Custom Contoured Seating: Ensuring Successful Outcomes Kelly Waugh, PT, MAPT, ATP Kelly Waugh, PT, MAPT, ATP kelly.waugh@ucdenver.edu 303-315-1951 Assistive Technology Partners University of Colorado, Anschutz Medical Campus, School of Medicine Department of Physical Medicine and Rehabilitation 601 East 18 th Street, Suite 130 Denver, Colorado 80203 303.315.1280 800.255.3477 Toll Free www.assistivetechnologypartners.org generalinfo@atpartners.edu Custom Contoured Seating: Ensuring Successful Outcomes I. INTRODUCTION II. III. IV. BASIC CLINICAL CONCEPTS CLINICAL ASSESSMENT TECHNOLOGIES AND METHODS V. IMPLEMENTATION Created by Kelly Waugh, PT, MAPT. 1
I. INTRODUCTION A. Terminology Custom contoured seating (CCS) = surfaces are shaped to match the unique contours of the person s body This is a generic term to describe a type of seating; not product specific B. What contributes to a successful outcome for custom contoured seating? What contributes to a successful outcome for custom contoured seating? 7 critical factors: 1. CCS is indicated and appropriate for the person 2. A thorough clinical assessment prior to the shape capture has resulted in: Prioritized goals A Postural Alignment Plan A shape capture plan An appropriate wheelchair prescription 3. The features of the recommended CCS product match the unique characteristics and needs of client What contributes to a successful outcome for custom contoured seating? 4. Successful shape capture Desired postural alignment achieved and maintained Even, intimate contact achieved with molding medium 5. Accurate shape translation 6. Accurate fabrication 7. Accurate integration of seating into wheelchair base Created by Kelly Waugh, PT, MAPT. 2
Custom Contoured Seating: Ensuring Successful Outcomes I. INTRODUCTION II. III. IV. BASIC CLINICAL CONCEPTS THE CLINICAL ASSESSMENT TECHNOLOGIES AND METHODS V. IMPLEMENTATION II. BASIC CLINICAL CONCEPTS A. Indications and Objectives for Custom Contoured Seating B. Advantages of Custom Contoured Seating C. Disadvantages/Contraindications of Custom Contoured Seating Indications for Custom Contoured Seating 1. Significant skeletal or joint deformity resulting in significant postural asymmetry, which cannot be accommodated with off the shelf contoured seating 2. Excessive abnormal, uncontrolled movement which results in significant postural asymmetry and/or inadequate postural stability to support optimal health and function. 3. Excessive postural collapse in the spine and pelvis due to paralysis, extreme weakness and/or low muscle tone, resulting in significant postural asymmetry and/or inadequate postural stability to support optimal health and function. 4. Skin breakdown from any of the above 5. Excessive pain from any of the above Created by Kelly Waugh, PT, MAPT. 3
Objectives for Custom Contoured Seating Strategy = apply intimate surface contact to areas of the body which are contoured in order to achieve the following objectives 1. Accommodate moderate to severe deformity in order to distribute pressure, maintain optimal alignment/orientation and maximize health and function 2. Inhibit/block abnormal movement patterns in order to maintain alignment and improve stability throughout trunk, buttocks and thighs 3. Prevent postural collapse in order to maintain alignment and improve stability throughout trunk 4. Decrease pain and/or prevent skin breakdown by optimizing pressure distribution and/or pressure re-distribution (off loading) CASE 1 - Indication: Spinal deformity and joint contractures resulting in significant postural asymmetry and risk of skin breakdown Fig 1 Fig 2 Objectives: Accommodate deformity/contractures to achieve optimal alignment of the core and to distribute pressure for prevention of skin breakdown CASE 2 - Indication: Abnormal movement and spasticity resulting in poor alignment and inadequate proximal stability to support functional head and upper extremity movement. Risk of increasing spinal deformity. Created by Kelly Waugh, PT, MAPT. 4
