A Healthcare Worker’s Guide to Seating Assessments – eBook

Our assessors have over 200 years of experience combined, so we wanted to take full advantage of their knowledge and expertise. We’ve written an eBook that will give you all the details you need to know when it comes to carrying out a seating assessment; from the initial contact with the client, to the measurements and specialist cushions to consider.

Sneak Peek

We wanted to give you a sneak peek of what to find in The Healthcare Professional’s Complete Guide to Specialist Seating Assessments eBook, so read on to become a master of seating assessments…

Sitting is a major part of our lives. We work, relax, talk, read, and eat whilst sitting. Many of us don’t even think about it, but we constantly make little adjustments to our posture whilst we’re sitting. We move our buttocks, change our arm position, add or remove cushions, change the chair height, put our feet up or down, lean to the side, or recline backwards.

When movement is reduced due to illness or disabilities, people can’t make these adjustments so easily.

And when you consider that the elderly and disabled are often sitting for even longer than most, it begins to dawn on you that getting seating right for these individuals is crucial.

Now picture this: you are unable to move, or shift position all day, and there’s no getting up and stretching your legs. You can’t adjust your backrest, change the lumbar support setting, or slide your chair back and forth.

Uncomfortable?

In fact, there’s a whole list of unpleasantries that come with incorrect seating:

• Poor posture
• Joint, muscle, back, or shoulder pain
• Irritated tissue or pressure damage
• Poor circulation
• Difficulty in getting up
• A lack of independence
• Reduced confidence, or social isolation
• Contractures and deformities

We could go on, but these numerous factors boil down to one thing: reduced quality of life.

The impact of correct seating and good posture

The flip side and more positive way of looking at this is simple: you can have an impact on improving people’s lives, through carrying out a detailed seating assessment.

At its core, according to Pauline Pope, this is what good posture looks like:

1. It facilitates effective functional performance
2. It’s energy efficient
3. It does not harm the body systems.

Many of us are all too quick to rush into the seating assessment without looking at the bigger picture.

By talking to the staff and the family and others, we can discover all sorts of valuable pieces of information which we can use to create our seating goals. If we pause and ask ourselves the question, “what do we want to achieve with a new chair?”, there’s a whole list of possible outcomes.

It’s a good idea to write your seating goals down and discuss them with everyone who’s involved.

This way, not only do you get a full holistic assessment, but you can be sure that you are getting all the information to make your decisions. You also get everyone on board with the change as they understand what we’re trying to achieve, how we’re trying to achieve it, and why we’re doing it in the first place!

Factors to consider

Before trying the client in a chair, these are some of the factors you might want to think about (in no particular order):

• How mobile are they? How do they transfer?
• Can they sit up without support? If so, how long for?
• Can they alter their position themselves whilst sitting?
• How long will the person be sitting for?
• How comfortable can we make them? Where and how do they experience discomfort at the moment?
• Is it safe to leave them in a chair? Are they at risk of sliding out? Is it safe to let them operate the chair themselves? Can they stand unaided? Will they try to stand even if they can’t? Are there pets or children in the house?

To see the full list of factors, download The Healthcare Professional’s Complete Guide to Specialist Seating Assessments.

Posture and the pelvis

A proportion of the time spent in most seating assessments should be devoted to pelvic positioning – it’s that important.

The pelvis is the foundation of seating — good posture starts with the pelvis, and the pelvic position dictates how the spine and legs are positioned.

If you aren’t used to assessing the pelvis position, you may want to get someone to help show you the next bit. Before you start, make sure the person and anyone with you knows what you are going to do and why you need to do it — make sure you have their permission to touch them first.

Thankfully, the pelvis has some bony prominent points on it which helpfully tell you what it’s up to. These are called the Anterior Superior Iliac Spine (ASIS) and the Posterior Superior Iliac Spine (PSIS).

To find the ASIS, put your hand on the front of their hips and locate the Iliac crest/hip bone. Palpate frontward from here. ASIS is a sharp notch above the femur/thigh bone when seated.

The PSIS is located on the back, just above the buttock. It can usually be seen and felt under the indents just above the buttock.

The position of the ASIS and PSIS in relation to each other is the basis of your postural assessment. In an ideal situation, the ASIS and PSIS must be level, with the pelvis tilted ever-so-slightly forwards (known as minimal anterior pelvic tilt). It’s worth mentioning at this stage that of course, some people have a fixed deformity which makes it impossible to get complete alignment.

For further information on the posture and the pelvis, download the eBook.

Common postural abnormalities and what to do about them

When it comes to abnormal positioning, there are lots of fancy phrases that get thrown around — I’m sure you’ll have heard of some of the conditions we mention below. However, don’t be intimidated — they aren’t as complicated as you may think.

