Specialist Seating – The Q&A Series Part 5: Conditions 3/3

Providing answers to some of the most commonly asked questions about Specialist Seating.

    1. What postural challenges can an individual with Parkinson’s disease experience?

    Parkinson’s disease is a neurodegenerative disorder of the central nervous system that belongs to a group of conditions called movement disorders, in which parts of the brain become progressively damaged over many years1. The signs and symptoms of Parkinson’s usually develop gradually and are mild at first. They vary from person to person but the main ones affect physical movement, including a tremor, slowness, muscle stiffness, postural instability and writing changes.

    The postural challenges that could present as a result include:

    • A stooped or flexed posture altering head position and increasing the risk of a fixed thoracic kyphosis
    • Leaning to one side resulting in an increased risk of a fixed scoliosis
    • Neck and back pain
    • Involuntary movements affecting postural stability
    • Abnormal muscle tone affecting postural symmetry
    • Contractures
    • Change in postural awareness (proprioception) increasing the risk of falls

     

    1. What seating is best to manage the signs and symptoms of Parkinson’s disease?

    Providing a chair for Parkinson’s disease, that is appropriately set-up for the individual with adequate postural support is critical for comfort, stability and management of abnormal movement patterns. Support at all body segments is needed, especially as a physical prompt to the head to promote safety and optimum physiological function such as swallow function, breathing and digestion.

    CareFlex chairs meet these key objectives through a range of functions and accessories:

    • Adjustability and flexibility will ensure the correct seat dimensions, including seat depth and seat width, especially as the individual’s needs change.
    • A ramped cushion can encourage pelvic stability at the back of the chair and aim to reduce the risk of sliding down or falling from the chair.
    • A reconfigured waterfall back can comfortably accommodate kyphotic postures, reducing the pressure at the apex of the thoracic spine.
    • An articulating headrest can further support an increased thoracic kyphosis if fixed.
    • For individuals who lean to one side and lack the ability to correct themselves back to an upright sitting posture the use of a contoured back or lateral supports may be indicated2.
    • For more complex postural needs, where safety within the chair is a concern, tilt-in-space can be considered following a risk assessment. Tilt-in-space can also encourage good energy management.
    • A negative angle leg rest can accommodate reduced range of movement at the knees should contractures be present.
    • Positioning aids, such as pelvic belts or chest harness following risk assessment, may also be indicated to maximise postural control.
    • WaterCell Technology (link) is at the heart of CareFlex seating; it provides a reliable and dynamic pressure redistributing solution to reduce pressure injury risk when used holistically as part of a 24-hour management programme.

     

    A rise and recline chair may be indicated for users who have the ability to stand independently but at times require assistance to do so safely. Rise and recline chairs should be comprehensively assessed and reviewed over time as they are not safe or appropriate for all users.

    Additionally, verbal prompting at regular intervals to adjust position in the chair may be indicated for those who lack postural awareness. It is also important to consider the environment and ensure any focal points, such a TV, is directly in front of the person3.

     

    1. How can specialist seating support an individual with multiple sclerosis?

    Multiple sclerosis (MS) is a neurological condition that affects the nerves in the brain and spinal cord, also known as the central nervous system. ‘Sclerosis’ means scarring or hardening of patches of tissue. ‘Multiple’ is added because this happens at more than one place in the brain and/or spinal cord4. Once diagnosed, MS stays with a person for life, but treatments and specialists can help them to manage the condition and its symptoms, which can include the following postural challenges:

     

    The correct chair would manage any postural challenges for individuals with progressive MS but also for those who experience relapses whilst assisting with their recovery during remissions.

    The HydroTilt offers a range of functions and accessories to fully support individuals who present with mild to moderate postural challenges:

    • Tilt-in-space, if safe and appropriate, can promote pelvic stability and energy management with the aim of encouraging normal movement.
    • A ramped base can further support the pelvis for security at the back of the chair.
    • A waterfall or contoured back can aid postural control and trunk alignment during periods of fatigue or weakness.
    • The addition of a tray can also allow the individual to maintain their occupation or hobbies.

     

    The HydroFlex offers high levels of adaptability for those with more complex posture and pressure management needs:

    • The flexibility is key for individuals with primary progressive MS or those who develop secondary progressive MS as it can be adapted and accessories fitted retrospectively as their needs change.
    • Back angle recline, following a risk assessment, can promote comfort and relaxation or support reduced range of movement at the hips due to contractures.
    • An articulating head support with adjustable wings can support the head in a safe midline position to promote social interaction and optimum physiological function.
    • The addition of a pommel can correct or accommodate windsweeping deformities.
    • Integrated WaterCell Technology can encourage maximum support with the aim of reducing the risk of pressure injury during periods of prolonged sitting.
    • There is also an ergonomic push handle to ensure the person’s support network can safely and easily handle the chair.