CASE 2 - Objective: Stabilize proximally in optimal pelvic/spinal alignment for improved distal mobility and function, using orthotic style custom contoured seat and back support Ready to be evaluated for power wheelchair using alternative drive controls! CASE 3 - Indication: Severe motor ataxia (uncontrolled movement) resulting in poor proximal stability, distal fixing and decreased functional mobility Fig 1: Client has severe Ataxia.he fixes for stability, with very poor motor control distally Fig 2: Assessing joystick control using simulator, with linear seating.. Fig 3: Assessing joystick control with custom contoured surfaces. Increased proximal stability resulted in improved joystick control CASE 3 - Objective: Stabilize proximally for improved distal mobility and function, using custom contoured backrest, contoured seat and arm troughs Before distal fixing to compensate for poor proximal stability New power wheelchair.note method of grasping joystick on right, and selfstabilizing left arm Created by Kelly Waugh, PT, MAPT. 5
CASE 5 - Indication: Total postural collapse due to muscle paralysis + scoliosis + weight. (muscular dystrophy) resulting in significant postural asymmetry and pain Fig 1: Front view - Severe left pelvic obliquity and left convex C-curve scoliosis, partially flexible Fig 2: Side view - Severe posterior pelvic tilt and kyphosis, partially flexible CASE 5 - Objectives: (1) Improve stability and alignment using custom contoured back support; (2) Decrease severe buttock pain using Roho Quatro seat cushion Fig 2: Fitting stage Fig 1: Before NOTE: Using a Roho seat cushion with custom contoured back support is very risky..why? Fig 3: Final. (Versaform pillow used to stabilize arms for optimal control of mini MEC joystick using thumb) II. BASIC CLINICAL CONCEPTS A. Indications and Objectives for Custom Contoured Seating B. Advantages of Custom Contoured Seating C. Disadvantages/Contraindications of Custom Contoured Seating Created by Kelly Waugh, PT, MAPT. 6
C. Advantages of Custom Contoured Seating (vs. planar or generic contour) 1. When indicated, it can address clinical objectives better than planar or generic contoured seating Greater surface area contact creates increased stability, alignment, and skin protection leading to improved health, comfort and function 2. Can be aesthetically more pleasing Less hardware and pads, cleaner smoother look 3. Easier maintenance Less hardware to repair/adjust II. BASIC CLINICAL CONCEPTS A. Indications and Objectives for Custom Contoured Seating B. Advantages of Custom Contoured Seating C. Disadvantages/Contraindications of Custom Contoured Seating D. Disadvantages of Custom Contoured Seating 1. Limited adjustment for growth, change or error (depending on type of custom contoured system product) 2. Limits dynamic movement (depending on aggressiveness of shape) and may therefore interfere with movements needed for function 3. Support surfaces do not swing away or remove for transfers, unless custom adaptations are made 4. Foam products tend to be insulating, so may be hot unless adaptations made 5. Foam products tend to be bulkier and heavier Created by Kelly Waugh, PT, MAPT. 7
D. Disadvantages of Custom Contoured Seating (continued) 6. Generally incompatible with adjustable recline 7. More costly 8. Requires considerable skill to do molding process well 9. Risks (and costs) of error can be high Assessing risk of poor outcome Degree of risk depends upon (1) the type of contouring technology being used (2) the characteristics of the client (3) technology available for the molding process, and (4) the skill of the seating practitioners involved Ask yourself: 1. How will we achieve / maintain the desired posture while capturing the shape, with this client, using this technology? 2. What extra resources are needed in order to achieve/maintain desired alignment while capturing the shape? Do we have access to needed supports/technology? 3. How experienced are team members with this technology? 4. Is client likely to be positioned consistently in the system? 5. What are the risks if client changes or is inconsistently positioned, with this technology? RED FLAGS Proceed with caution when considering custom contoured seating in these situations: Client uses independent movement of their trunk (leaning to side, for example) to function Client likes to move in their wheelchair, shifting their weight or readjusting their body on their own Client independently transfers in/out of wheelchair Client s body is likely to change significantly due to growth or other changes (growing child, upcoming surgery, weight) Created by Kelly Waugh, PT, MAPT. 8