We’ve also covered other postural deformities like:

• Anterior Tilt
• Pelvic Obliquity
• Pelvic Rotation
• Abduction and Adduction
• Kyphosis
• Scoliosis
• Contractures
• Leg Length Discrepancy

To see even more hints and tips on how seating can help to alleviate postural conditions and abnormalities, download our Seating Assessment eBook.

Pressure care in seating

If you’re a healthcare professional, you’ll know that pressure care is a huge subject.

The interesting thing is, seat sizing has a huge impact on both posture and pressure care. So if you get seat sizing correct (we’ll go into this in more detail later), you’re over halfway there.

So always bear in mind that all three — posture, pressure care and seat sizing – are closely linked.

WHAT IS A PRESSURE ULCER?

“A pressure ulcer is a localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear” — EPUAP & NPUAP 2009.

Pressure ulcers are also known as bed sores, pressure sores, or decubitus ulcers.

They occur when there is an interruption to the supply of oxygen and nutrients through the blood not being able to circulate. Cells die and the skin and tissue deteriorates, resulting in a pressure injury.

HOW LONG DO PRESSURE ULCERS TAKE TO FORM?

Contrary to what you may think, it’s very quick.

A study done in the lying position by Amit Gefen suggested that “pressure ulcers in subdermal tissues under bony prominences very likely occur between the first hour and 4 to 6 hours after sustained loading”.

That’s scary when you think about it, and it shows the importance of getting the chair correct right from the start.

CAUSES OF PRESSURE ULCERS IN SEATING

There are many factors that contribute towards the formation of a pressure sore. It may be one of these factors, or it could be a combination of several:

For more information on how pressure effects seating and see a more comprehensive list of causes, download our eBook.

HOW TO PREVENT PRESSURE ULCERS IN SEATING

Everyone knows the famous phrase for buying a property: ‘location, location, location’. When it comes to pressure care, the catch phrase is slightly different:

Prevention, prevention, prevention.

So always remember: prevention is better than cure.

Pressure ulcers cause considerable pain, discomfort and cost, and they take much longer to heal than they do to create.

So if a patient is at risk, ensure you do something about it. It’s much better to overcompensate and be safe than sorry. Make sure you prescribe something that will suit their future needs as well, particularly if their condition is likely to deteriorate.

This leads us nicely onto our five seating pressure prevention strategies…

To see our full five-fold pressure prevention plan, download The Healthcare Professional’s Complete Guide to Specialist Seating Assessments.

Medical conditions and how they impact on seating needs

Many people have specific disabilities, diseases and conditions, and often there are specific seating hints and tips for patients depending on their diagnosis.

Whilst these observations and ideas are based on years of experience of working with clients with these conditions, it’s important to note that everyone is different, and what works for most people won’t work for everyone. It’s down to the seating specialist to assess the situation.

We’ve not gone into a huge amount of detail here as we have specific blog posts on each condition in relation to seating, and we’ll keep adding the links to new articles as they get written — so keep checking our blog to see what we’ve covered.

STROKE PATIENTS

A stroke, otherwise known as a Cerebral Vascular Accident (CVA), is usually caused by the blood flow to the brain being cut off, often due to a blood clot. It’s important to note that many people recover from strokes, so a specialist chair may only be needed for rehabilitation.

Often a good level of lateral support will be needed, as will head support, a tilt-in-space action, and a mobile base, as detailed in our blog post.

You may want to look for something with flexibility which can be altered to suit the patient’s needs over time.

SPINA BIFIDA

When a baby’s spine and spinal cord don’t develop properly during pregnancy, defects such as a gap in the spine can occur. This is known as Spina Bifida.

Symptoms can include weakness or total paralysis of the legs, incontinence, and a loss of skin sensation in the legs and bottom. Some people with Spina Bifida also have learning difficulties.

As the condition is from birth, consider a chair that can easily be adjusted in terms of size and support, particularly if they are still growing.

Chairs with fully adjustable backrests are great for Spina Bifida patients, as they can be ‘moulded’ to the shape of the spine to ensure support and comfort and reduce the risk of pressure damage.

BARIATRIC CLIENTS

Obesity is becoming a challenge to healthcare systems throughout the world, and the UK is no exception.

Bariatric or plus-sized patients obviously need chairs with a higher weight limit, but your considerations shouldn’t stop there.

Ensure the weight limit includes a safe margin to cope with any fluctuation in body weight over time (you may be wise to check previous medical records to see if this is likely), and to withstand any sudden movements, such as sitting down in the chair suddenly.

