Evaluation, Simulation and Dynamic Seating Trials

Recently a therapist asked me how she could recommend Dynamic Seating components if she didn’t actually try these with a client. Great question! It is not typically realistic to conduct Dynamic Seating trials as one would need to place Dynamic Seating components on a client’s wheelchair for trial and often the frame would need to be modified to accept these components. A similar situation occurs with molding seating. Molded seating cannot truly be simulated without a shape capture and/or providing the fabricated molded seating system. Instead, clinical reasoning is used to determine that molded seating is indicated.

Here are some suggestions for simulating a Dynamic Seating Trial to identify if Dynamic Seating would be appropriate during an evaluation:

1. Dynamic Back


If you are working with a client who extends within their seating system, particularly at the hips, a Dynamic Back may be indicated. But how is this determined without actually trialing a Dynamic Back?
Sit behind the client while sitting on the edge of a mat table. When the client extends at the hips, slowly move back approximately 10 degrees until the client’s tone relaxes and extension decreases and then slowly move the client back to an upright seated posture. If the client extends against you, if their tone reduces with posterior movement and you can return the client to upright, a Dynamic Back is indicated.

If a client often ‘rocks’ from their hips, seeking out movement, a Dynamic Back will move with the client – providing movement without damaging the equipment.

2. Dynamic Footrests


If you are working with a client who extends within their seating system, particularly leveraging off of the footplates, Dynamic Footrests may be indicated. But how is this determined without actually trialing Dynamic Footrests?

Swing the footrest hangers to the sides. Without this leverage, the client may be unable to extend within the seating system or may extend only at the knees. If you notice a decrease in overall extension, Dynamic Footrests are indicated.

Another strategy is to try and move the client’s foot on the footplate during extension. If you cannot move the foot on the footplate due to significant force, Dynamic Footrests are indicated.

3. Dynamic Head Support hardware

If you are working with a client who extends with force against their head support, Dynamic Head Support hardware may be indicated. If the client has broken the head support or mounting hardware, a dynamic solution may also be indicated.

Move the head support pad posteriorly approximately 2” and place a 2” thick piece of foam between the head support and the client’s head. As the client extends, note if this piece of foam is compressed. If it is, Dynamic Head Support hardware is indicated.

Another strategy is to place your hand between the head support pad and the client’s head. During extension if you feel significant force, Dynamic Head Support hardware is indicated.

Other resources which may be helpful include our Clinical Guidelines- Increased Muscle Tone, Clinical Guidelines – Providing Movement,  Sample Medical JustificationsSample Letter of Medical Necessity – Breakage & Movement, and Sample Letter of Medical Necessity – Breakage & Diffusing Tone. Click on the links to download these free resources.

How do you determine if a client would benefit from Dynamic Seating during your evaluation? I’d love to hear from you!

Without his feet in contact with the footplates, Taylor shows extension in his knees, however his pelvis remains in contact with the seat and overall extension is reduced. Dynamic Footrests allowed his feet to be on the footplates, but also allowed knee extension to reduce overall tone.

Phillip: an update on Dynamic Seating and Supporting Movement

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Phillip is a 61 year old man who resides at the Mary Campbell Center in Wilmington, DE. We featured Phillip in a blog in October of 2017. I had the opportunity to work with Phillip in May of 2017 and recommended Dynamic Seating components at the knees, back, and head. I wanted to catch up with his physical therapist, Diana Hoopes, to see how he is doing. Diana graduated in 1975 from the University of Baltimore and later received her master’s degree in Special Education. Diana is retiring soon to spend time with her 11 grandchildren! She has worked at the Mary Campbell Center for many years and loves what she does.

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The 2019 International Seating Symposium

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Every March, thousands of people working in the field of Seating and Wheeled Mobility come together for education, a chance to explore a massive and comprehensive exhibit area, networking, and catching up with old friends. The 2019 35th International Seating Symposium (ISS) in Pittsburgh did not disappoint, with over 2000 people from more than 35 countries in attendance. Continue reading

Let’s Get Together! Using Multiple Dynamic Seating Components

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Dynamic Seating components are often used at the hips (dynamic backs), knees (dynamic footrests) and the neck (dynamic head supports). Dynamic components can be used individually, however combining these components can often maximize the impact Dynamic Seating can make and better meet the client’s needs. Continue reading

Dynamic Seating: What Does the Research Say? Part 3

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Our last two blogs explored some of the published research that has been done on Dynamic Seating, demonstrating the effectiveness of this intervention for many of the clients using wheelchair technologies. This blog will review some additional research that has been presented at Wheeled Seating and Mobility conferences such as the International Seating Symposium, but has not been published. Although this information is not in the literature, it can still be helpful in directing our interventions.

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Dynamic Seating: What Does the Research Say? Part 2

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Our last blog explored some of the research that has been done on Dynamic Seating, demonstrating the effectiveness of this intervention for many of the clients using wheelchair technologies. This blog will review 3 additional studies. Although these studies are now dated, the information is still relevant to our practice today. More studies are needed, however, to update the evidence we use to inform our practice. Continue reading

Dynamic Seating: What Does the Research Say? Part 1

Seating Dynamics Fumgali Dynamic VS Rigid Seat System Cerebral Palsy
R82 x:panda dynamic seating system used in Fumagalli research

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

If you have been reading our blogs, thanks! You have seen that we are passionate about Dynamic Seating and have addressed many issues in these blogs and in other resources – clinical indicators, case studies, clinician and supplier perspectives, funding, maintenance and more! In this blog series, I would like to address Evidence. Is there Evidence for the use of Dynamic Seating? Continue reading

FAQ: Can Dynamic Seating be used on a Power Wheelchair? Yes! Let’s Talk Compatibility.

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Ted Ruckstuhl is the Business Development Manager at Seating Dynamics. You may have spoken to him on the phone, he provides quite a bit of support to customers that way. One question he is asked frequently is whether Dynamic Seating can be used on a power wheelchair. Continue reading