CHECK YOUR LEARNING: What contributes to a successful outcome for custom contoured seating? 1. CCS is indicated and appropriate for the person: Possible indications: Skeletal deformity/fixed contractures Excessive abnormal movement/tone Postural collapse Skin breakdown/pain What are the risks of doing CCS for this person? What is the potential for a positive outcome for this person? Custom Contoured Seating: Ensuring Successful Outcomes I. INTRODUCTION II. III. IV. BASIC CLINICAL CONCEPTS CLINICAL ASSESSMENT TECHNOLOGIES AND METHODS V. IMPLEMENTATION III. THE CLINICAL ASSESSMENT Disclaimer: It s beyond scope of this presentation to instruct you in completing a comprehensive wheelchair seating assessment! 1. Critical outcomes of seating assessment include: Prioritized goals A Postural Alignment Plan A shape capture plan Appropriate wheelchair prescription 2. Therapist s role: Therapist has primary responsibility for performing the clinical seating assessment 3. Supplier s role: It is your job to support and possibly coach a therapist through this process, so you get the information you need Created by Kelly Waugh, PT, MAPT. 9
III. SEATING ASSESSMENT Critical Components A. Establish and Prioritize Goals B. Posture and Function Assessment C. Mat Exam D. Seating Simulation E. Implementation Plan A. Establish and prioritize goals Goals are discussed during the initial client interview, and clarified as needed throughout the assessment process Goals can be categorized into the areas of Health, Comfort, or Function To prevent re-occurrence of skin breakdown (HEALTH) To decrease back pain (COMFORT) To be able to reach forward and use computer from wheelchair (FUNCTION) A. Establish and prioritize goals Each team member may have different opinions and perspectives which should be considered; however the client s primary concerns and goals are paramount. Goals and strategies may need to be refined at end of assessment process, after you have more information about tradeoffs that will be required to achieve certain goals. Created by Kelly Waugh, PT, MAPT. 10
Example: Re-prioritizing goals at end of assessment Fig 1: Current seated posture Fig 2: Possible postural alignment goal - seating simulation with trunk laterals and custom contoured seat Goals for health (skeletal alignment, breathing, prevention of skin breakdown) contradicted client s personal goals for comfort and function SEATING ASSESSMENT Critical Components A. Establish and Prioritize Goals B. Posture and Function Assessment C. Mat Exam D. Seating Simulation E. Implementation Plan B. Posture and Function Assessment 1. Assess Function What does this person need to be able to do from their wheelchair? What movements are important that this individual be able to do to function? This is critical in planning for a custom contour as you can t take away functional movement Created by Kelly Waugh, PT, MAPT. 11
B. Posture and Function Assessment 2. Assess Transfers Is client independent in transfers? If so, will they still be able to transfer in/out of a CCS system? If dependent, how is the transfer done and by whom? If using a mechanical lift, is the sling left underneath the person? (Slings should be removed) B. Posture and Function Assessment 3. Assess current seated posture in wheelchair Observe, feel and document alignment of pelvis, trunk, lower extremities and head in all three planes, or views (sagittal, frontal and transverse) Note abnormal tone and movement patterns that affect posture Measure and document relative body segment angles 4. Measure and document key angles and dimensions of current seating system Assess postural deviations in Frontal and Transverse planes Severe left pelvic rotation and left pelvic obliquity, falls to the right; uses tone to sit upright Measure and document: Frontal pelvic angle Transverse trunk angle Transverse pelvic angle Created by Kelly Waugh, PT, MAPT. 12
Assessing postural deviations in sagittal plane Measure person: Measure equipment: 3 Relative Body Segment Angles 3 Relative Support Surface Angles SEATING ASSESSMENT Critical Components A. Establish and Prioritize Goals B. Posture and Function Assessment C. Mat Exam D. Seating Simulation E. Implementation Plan MAT EXAM, Unsupported Sitting Assessment Fig 1 Fig 2 Fig 2 Skeletal deformities are often best viewed in a sitting position Created by Kelly Waugh, PT, MAPT. 13
