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

I often say that the only constant in the clients that I serve is CHANGE. I work mostly in pediatrics, so kids tend to grow and, as a result, outgrow their equipment. In kids, however, we have to deal with more change than simple linear growth.

Changing Medical Presentation

• As children grow, it is common to see orthopedic changes such as spinal asymmetries and hip subluxation or dislocation.
• Surgery to place a G-Tube can lead to sudden weight gain and, often, growth.
• Tone management, such as oral medications, injections, a Baclofen pump, or even a Dorsal Rhizotomy, can change tone, range of motion, strength, and the amount of postural support required.
• Orthopedic surgeries, such as tendon releases, hip surgeries, and spinal fusions can significantly impact available range of motion, body dimensions, and body shape.
• Some children have a progressive condition and will require increasing postural support and possible accommodation of asymmetries and changes to body shape.

Adults experience changes in seating needs, as well.

• While adults do not grow in length, they certainly can experience some weight gain which may impact the required seating dimensions.
• Many conditions can lead to muscle atrophy as well as other changes to tissue integrity. This can increase the risk of pressure injuries and impact the degree of pressure mitigation and postural support that is required within the seating system.
• Surgeries and medical interventions can impact seating needs.
• Adults also can develop a progressive condition and will require more postural support and possible accommodation of asymmetries and changes to body shape.

Changing Seating Needs

Whenever a client experiences a change in medical presentation, seating re-evaluation is required to determine if seating system growth, modification, or replacement is indicated. If the client’s medical condition has changed, funding is typically available despite the age of current equipment.

Changing Seating Needs and Dynamic Seating

Sometimes changing medical presentation may indicate a need for Dynamic Seating intervention. The client’s current extensor forces, movement patterns, postural support needs, and /or need for movement may have changed. What specifically should we be looking for?

• Children often present with low tone and limited movement at a very young age. As they grow and develop, we may observe increased muscle tone and/or large and forceful movement patterns, such as dystonia. Dynamic Seating can move in response to extension and movement patterns, diffusing force.
• Adults with an acquired condition, such as a brain injury or spinal cord injury, may present initially with low to normal muscle tone before demonstrating increased tone. Dynamic Seating can move in response to extension, diffusing force.
• Clients with certain progressive conditions may develop extraneous movement patterns which can be large and forceful. Dynamic Seating can move in response to extension and movement patterns, diffusing force.
• The client may also develop a need for movement to calm agitation and/or increase alertness. Dynamic Seating can provide movement in response to client movement.
• Finally, if postural support needs and/or muscle tone has changed, we may observe that a client is extending within the seating system and sliding into a posterior pelvic tilt. Dynamic Seating can allow movement with force while returning the client to a neutral starting position without loss of pelvic position.

Client change requires the seating and wheeled mobility team to reassess seating solutions. Sometimes a part of that solution will be Dynamic Seating interventions. Aren’t sure if a client is appropriate for Dynamic Seating? Contact us, we are happy to help you out!