair for mobility in school and comes home to sit on the sofa. The child just spent 7 hours being perfectly positioned and now is slouched on the sofa for the next 3 hours. Does this negate the past 7 hours of positioning? We will explore this year how we can take that positioning, and skin protection, across 24 hours to ensure the best possible outcome for the end-user.
 
I hope that you will find these blogs useful and meaningful. 
 
Rachel