MAT EXAM, Assessing joint flexibility During the mat exam, the therapist should assess Flexibility of the spine and pelvis, including head/neck Passive range of motion of the hips Hip flexion Hip Abduction/Adduction Hip Internal/External rotation At what point in range does pelvis move away from best alignment? Passive range of motion of the knees Knee extension with hips flexed (hamstring flexibility) Knee flexion Passive range of motion of the ankles Ankle dorsi/plantar flexion Passive range of motion of the UE general screening Example: Assessing pelvic/spine mobility Fig 1: Postural tendency is left pelvic obliquity, left pelvic and trunk rotation Fig 2: Postural tendency is severe left pelvic obliquity Fig 3: Assessing flexibility of pelvis and spine in frontal plane can pelvis be leveled? Example: Assessing passive hip abduction and adduction Assessing right hip adduction Her hand is on the pelvis so that she can feel when the pelvis rotates, as that will be an indication of end range of hip abduction or adduction for seating Assessing left hip abduction Created by Kelly Waugh, PT, MAPT. 14
Example: Assessing passive hip flexion range of motion Assessing hip flexion range of motion for seating. 135 45 And then measuring hip flexion to determine minimum thigh to trunk angle Translating joint range of motion values into corresponding body and support surface angles Passive joint ROM Corresponding Body Segment Angle Support Surface Angle HIP FLEXION 60 R, 80 L Thigh to Trunk Angle 120 R, 100 L Seat to Back support Angle 110 KNEE EXTENSION/ Popliteal Angle 100 R, 80 L Thigh to Leg Angle 100 R, 80 L Seat to Leg Support Angle 100 R, 80 L ANKLE DORSIFLEXION 0 R, -10 L Leg to Foot Angle 90 R, 100 L Leg/Foot Support Angle 90 R, 100 L Mat Exam Outcome From information gathered so far team should be able to. 1. Determine whether a neutral sitting posture can be achieved passively based on joint flexibility. And if not, determine client s best potential for alignment, gravity eliminated, in all areas of the body. Preliminary Postural Alignment Plan Created by Kelly Waugh, PT, MAPT. 15
Postural Alignment Plan includes: Body Segment Angles Thigh/Trunk Angles, R + L Thigh/LowerLeg Angles, R + L LowerLeg/Foot Angles, R + L This is the information you need from the therapist!! Based on end comfortable range of motion for seating Goal for alignment and orientation of body segments Pelvis level, rotated, oblique? Trunk midline or off center? Rotated? Neutral extension? LE s forward facing, windswept, Abd/Add, IR/ER? How does this person s lower extremities need to be aligned in order to achieve the maximum alignment in the pelvis/spine, trunk and head? Mat Exam Outcome From information gathered so far team should be able to. 1. Determine a preliminary postural alignment plan 2. Develop a hypothesis regarding source of postural problems I think the reason Mr. Smith is sitting in a severely kyphotic posture is that his tight hamstrings are not being accommodated in his wheelchair 3. Obtain linear and angular body measurements, in order to delineate preliminary seating equipment angles and dimensions Allows set up of trial support surfaces in order to finalize postural plan/objectives and finalize equipment measures needed to support that resting posture SEATING ASSESSMENT Critical Components A. Establish and Prioritize Goals B. Posture and Function Assessment C. Mat Exam D. Seating Simulation E. Implementation Plan Created by Kelly Waugh, PT, MAPT. 16
D. Seating Simulation Assessment in sitting position using mock-up of equipment surfaces to help simulate the desired seated posture and determine/finalize postural alignment objectives Test out your preliminary postural alignment plan Adding gravity may need to adjust postural objectives Test your hypothesis about source of postural problems Finalize seating objectives and required equipment properties Finalize Postural Alignment Plan Take FINAL measurements with client sitting in the desired sitting posture/orientation Seating Simulation using planar seating simulator Current posture Simulation of preliminary postural alignment plan What is causing him to sit like this? What do you think our hypothesis was based on mat exam findings? Seating Simulation using planar seating simulator Current posture Desired posture simulated Seat to back support angle 115 Right side body segment angles: Thigh/trunk angle = 125 Thigh/lower leg angle = 120 Lower leg/foot angle = 105 Sagittal thigh angle = +10 Created by Kelly Waugh, PT, MAPT. 17
