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.

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