05th March 2024

Choosing the right chair for the patient with MS

We discuss the benefits and considerations of seating arrangements for individuals with multiple sclerosis (MS) to enhance comfort and mobility.

What is Multiple Sclerosis?

Multiple sclerosis (MS) is a lifelong autoimmune condition, which affects the brain and spinal cord. The body’s autoimmune system fights the myelin sheath, which is a layer of protection surrounding nerves of the brain and spinal cord.

MS can develop in any age, however it is commonly diagnosed in people aged in their 20s, 30s and 40s, and is 2-3 times more likely to occur in women than men.

Research has found that MS is the most common cause of disability in young adults.

It is imperative that the patient with MS receives a comprehensive seating assessment to identify their seating and postural requirements to ensure their needs are being met.

Some signs and symptoms include:	Challenges relating to seating:
Reduced/impaired mobility.	Difficulty maintaining correct seated position.
Difficulties with vision, balance and co-ordination.	Constant movement
Sensory impairments.	Increased risk of skin damage due to shear and friction
Fatigue.	Increased risk of falls during transfers
Reduced information processing ability, learning, planning and thinking	May require supervision/assistance during transfers
Poor postural control.	Difficulties using remote
Foot drop	Difficulty loading feet on foot plate
Spasticity and muscle stiffness	May experience extensor spasms, making seating difficult
Bowel and bladder issues	Cushion require waterproof covering
Pain	Comfort in sitting a priority

Symptoms can come and go, or can progressively get worse, depending on the type of MS the patient has. As the symptoms of MS fluctuate, during a relapse or remission, the chair should be adjustable to meet the changing needs.

Goals of seating should be discussed at the interim to identify the right chair to suit the patient; feeding, mobilising to other rooms, promote independence, facilitate transfers etc. Consideration should be given to how long the patient will be sitting in the chair, can the patient reposition independently, have they any current pressure sores?

Seating Considerations

Seat width: Ensure correct seat width of chair to stabilise the pelvis and prevent pelvic rotation and lateral leaning. Correct seat width will increase feelings of security, safety and comfort.

Seat depth: Seat depth must be adjusted to suit the patient to adequately load the whole lower limb. This will prevent posterior pelvic tilt and pressure injuries.

Foot support: The patient’s feet should be sufficiently loaded in the footplate to reduce risk of pressure injuries, increase comfort and prevent/prevent worsening of foot drop.

Cushion: The cushions should be pressure relieving to reduce the risk of developing pressure injuries due to pressure or shear. Patients can suffer with incontinence so cushions should be waterproof and machine washable to clean easily and reduce infection risk.

Motorized/manual: Consider the patient’s need for motorized control to maintain the person’s independence and facilitate effective repositioning for the patient and carer.

Tilt in space: Tilt in space function works by tilting the whole chair and maintaining the angles at the hips, knees and ankles. This facilitates frequent redistribution of weight and pressure which reduces the patient’s risk of developing pressure injuries and reduces discomfort.

Lateral supports: Lateral supports accommodate/correct postural deviations and help achieve and upright sitting position. A lateral back cushion can provide effective trunk support. An upright sitting posture is important for physiological functions, such as breathing and swallowing, for psychological benefits and for engaging in everyday functions, such as reading, or activities. Assess the patient’s ability to sit unsupported and their level of postural support required.

Transfers: Consider the patient’s method of transferring in and out of the chair. Depending on the patients level of mobility, you may need to accommodate an independent transfer, transfers with assistance of a carer, a sit to stand hoist, a sara stedy, or a full hoist.

Transfer Method	Considerations
Independent/ assistance of a carer	Feet should be loaded on the floor to reduce risk of falls. Chair may require rise recline function or anterior tilt to facilitate sit to stand movement
Sit to stand hoist/ sara stedy	Chair should accommodate this equipment to ensure patient is sitting back into the chair sufficiently to prevent posterior pelvic tilt.
Full Hoist	Chair must be compatible with a full hoist. Hoist must be able to fit underneath the chair and tilt in space function necessary to ensure correct positioning during transfer.

Seating Matters

Seating Matters has a range of therapeutic chairs which adapt and adjust to changing patient needs. The Sorrento chair offers the patient with MS, postural support and has tilt in space feature to redistribute pressure to reduce the risk of pressure injuries. It has anterior tilt to assist the patient with transfers when rehabilitating during remission. The handset allows the patient to control the movement of the chair independently, to facilitate independence and promote a sense of dignity. For the patient with more complex postural needs, the phoenix chair offers additional support to meet the patient’s seating and postural needs.

Seating matters understands that it is more than just a chair. Our chairs are designed with the patient and carer in mind.

Links

Link to MS Ireland https://www.ms-society.ie/

Link to MS society UK https://www.mssociety.org.uk/

References

NHS (2022) ‘Multiple Sclerosis’, available: https://www.nhs.uk/conditions/multiple-sclerosis/ [4th March 2024].

MS Society (2022) ‘What is MS?’, available: https://www.mssociety.org.uk/about-ms/what-is-ms [4th March 2024].

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