Wheelchair Seating: Are We Speaking the Same Language?

Universal Language Wheelchair Seating: Are We Speaking the Same Language? Andrée Gauthier, OT Reg. (Ont.) Seating Clinic, Lyndhurst Centre Toronto Rehab Institute University Health Network andree.gauthier@uhn.ca Stephanie Hadi, OT Reg. (Ont.) TRI Research, Lyndhurst Centre Toronto Rehab Institute University Health Network stephanie.hadi@uhn.ca May 14, 2014 29 th Canadian Seating & Mobility Conference Universal Language Standards for Wheelchair Seating Vocabulary & Measuring ISO 16840-1:2006 Wheelchair Seating: Vocabulary, reference axis convention and measures for body segments, posture and postural support surfaces Clinical Application Guide (Aug 2013) Project Director/Author: Kelly Waugh, PT, MAPT, ATP Primary Project Consultant/Co-Author: Barbara Crane, PT, PhD, ATP/SMS Resource Link: http://at-partners.org/wheelchairseating It s Free! Clinical Application Guide (Aug 2013) CONTENTS 1. Conventions for Labeling the Body and Seating Support Surfaces 2. Global Coordinate System 3. Linear Body Measures 4. Linear Support Surface Measures 5. Tools for Measurement 6. Angular Body Measures 7. Angular Support Surface Measures

Glossary of Terms (Dec 2013) Benefits of a Standardization CONTENTS 1. Wheeled Mobility Device Types and Related Terms efficiency 2. Wheelchair Components and Styles 3. Seating Support System 4. Angular and Linear Dimensions communication barriers Standards Standardizes research methodology Quantifies postural changes over time Image Source: Waugh et al., 2013 Objectives At the end of this session, the attendee will be able to: Ambiguities in Seating 1) Recognize the clinical importance of adopting the international standards for wheelchair seating and utilizing the clinical application guide 2) Use standardized vocabulary, terminology, and some measures to describe and quantify body segments, posture and postural support surfaces 3) Implement some of the techniques in practice after receiving core concepts and practical information Image Source: gettyimages Measuring Seat Depth Measuring Seat to Floor Height

Lateral Supports: Length x Height? Back Supports: Length vs. Height? What does it mean by: Height vs. Length: 13,17,14 Ordering "Arm Troughs" Using Appropriate Terms for Joint Motion Mr. Cat sits with a right pelvic obliquity and left pelvic rotation, trunk laterally flexed to the right, with hips extended and right leg abducted 15 Image Source: personalcarephysicians.com Using Appropriate Terms for Joint Motion Hip Flexion, NOT Hip Extension Using Appropriate Terms for Joint Motion Which Joint Motion Do You Measure?

Using Terms for Joint Motion Which Joint Motion Do You Measure? Using Terms for Joint Motion Windswept Fig. 2.4: Thigh to trunk angle vs. hip flexion angle Using Terms for Joint Motion Windswept Clinical Application Guide (Aug 2013) CONTENTS 1. Conventions for Labeling the Body and Seating Support Surfaces 2. Global Coordinate System 3. Linear Body Measures 4. Linear Support Surface Measures 5. Tools for Measurement 6. Angular Body Measures 7. Angular Support Surface Measures Fig. 2.40: Right windswept posture ; Waugh & Crane, 2013 Body Segment Terminology Conventions for Labeling the Body and Seating Support Surfaces

Relation to Body Support Surfaces Surfaces in w/c intended to contact user s body are called supports, not rest or pad Body Support System Body Support System: refers to all parts of the w/c intended to directly contact the user s body, including: seat, back, arm, foot and head support. Postural Support Device: refers only to the support component and not the attaching hardware. Postural Support Assembly: refers to the postural support device AND its attachment hardware, as a unit. Image Source: Sunrise Medical, 2013 Image Source: Sunrise Medical, 2013 Reference Planes Revisiting Lateral and Back Support Examples Body Segment Landmarks Body Segment Lines Fig. 1.8: Examples of body segment lines in each plane

Required Tools Conventions for Measuring the Body and Support Surfaces Body Measures 2.1 Buttock/thigh depth Purpose: To document the depth of the buttock/thigh segment when seated in the desired sitting posture Support Surface Measures EFFECTIVE SEAT DEPTH Clinical relevance: This measure is used to help specify the desired seat depth. BUTTOCK/THIGH DEPTH Type of Measurement: Body Linear, left and right Description: The distance from the back of the buttocks to behind the knee for a seated person. Landmarks (end points) used: Most posterior aspect of the buttock Left and right popliteal fossa Definition: Linear distance from the most posterior point of the buttocks to the popliteal fossa, measured parallel to the thigh. Type of Measurement: Support Surface Linear Description: The distance from the back support to the front edge of the seat contact surface. End points used: Midpoint of the intersection between the back support reference plane and the seat reference plane. Midpoint of front edge of the contact surface side of the seat. Definition: Linear distance from the intersection of the back support and seat support reference planes to the front edge of the contact surface side of the seat, measured parallel to the seat reference plane along the seat centerline. Angular Body Measures Purpose: To document the existing or desired angular position of the trunk relative to the thigh 3 Key Angular Body Measures 1) Thigh to Trunk Angle 2) Thigh to Lower Leg Angle 3) Lower Leg to Foot Angle Clinical Relevance: The thigh to trunk angle is a reflection of the position of hip flexion, and it can be used to help determine the desired seat to back support angle in the case of a single angle (straight) back support. THIGH TO TRUNK ANGLE Type of Measurement: Relative body segment angle, right and left Description: The angle between the thigh and the trunk, viewed from the side. Landmarks used: Lateral hip center point (center of rotation) Lateral femoral condyle Lateral lower neck point Body segment lines used to form angle: Sagittal trunk line Sagittal thigh line Angle measured: The anterior side of the angle formed between the sagittal trunk line and the sagittal thigh line. Fig. 2.3: Thigh to trunk angle Fig. 2.5: Thigh to lower leg angle Fig. 2.8: Lower leg to foot angle SRP Value: 90 degrees Fig. 2.3: Thigh to trunk angle Typical Values: 90 120