Seating Simulation using planar seating simulator Current posture Desired posture simulated Seat to back support angle 115 Left side body segment angles: Thigh/trunk angle = 95 Thigh/lower leg angle = 100 Lower leg/foot angle = 100 Sagittal thigh angle = - 20 Seating Simulation Can client function from this resting posture? Is this the OPTIMAL resting posture? Objectives/equipment parameters for the head often cannot be determined until after client is seated in desired alignment Final seating measurements are taken with client sitting in desired posture/orientation/alignment How does this posture affect specification of wheelchair base dimensions and components? Created by Kelly Waugh, PT, MAPT. 18
Why bother doing a Planar Seating Simulation prior to shape capture? Doing planar simulation and determining final postural alignment plan at time of initial eval helps to: Justify need for custom contour Determine mobility base prescription Develop an efficient and accurate plan for the molding session SEATING ASSESSMENT Critical Components A. Establish and Prioritize Goals B. Posture and Function Assessment C. Mat Exam D. Seating Simulation E. Implementation Plan E. Implementation Plan 1. Finalize Wheelchair/Seating Prescription 2. Finalize Postural Alignment Plan 3. Develop Plan for Shape Capture Created by Kelly Waugh, PT, MAPT. 19
1. Finalize wheelchair/seating prescription With person seated in desired alignment during simulation, you can more accurately determine final specifications of seating and mobility base Specify type and size of mobility base/frame, type of seating system, interfacing hardware, additional components, etc This is the information you need from the therapist!! Final Resting Body Segment Angles measure with person sitting in desired alignment in simulation set up: Desired Thigh to Trunk Angle, R/L Desired Thigh to Lower Leg Angle, R/L Desired Lower Leg to Foot Angle, R/L 2. Finalize postural alignment plan Goal for alignment and orientation of body Pelvis; Trunk/shoulders; Lower Extremities; Head/Neck Measure and document key absolute body segment angles Frontal and transverse pelvic angles Frontal sternal angle Transverse trunk and thigh angles Frontal lower leg angles 3. Shape Capture Plan Write down your plan! Set up of molding simulation frame Three relative support surface angles Effective seat depth Foot support needs/placement where will feet be? Do they need support? How will we support? Head support Bag prep Where more beads will be needed? What pre-shaping needs to be done? Key clinical considerations to remember Key points of control to achieve postural alignment Active/functional movements to be allowed or encouraged Orientation in space issues (relationship between relative and absolute angles) Created by Kelly Waugh, PT, MAPT. 20
CHECK YOUR LEARNING: What contributes to a successful outcome for custom contoured seating? 2. A thorough clinical assessment prior to the shape capture has resulted in: Prioritized goals Health, Posture, Comfort, Function A Postural Alignment Plan Body segment angles, relative and absolute An appropriate wheelchair prescription Supports seating objectives and postural alignment plan A shape capture plan Support surface angles and key dimensions Secondary support needs Key points of control Custom Contoured Seating: Ensuring Successful Outcomes I. INTRODUCTION II. III. IV. BASIC CLINICAL CONCEPTS THE CLINICAL ASSESSMENT TECHNOLOGIES AND METHODS V. IMPLEMENTATION IV. TECHNOLOGIES AND METHODS A. Parameters to Compare B. Direct vs. Indirect Methods C. Indirect/Vacuum Consolidation Method D. Product Descriptions Created by Kelly Waugh, PT, MAPT. 21
A. Parameters to Compare The primary differences between custom contouring technologies can be compared by looking at: 1. Process Features 2. Product Features A. Parameters to Compare Process Features 1. The method of capturing the desired body shape or contour This will affect your ability to achieve and maintain the client s desired posture while the shape is being captured 2. How the shape/contours are read to produce contour information (shape translation) 3. The process for translating the contour information into the actual seat and back supports (fabrication) 4. The company s service delivery process and policies Policies re: trial fit, re-makes, fabrication time, etc A. Parameters to Compare Product Features 1. Primary Materials what s it made of? Foam, Plastic/Orthotic shell, other materials Options or no options 2. Surface Covering Options Stretchy vs. non stretchy; Water resistant/proof; Breathability Removable or not 3. Construction Features and Options Lateral support features depth (max pull); min thickness; reinforcement; thinning; swing away, removable, wrap around Cut outs/recessed areas soft spots; gel/fluid/air inserts Belt notches, strap slots 4. Mounting Options Created by Kelly Waugh, PT, MAPT. 22
