The Clinician's Seating Handbook

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Ben's Story

  • Phoenix

Ben, an 87-year-old male, had suffered a stroke (CVA) and osteoarthritis. He had a history of pressure injuries and spent up to 14 hours per day in his chair and used a patient lift for all transfers.

Background

  • 87 years old.
  • CVA.
  • Osteoarthritis.
  • History of pressure injuries.
  • Hoisted for all transfers.
  • Spent approximately 14 hours each day in his chair.

Problems with old chair

  • Little head support.
  • No tilt in space or gravity-assisted positioning.
  • This contributed to the fixed kyphotic curve which Ben had developed at his cervical spine and neck.
  • This made it difficult and painful for him to lift his head or extend his neck.
  • His visual field was compromised and restricted.
  • His safety when eating, drinking or respiring was impaired and the risk of aspiration was high.

Ben would often slide down the chair and was continually developing red areas on his sacrum for which he was nursed in bed to alleviate the pressure and shearing forces experienced when seating.

Caregiver Issues

The caregivers reported that Ben;

  • Was difficult to position in his chair in the morning;
  • Would regularly slide down the chair throughout the day. This was strenuous for the caregivers and also Ben. This increased the shear forces as he would ‘slide and return’ many times per day.
  • Was very difficult to move throughout the home as there was no push handle on the chair.

Postural Issues

Marked spinal kyphosis

  • Made activities such as eating and drinking difficult.
  • Also limiting his visual field and interaction.

Sliding forward in the seat

The curved position of his spine combined with the inadequate seat depth was encouraging him to slide forward in chair. This provided insufficient femoral thigh support.

Pelvic obliquity

  • Ben’s pelvis was uneven as the right side was lower than the left.
  • This caused an imbalance in weight and pressure distribution.

Pelvic rotation

  • Ben’s pelvis was observably rotated to the right.
  • Evident from the position of his lower limbs.
  • Ben had a leg length discrepancy.

Intervention

It was suggested that a tilt in space chair would be beneficial to Ben and would improve his postural alignment and reduce or prevent further kyphotic deterioration.

A Seating Matters Phoenix™ chair was chosen due to the extensive upper body and head support.

Qualitative Client Feedback

Ben expressed that he was more comfortable in the new chair and was able to interact and communicate with others in the room.

Phoenix

  • Complex Upper Body Support
  • 45° Tilt
  • Fully Adjustable

For highly dependent patients with complex postural and seating needs, the Phoenix has been clinically designed to provide maximum postural support and comfort. Accommodating a variety of spinal conditions, the Phoenix adapts to the changing needs of patients in ICU, HDU, SCI and through rehabilitation, or to meet the long term needs of a progressive condition.

Postural Changes

  • The curved position of bens head and spine was supported and accommodated using the adjustable later, head and shoulder supports.
  • The strain on bens shoulder muslces was lessened due to the arms being adjusted to suit bens arm height.
  • Tilt and space was used to change the position of the centre of gravity.
  • His visual field was improved and was a much safer position for drinking, feeding and respiring as his head and neck were supported in a more extended and functional position.
  • Pelvic obliquity and rotation were eliminated by providing a supportive seating surface that was adjusted to bens physical measurements

Caregiver Family Feedback

After assessment and in light of Ben’s difficulty weight bearing, it was recommended that the carers use a full hoist in order to effectively position Ben in the chair each morning. After educating the caregivers and staff as to how to position Ben, they felt more involved with Ben’s care and postural management and were motivated and enthused to take part in this every day.

Functional Changes

Ben’s chair could be easily moved throughout the home. With the ease of manoeuvrability, he could spend time in different environments without having to compromise his posture or positioning by transferring to an unsupportive wheelchair. This was particularly evident at mealtimes when Ben could be transported to the dining room in his clinical therapeutic chair.

Social Interaction

The caregivers reported that Ben’s improved position and the manoeuvrability of the chair facilitated better communication and interaction with others. He was now able to move throughout different rooms within the home and spend time with more residents and staff.

The improved head position facilitated better voice projection and respiration, meaning his communication and speech was more audible and clear. In addition, Ben did not fatigue as easily in this activity and could participate for longer periods of time without becoming tired and strained.

Impact on Skin

  • Correct positioning and the use of tilt in space have significantly reduced the risk of pressure injury development.
  • Ben’s contact between his body and the supporting surface was maximised.
  • This helped to evenly distribute pressure and prevent high interface pressures under any bony prominences.
  • Tilt in space redistributed the weight distribution and pressure from his sacrum and buttocks to his back.
  • The same level of pressure management materials is included in the back and headrest of the Phoenix™ as standard to protect this area too.

Next Steps

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