Clinician Interview: Stefanie Laurence, B. Sc. OT, OT Reg
Problem Solving during the Seating Assessment
Michelle L. Lange, OTR/L, ABDA, ATP/SMS
Stefanie is the Clinical Educator at Motion, Inc. in Toronto, Ontario, Canada. Prior this position, Stefanie was at Bloorview Children’s Hospital for many years. She is an amazing clinician who is extremely knowledgeable in the field of wheelchair seating and mobility. I had the privilege of catching up with her today.
Stefanie often recommends dynamic seating interventions for clients who have increased muscle tone or who just need to move. She has found that dynamic seating makes client lives better as this intervention reduces equipment breakage, staff frustration, and needed repairs. She has found that dynamic seating reduced or eliminated component breakage resulting in extended life of the wheelchair.
“It is important to look at the causes.”
One client who Stefanie worked with is visually impaired and a sensory seeker. The team had rigged a 2 x 4 piece of wood between the back of this young woman’s head support and the stroller handle of the wheelchair frame to prevent further breakage of the hardware. Much of wheelchair design focuses on durability. However, without addressing the cause (such as extreme client forces), the solution may not truly meet the client’s needs. A more durable component may not break; however, forces remain unrelieved, leading to loss of client position and even injury. After evaluation of this situation, Stefanie and the team recommended dynamic head support hardware and a dynamic back. “It is important to look at the causes. This young woman was breaking her head support hardware because she was colliding against it with tremendous force. Stabilizing the current head support was preventing equipment damage, but not addressing the root cause – her unrelieved forces. Using dynamic seating absorbed these forces, protecting the hardware, but also protecting her from injury.” A dynamic back was also recommended as a great deal of force was coming from the client’s hips and resulting in the entire wheelchair frame ‘bouncing’ across the floor. The dynamic back absorbed these forces, allowing the client to move, but keeping the wheelchair in one place.
How are you using Dynamic Seating with the clients you work with?
“I mostly use dynamic seating with people who are sliding out of position – it is not the shape of their seat; it’s their tone and the seating equipment needs to absorb some of that energy.” Stefanie finds that strong muscle tone and movement patterns are often the root cause of positioning challenges. “If a client keeps breaking their back canes, stop and ask why. Don’t just keep replacing product.” When a client exhibits strong tone and movement in a static seating system, they will move in relation to the seating surfaces. When the seating surfaces move, as with dynamic seating, stability and posture are maintained.
“If a client keeps breaking their back canes, stop and ask why. Don’t just keep replacing product.”
Stefanie not only employs dynamic seating, but also looks to the seating materials and upholstery to provide additional, if small, movement and force absorption. These micromovements can be very effective in absorbing force, increasing alertness and comfort, and decreasing agitation.
Stefanie finds that many team members in her area are not recommending dynamic seating when appropriate for the following reasons:
- They may not be aware of dynamic seating
It is very challenging to stay up to date with seating and mobility interventions and product options. Successful client outcomes depend on our willingness to stay up to date.
- They are afraid of dynamic seating
Working with unfamiliar and/or new products is definitely a learning curve. This takes time, effort, and even a degree of risk. Team members must learn about dynamic seating product options, applications, and even technical aspects – such as how to determine an appropriate level of resistance and monitor the components for required maintenance, such as replacing a worn elastomer. Team members may also be concerned that providing movement will lead to loss of position and stability.
- They are concerned about funding
Especially when this technology is unfamiliar, it is challenging to know how to justify dynamic seating in documentation for successful funding. “Documentation needs to include what problems you are trying to solve and what is required to do so.” Click here for sample justification wording.
What is missing?
“I wish it were more of a standard option, like on an order form. You can’t try it (a dynamic back) if you have to cut the back canes.” Stefanie would love to see dynamic seating options more readily available to clinics and equipment suppliers so that this technology was easier to try. The Seating Dynamics components are available on several manufacturer’s order forms now (such as PDG, Freedom Designs, and Ki Mobility), but otherwise have to be ordered separately for compatible frames.
Stefanie would love to see less spending on replacement items that only put a bandage on the problem, instead of addressing the root causes with interventions such as dynamic seating. She would also like people to feel more comfortable recommending and justifying this technology.
Thanks, Stefanie for your time, expertise, and passion!