The Clinician's Seating Handbook

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Rachel's Story

  • Atlanta

Rachel, a 94 year old female, had arthritis in her left knee and a history of falls. She mobilized with a walking frame and needed assistance for all transfers*.

Background

  • 94-year-old participant.
  • Arthritis in her left knee.
  • History of falls.
  • Mobilised with a walking frame.
  • Assistance of one for transfers.

Problems with old chair

  • The chair was not made to fit her size, nor specially adjusted to suit her small frame and stature.
  • The long seat depth and high seat height were causing her to slide from the chair.
  • She was in a near horizontal position for long periods of the day.
  • There was high pressure underneath small, bony load bearing areas like her heels, sacrum, shoulders and the back of her head.
  • This was very uncomfortable position.
  • It was a non-functional and limiting position for Rachel who would have been an independent lady and able to complete most activities of daily living with little assistance.

Caregiver Issues

The caregiver’s main frustrations were that no matter how well they tried to position Rachel she would always slide into the posture shown in the Before image, ‘bracing’ herself in the chair with this extended position. It then became very hard to assist Rachel to stand as she could not position her feet behind her knees in a ‘ready stand’ position or use the armrests for a propulsion and support.

Postural Issues

On assessment it was found that Rachel had normal range of motion at her joints. She had no postural difficulties that would cause her to slide from the chair as she did. It was purely due to oversized seating that could not be adjusted to suit her needs.

Intervention

In the assessment stage it was identified that Rachel had few postural difficulties or complaints. Her joints were flexible and would be easily accommodated in a sitting position. She needed customised seating which would accommodate her small physique, while safely facilitating stand transfers and participation in other activities of daily living.

It was decided that she should use a Seating Matters Monaco™ chair.

Rachel no longer slid from the chair.

Qualitative Client Feedback

Rachel felt that the chair was very comfortable and she became happy that she could enjoy a scone and cup of tea easily without fear of spilling it on herself or choking.

Monaco

  • Multi-Functional
  • Designed for Mobility
  • Designed for Comfort

The Monaco has been designed for comfort and mobility with independence at the forefront of its design. The Monaco reduces sliding, discomfort and shear as it helps to maintain positioning of the pelvis.

Postural Changes

  • Rachel no longer slid in a near-horizontal position.
  • She was able to easily maintain her upright posture and recruit flexion at her knees and hips.
  • This is a natural sitting position and exerted much less strain on her lower limbs and back muscles.
  • Her pelvis was supported in a neutral position, which prevented any secondary complications or abnormal positioning of the spine or lower limbs.

Functional Changes

Hand function

  • Rachel was able to maintain an upright and functional position from which she could easily eat, drink and participate in many other activities.
  • She no longer needed to brace herself in the chair and had regained free hand and arm function.
  • The arm supports of the Monaco™ chair were also set at a height that suited her and as is evident from the After image, she was able to use these for support and stability.

Transfers

  • With the adjustable angle seat and with the help of correct positioning, Rachel was able to safely transfer to a standing position with minimal assistance of one caregiver.
  • This was completed with a lot less strain on both Rachel and her caregivers and facilitated safe moving and handling techniques.

Impact on Skin

As a result of her almost horizontal position in the previous chair, Rachel was concentrating the majority of her weight in sitting over a smaller surface area and underneath bony prominences, such as the heels and sacrum. Since using the Monaco™ chair, which was made and adjusted according to her size, the risk of developing pressure injuries was significantly reduced as Rachel was spreading her weight over a larger surface area. Her feet were also loaded entirely through the footplate, which was made with the same pressure management materials as the seat.

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