Also think about the distribution of weight; clients with oedematous legs may need a reinforced legrest to cope with the extra weight of the swelling. Tilt-in-space with high legrest elevation is a must for clients with oedema…

We’ve also taken a look at conditions like:

• Arthritis, Osteoarthritis, and Rheumatoid Arthritis
• Osteoporosis
• Multiple Sclerosis (MS)
• Dementia / Alzheimer’s Disease
• Brain Injury
• Cerebral Palsy (CP)
• Huntington’s Disease
• Motor Neurone Disease (MND)
• Parkinson’s Disease
• Spinal Cord Injury (SCI)
• Incontinence

To find out more about how numerous other medical conditions affect seating, download our free eBook.

Chair types, categories, and features

At the risk of teaching, you how to suck eggs, in this section we’re going to discuss types of chairs.

Bear with us though; there may be some tips and options here that you haven’t thought about!

When thinking about the type of chair needed, we always ask one question:

Is the patient hoisted?

As a general rule, if the person is hoisted for transfers, a care chair offers better support, is easier to hoist from, and can be wheeled from room to room to cut down on hoisting transfers.

If the patient is still standing for transfers, you’ll likely be looking at a riser recliner chair or a high seat chair.

However, as with any rule, there are exceptions.

Sometimes the client will need the support of a care chair even if they are still standing, and some care chairs will accommodate this.

Other patients may have on and off days — ie., days when they can stand and days when they need to be hoisted.

In these circumstances, it’s best to make a decision based on:

1. Priorities (eg. is support more important than easy standing transfers?)
2. What will be most suitable for them for the majority of days?
3. Will their condition change over time – what will be needed in the future?

Now let’s look at the main types of chairs available in the UK:

• High Seat Chairs
• Manual Recliners
• Rise and Recline Chairs
• Care Chairs
• Dining Chairs
• Office Chairs
• Tilt-in-Space Wheelchairs

To see the full list of chairs available and how they can help with postural and medical issues, download the Specialist Seating Assessment eBook.

How to measure for seat sizing during a seating assessment

Before we start, here’s a few tips:

• A tape measure with both inches and millimetres is an important part of a seating assessor’s arsenal. Make sure you keep one in your bag!
• Care chairs are often measured in millimetres, with high seats and riser recliners measured in inches. Don’t ask me why, it’s something to do with traditional craftmanship versus modern manufacturing methods for care chairs!
• If you are using a fabric tape measure, don’t let it bend around the body as this can produce a very different measurement.
• It’s best to carry out the assessment in the chair you are prescribing wherever possible. Alternatively, a dining chair works well. In some situations, you may have to measure up whilst the client is in bed, but it’s advisable to work with someone who has done this before if you’re not experienced in this.
• Explain what you will be doing before starting measuring or touching the patient.

To find out all the details about measuring for seat height, depth, width, armrest height, and back height, download our Specialist Seating Assessment eBook.

Justifying your seating prescription decisions

If you are a healthcare professional, there’s a few reasons why you should document your findings and justify the decisions you’ve made:

• Legal reasons — you have a duty of care to the patient, and you need to show why you made decisions, so you are covered for any eventualities. For example, if a case of clinical negligence went to court, you could show how the seating provision was carefully considered and didn’t contribute towards the case.
• To aid future care – You may want to look back at your notes in future to see how the client has changed.
• To obtain funding – If the funding for the chair is being provided by the local authority, equipment loan store, other public body, or a solicitor fund, you’ll need to explain why the chair is required, the benefits, and the risks of not having the chair.
• To be able to go back to your reasoning as to why the chair with these functions was supplied in the first place.

To see a full list of hints and tips for writing seating justifications, download our specialist seating assessment eBook.

After the seating assessment

Seating provision doesn’t stop at the assessment!

There are still a few important steps to take:

• Chair setup — Make sure the chair is adjusted correctly for the patient, otherwise it won’t do its job properly!
• If relevant, create a seating care plan to document how the chair should be setup, how the client should be seated, and how long for.
• Train the patient, carers, or family members on the correct use of the chair.
• Schedule return visit(s) to reassess the client and adjust the chair if necessary.

Let’s look at these steps in more detail…

Download the eBook to see the full step-by-step guide.

A final word…

Some specialist seating companies will arrange free seating training events to help you expand your knowledge further. These can be lunch-and-learn sessions or more in-depth events.

Alternatively, you can learn at your own pace by watching online training videos.

Once you’ve absorbed all the information in this guide, you’ll want to keep up to date with the latest seating hints and tips as well, which you can do by following the Vivid Care blog or by signing up to our e-newsletter.

Download the full 88-page Healthcare Professional’s Complete Guide to Specialist Seating Assessments for free right here.