     

    1. How can specialist chairs support individuals with traumatic brain injury?

    Traumatic brain injury (TBI) is defined as a sudden disruption in the normal function of the brain resulting from a bump, blow, or jolt to the head, or penetrating head injury5. The effects of a TBI on an individual depend on a number of factors such as the type, location and severity of brain injury.

    Individuals with a severe head injury are likely to be hospitalised and receive rehabilitation once the acute phase has passed. A severe head injury can cause devastating and lifelong effects6, including cognitive, communication, emotional and behavioural changes. Physical effects can include epilepsy, mobility problems, muscle weakness or paralysis, spasticity, ataxia, sensory impairments, physiological dysfunction and fatigue. This can result in the following postural challenges:

    • Poor postural control
    • Pelvic instability
    • Involuntary movements
    • Posturing
    • Contractures
    • Fatigue

    Good postural management throughout the full 24-hours can enhance an individual’s recovery and rehabilitation following a TBI. Specialist seating can support this management programme by offering a solution for balancing the key principles when choosing a chair – comfort, function, postural support, and pressure care. In combination with adjustability to ensure correct individualised set-up, CareFlex chairs for traumatic brain injury offer a range of functions and accessories to promote postural stability and encourage normal movement:

    • The HydroTilt could be a great solution for individuals who present with mild to moderate postural needs.
    • Tilt-in-space, if safe and appropriate, can aid pelvic stability without affecting the hip and knee angles. Tilt-in-space can also be utilised to achieve pressure redistribution and energy conservation by allowing periods of rest.
    • A choice of back and head supports can encourage trunk alignment for optimum physiological function and a midline head position for interaction and engagement.
    • A negative angle leg rest can facilitate standing and offer a more comfortable seating position for users with tight hamstring muscles or knee contractures.
    • AutoTilt actuation can enhance the standard pressure management functions by automatically moving the user through small degrees of tilt at short intervals to regularly redistribute pressure.
    • Individuals with moderate to complex postural needs may require the HydroFlex that offers back angle recline, if safe and appropriate, to promote comfort and accommodate any hip contractures. The addition of a pommel may be indicated for a windsweeping deformity.
    • A contoured back and the option to add laterals can accommodate and where possible correct increased leaning at the trunk.
    • Positioning aids, such as pelvic belts or chest harness following risk assessment, may also be indicated to maximise postural control.
    • The SmartSeatPro may be indicated for individuals who present with more complex postural needs. The multi-segmental back can accommodate, or correct where possible, any lateral movement or rotation through the spine and pelvis.
    • Flexible postural support throughout, with the ability to adjust both left and right sides of the chair, can uniquely accommodate asymmetries in combination with a contoured cushion.
    • The independently elevating and floating-tracking leg rest smoothly follows the biomechanical movement of the lower legs as they pivot at the knee joint, giving uniform support to the lower legs and knee whilst preventing drag to the skin and entrapment during elevation. Channels also help keep the legs in an aligned and safe position.
    • If something more bespoke is identified at assessment due to highly complex postural needs, the tailored seating solutions service can enable the provision of a unique seating system.

     

    A comprehensive holistic seating assessment is critical to an appropriate seating prescription. Please do not hesitate to get in touch with us to discuss any queries or book a free assessment.

     

    References:

    1.NHS Choices (2016) Parkinson’s diseaseAvailable from: nhs.uk/conditions/parkinsons-disease/

  1. 2.Pope PM (2007) Severe and complex neurological disabilities: management of the physical condition. London: Elsevier.
  2. 3.Royal College of Occupational Therapists (2018) Occupational therapy for people with Parkinson’s 2nd edition Available from: www.rcot.co.uk/occupational-therapy-people-parkinsons [Accessed 13th January 2022]
  3. 4.Multiple Sclerosis Trust (2018) MS: the factsAvailable from: https://www.mstrust.org.uk/about-ms/what-ms/ms-facts
  4. 5.Centres for Disease Control and Prevention (2017) Traumatic Brain Injury & ConcussionAvailable from: cdc.gov/traumaticbraininjury/index.html
  5. 6.Headway (2018) Effects of brain injuryAvailable from: headway.org.uk/about-brain-injury/individuals/effects-of-brain-injury/