Relative Support Surface Angles 3 Key Relative Support Surface Angles Purpose: To provide a standard measure of the angular position of the back support relative to the seat in the sagittal plane 1) Seat to Back Support Angle 2) Seat to Lower Leg Support Angle 3) Lower Leg Support to Foot Support Angle Clinical relevance: The angle between the seat and back support can have a significant influence on the individual s comfort, posture, health and function, and therefore it can be clinically useful to document the existing and/or desired seat to back support angle. SEAT TO BACK SUPPORT ANGLE Type of Measurement: Relative support surface angle Description: The angle between the seat and the back support viewed from the side. Reference Planes Used: Back support reference plane Seat reference plane Angle measured: The anterior side of the angle formed between the back support reference plane and the seat reference plane, as viewed from the side. SSRP Value: 90 degrees Fig. 3.2: Seat to back support angle Fig. 3.5: Seat to lower leg support angle, no calf pad Fig. 3.9: Lower leg support to foot support angle Typical Values: 80-120 degrees Common Linear Body Measures Back to the Clinic and adapted by Gauthier & Hadi, 2014 Dimensions of Back & Lateral Support Dimensions of Other Supports Head Support Length Foot Support Depth Arm Support Width Toronto Rehab UHN, 2014

! Cheat Sheet Version 1 Proper Terminology on Our Forms! Linear'Body'Measures'!!!!! Inaccurate Terms Hip Bolster Pommel Armrest Pelvic Strap Laterals Hip Extension Standardized Terms Lateral Thigh Support Medial Thigh Support Arm Support Pelvic Support Lateral Trunk Support Thigh to Trunk Angle!!!!!!!!!!! Adapted'from'Chapter'4'from' A'Clinical'Application'Guide'to'Standardized'Wheelchair'Seating'Measures'of'the'Body'and'Seating'Support'Surfaces '' Page'1' Enhancing Documentation Enhancing Documentation: Quotation LETTER OF JUSTIFICATION FOR NEW CUSTOMIZED BODY SUPPORT SYSTEM: Mr. P is living with C 5-6 quadriplegia and relies on a power wheelchair and specialized seating for his everyday mobility. He is having ongoing skin breakdown and now requires a full customized body support system in order to offload his bony prominences and to protect his posture. His present seat and back support no longer meet his needs because of weight loss over a 2 year period... Relative Angles Importance of Relative Angles

Importance of Relative Angles Importance of Relative Angles Monitor Posture. Intervene Sooner. Custom Sooner - Tom Hetzel Lumbar Curve Depth Monitor Posture. Intervene Sooner. Custom Sooner - Tom Hetzel Thigh to Pelvis Angle Toronto Rehab UHN, 2014 Toronto Rehab UHN, 2014 Monitor Posture. Intervene Sooner. Custom Sooner - Tom Hetzel Thoracic Curve Depth Monitor Posture. Intervene Sooner. Custom Sooner - Tom Hetzel Occiput Depth Toronto Rehab UHN, 2014 Toronto Rehab UHN, 2014

Future Considerations Importance of training Understand clinical relevance Ongoing coaching Implications for University Programs Conclusion It is important to be familiar and adopt standardized terminology for describing and measuring an individual s seated posture. Speaking the same language will: 1) Enhance communication between team members; 2) Enable accurate wheelchair prescription and set up of seating products; and 3) Allow for appropriate documentation of outcomes related to seated posture in both clinic and research settings. References Acknowledgements 1. Rehabilitation Engineering & Assistive Technology Society of North America (RESNA) Board of Directors. (2011). RESNA wheelchair service provision guide. RESNA. Arlington, VA. 2. Waugh, K., & Crane, B. (2013). A clinical application guide to standardized wheelchair seating measures of the body and seating support surfaces. Assistive Technology Partners. Denver, CO. We would like to thank Kelly Waugh for her ongoing support. 3. Waugh, K., et al. (2013). Glossary of wheelchair terms and definitions, Version 1.0. Assistive Technology Partners. Denver, CO. Image Source: Kelly Waugh