Dynamic Seating – interventions and reality
Michelle L. Lange, OTR/L, ABDA, ATP/SMS
Jill Sparacio, OTR/L, ATP/SMS, ABDA works in the Chicago area. She has over 37 years’ experience and currently provides occupational therapy services to children and adults with intellectual disabilities and medical fragility, specializing in seating and wheeled mobility. Jill uses Dynamic Seating quite a bit and so I asked if I could take up some of her valuable time for a phone call.
How long have you been using Dynamic Seating?
Jill has been using Dynamic Seating interventions since the late 1990s. Wow!
What first led you to this intervention?
Jill was seeing a tremendous amount of equipment breakage – seat rails, side frames, rear canes, legrests, welds broken, and more. She hoped that Dynamic Seating would reduce these issues.
I asked Jill if tone management has helped reduce equipment breakage. Her facility has gone back on forth on these medical interventions, and many of the clients who used to have Baclofen pumps have had these removed. As a result, she has had to add more Dynamic Seating to compensate for increased muscle tone.
What did you first use to provide Dynamic Seating?
Jill began with a 2 level footboard connected by springs on a Kid Kart adaptive stroller. She can’t quite remember where this came from, but it not only diffused extensor tone from the lower extremities, it also captured asymmetrical forces, as clients do not typically push with equal force on both sides of the body. From there, she began using Miller’s Adaptive Technologies products, as well as the Kids Rock wheelchair (now discontinued).
Today, Jill uses Dynamic Seating products from PDG, Miller’s and Seating Dynamics.
What primary benefits are you seeing for the clients you work with?
Dynamic Seating makes a huge difference. Jill assesses the client to determine where their primary source of movement originates and then matches that up with the right product. She finds modular components work better for these reasons.
Jill recommends primarily dynamic backs, followed by dynamic footrests, and then dynamic head support at times. She has found that once forces are diffused at the hips and knees, her clients often do not require Dynamic Seating at the head.
“Dissipation of tone pattern when it is not met with resistance.” Jill has found that her clients will persist in extending against non-yielding surfaces. The extension reduces when resistance is not present, such as when the component moves in response to force. She also uses Dynamic Seating with young kids who rock – allowing movement – and this prevents the wheels from lifting in the front or back, increasing safety. As a result, these clients show decreased agitation.
What barriers to Dynamic Seating provision do you encounter?
Jill has encountered limited funding in her region, particularly IL Medicaid and Medicare.
Medicare was paying for some Dynamic Seating in the past, but she is facing more resistance lately. These funding sources often have an allowable and the wheelchair, seating system, and Dynamic Seating components often exceed this amount.
What improvements do you think need to occur?
Jill would like to see lower costs so she could more readily provide this technology to clients who need it.
Seating Dynamics will work with Jill and the suppliers in her state in an effort to improve the funding situation. We have had good success in other areas and hope to make inroads in the Midwest!
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