Peanut Butter and Jelly: Dynamic Footrests and Securing the Feet
Michelle L. Lange, OTR/L, ABDA, ATP/SMS
In a recent blog, we discussed how, just like Bread and Butter, use of a Dynamic Back requires the use of a Pelvic Positioning Belt to maintain the position of the pelvis during movement . Well, just like Peanut Butter and Jelly, use of Dynamic Footrests requires the feet to be secured in order for client forces to activate this dynamic component.
The client’s feet need to be secured using ankle and/or toe straps, “ankle huggers,” or shoe holders with straps to maintain contact with the footplate and activate the Dynamic Footrests. Otherwise, the client's feet may simply move off of the footplate during movement. Some clients may push directly downward on the footplate and activate the telescoping feature. More often, however, extension at the knees results in rotation which is captured by both the telescoping and elevating features together. In order to move the dynamic component through this arc, force must be maintained on the footplate itself. Extension frequently leads to the feet moving in front of the footplates instead.
It is important that the client’s feet remain in good contact with the footplate. An “ankle hugger” type support keeps the feet generally on the footplate, but allows movement of the foot. When the client extends at the knee, they will move within the limitations of the ankle hugger and less force will be translated into the Dynamic component. Shoe holders with straps ensure that the most force is translated to the Dynamic Footrests.
If the client’s feet are secured, isn’t that considered a restraint?
A positioning device, such as an ankle strap, is designed to maintain alignment with the support surfaces (i.e. a footplate), provide stability and postural support, and promote function. A restraint is intended to limit movement to protect the client and/or others.
For specific restraint regulations and documentation requirements to allow provision of necessary postural supports, please refer to the following documents on our Downloadable Resources page:
Positioning vs. Restraint – Frequently Asked Questions
RESNA Position on the Application of Wheelchairs, Seating Systems, and Secondary Supports for Positioning vs. Restraint
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