III. TECHNOLOGIES AND METHODS A. Parameters to Compare B. Direct vs. Indirect Methods C. Indirect/Vacuum Consolidation Method D. Product Descriptions B. Direct vs. Indirect Methods Direct: The medium that is used to capture the body contours actually becomes the final seat and back support, so there is no reading of the contour required, nor translation/fabrication Examples: Hand-carved foam, Foam-in-Place, ShurShape, Matrix System. B. Direct vs. Indirect Methods Indirect: The medium used to capture the body contours is not the final cushion. A particular medium is used to capture the body contours, then the contours are read and this contour information is translated into a final cushion using a variety of methods, depending upon the manufacturer Examples: OBSS, Contour-U, Prairie Seating s Reflections, PRM s Signature Fit, AES SculptureFit Modified orthotic shell seating (Gillette, Aspen Seating Orthosis, Ride Designs Custom, Certified Orthopedic s Custom Seating Orthosis) Invacare s Silhouette Created by Kelly Waugh, PT, MAPT. 23
III. TECHNOLOGIES AND METHODS A. Parameters to Compare B. Direct vs. Indirect Methods C. Indirect/Vacuum Consolidation Method D. Product Descriptions C. Indirect Vacuum Consolidation Most common indirect method In this method, a bag filled with small beads is used to capture the desired body contours in the sitting position. The client is seated in a special fitting chair that holds the manufacturer s molding bags. Air is then sucked out of bag using a pump, which progressively hardens the bag. C. Indirect Vacuum Consolidation ADVANTAGE: The bags can be manipulated and shaped while the client is seated upon them, offering support to maintain postures as the practitioner fine-tunes the surface contour shape correcting flexible postures and/or accommodating fixed postures and deformities. Created by Kelly Waugh, PT, MAPT. 24
C. Indirect Vacuum Consolidation Once the desired posture and supporting bag shape is attained, the air is sucked out and the bags become rigid with the desired contour. After the client is transferred from the fitting chair, the bag s shape is then read in a variety of ways, depending on the manufacturers technology C. Indirect Vacuum Consolidation The process of attaining the desired posture and shaping the bags to capture the resulting body contour is essentially the same in all of these technologies Otto Bock s OBSS PinDot Contour-U Prairie Reflections PRM Signature Fit AES Sculpture Fit Certified Seating Orthosis Aspen Seating and Ride Custom use this process for their back supports, but use a different process to attain the seat shape Aspen Seating Orthosis Ride Custom CHECK YOUR LEARNING: What contributes to a successful outcome for custom contoured seating? 3. The features of the recommended CCS product match the unique characteristics and needs of client The process features of the product will enable you to achieve desired postural alignment while capturing the shape The product features match client s needs and preferences Created by Kelly Waugh, PT, MAPT. 25
Custom Contoured Seating: Ensuring Successful Outcomes I. INTRODUCTION II. III. IV. BASIC CLINICAL CONCEPTS THE CLINICAL ASSESSMENT TECHNOLOGIES AND METHODS V. IMPLEMENTATION V. IMPLEMENTATION A. The Shape Capture B. Shape Translation C. Fabrication D. Integration of final CCS product into wheelchair base E. Client Fitting/Delivery A. The Shape Capture 1. Set up fitting chair (whatever you are capturing the shape in) Seating Angles, Seat Depth, other secondary supports 2. Prepare the bags Pre-shape bags for approximate contour Use additional blocks or wedges of foam with aggressive shapes 3. Position client in desired posture and orientation and shape bags for total contact Work proximal to distal Don t fold laterals Re-check postural objectives frequently Created by Kelly Waugh, PT, MAPT. 26
A. The Shape Capture 4. Take final measurements and photos Document postural alignment achieved, incl. body segment angles Measure final width within frame dimensions? 5. Shape translation product/manufacturer specific Bag prep marking for top of back, depth of seat, trim lines Digitizing/casting/scanning Filling out order forms What defines a successful shape capture? What defines a successful shape capture? Client s optimal seated posture must be achieved during the molding process for successful outcome I believe this is the most important factor contributing to successful outcome Achieve and maintain the desired postural alignment while you are capturing the shape of person s body Client s desired optimal alignment is determined ahead of time, during the clinical assessment What defines a successful shape capture? Intimate contact has been achieved between the molding medium and the contours of the person s body The shape of the bags should accurately reflect the contours of the person s posterior trunk, pelvis, buttocks and thighs This can be difficult to assess Lean person forward to view back support shape Transfer client out and check shape.does it match what you know about the client s shape? Created by Kelly Waugh, PT, MAPT. 27
V. IMPLEMENTATION A. The Shape Capture B. Shape Translation C. Fabrication D. Integration of final CCS product into wheelchair base E. Client Fitting/Delivery B. Shape Translation How is the shape of the molding bags translated into contour information? Plaster cast Something is poured into shape to create positive mold Contours are digitized, to create an electronic file Product specific CRT supplier needs to have training and experience in the product; errors can be made during this stage C. Fabrication Contour information is used to fabricate the final seat and back supports Fabrication process is product specific Accurate fabrication The shape of the final seat and back support matches the shape created during the shape capture Is the contour information intentionally modified before fabrication? Created by Kelly Waugh, PT, MAPT. 28
D. Integration of final CCS product into wheelchair base Responsibility of the CRT supply company The final seat and back support components must be mounted into wheelchair frame in a manner which achieves desired support surface relative angles, and key dimensions Errors here will affect outcomes. For example. Is the foot support placement adjusted to achieve prescribed seat to lower leg support and LLS/Foot support angles? Is back support placed and adjusted properly to achieve the desired effective seat depth and seat to back support angle? E. Client Fitting/Delivery Original team from shape capture present Prior to getting client into the new system: Review prioritized goals (what s the big important thing?) Review specifications for support surface relative angles and primary dimensions Review Postural Alignment Plan and seating objectives During fitting: Postural objectives and overall goals met? If having difficulty, review mat exam findings After fitting: Document final set up (angles/dimensions) especially if changed from original plan Document final postural alignment achieved (i.e., relative and absolute body segment angles) CHECK YOUR LEARNING: What contributes to a successful outcome for custom contoured seating? 4. Successful shape capture Desired postural alignment achieved and maintained Even, intimate contact achieved with molding medium 5. Accurate shape translation 6. Accurate fabrication 7. Accurate integration of seating into wheelchair base Created by Kelly Waugh, PT, MAPT. 29
What contributes to a successful outcome for custom contoured seating? 7 critical factors: 1. CCS is indicated and appropriate for the person 2. A thorough clinical assessment prior to the shape capture has resulted in: Prioritized goals A Postural Alignment Plan A shape capture plan An appropriate wheelchair prescription 3. The features of the recommended CCS product match the unique characteristics and needs of client What contributes to a successful outcome for custom contoured seating? 4. Successful shape capture Desired postural alignment achieved and maintained Even, intimate contact achieved with molding medium 5. Accurate shape translation 6. Accurate fabrication 7. Accurate integration of seating into wheelchair base Resources Link to A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces http://at-partners.org/wheelchairseating Created by Kelly Waugh, PT, MAPT. 30
QUESTIONS? HC-1 CASE STUDIES HC - 2 CASE STUDIES Created by Kelly Waugh, PT, MAPT. 31
HC - 3 CASE STUDIES HC - 4 CASE STUDIES HC- 5 CASE STUDIES Created by Kelly Waugh, PT, MAPT. 32
HC - 6 CASE STUDIES QUESTIONS? Created by Kelly Waugh, PT, MAPT. 33