Clinician Interview: Elaine T. Lu PT, MHEd, ATP
Michelle L. Lange, OTR/L, ATP/SMS

Elaine Lu is a physical therapist in Salt Lake City, UT who has many years of experience in wheelchair seating and mobility, including Dynamic Seating (DS).  In a recent advocacy effort with the Centers for Medicare & Medicaid Services (CMS), Elaine shared valuable insight on the importance of DS, which we have shared here.

Who Uses Dynamic Seating?
“Many of the clients we see as physical therapists have neurological diagnoses. These conditions often include increased muscle tone and abnormal posturing. Whole body extensor tone, movement disorders, and rocking movements are frequent and often increased when the client is placed in a static seating system in a wheelchair.”

Problem – moving seating out of alignment
“A client may frequently move seating components out of alignment, increasing their postural asymmetries and decreasing the effectiveness of the prescribed seating system. This system has been recommended by health care professionals for the client’s best positioning and prevention of medical complications.”

Problem – equipment breakage
“The client who goes into extensor positioning patterns due to increased muscle tone often breaks seating components, hardware, and/or the wheelchair frame which becomes a costly factor in repairs. Dynamic Seating can decrease repair costs for clients with these specific neurological and behavior tendencies resulting in high muscle tone, dystonia, or behavioral ‘rocking’.”

“Whole body extensor tone, movement disorders, and rocking movements are frequent and often increased when the client is placed in a static seating system in a wheelchair.”

Problem – seeking out movement
“Many of our clients with these neurological diagnoses seek out movements such as rocking, which tends to break the wheelchair back canes. Often when dynamic seating is applied, the client is more alert and less agitated when motion is allowed using dynamic seating.”

Problem – client injury and loss of position
“I have seen injuries to clients from colliding with portions of the seating system or wheelchair frame with sudden forces due to dystonia or increased muscle tone/hypertonicity. At times the client is “standing up” in the seating system due to the force of his/her muscle tone and extensor pattern positioning which results in the client moving out of alignment with the prescribed seating system. This is dangerous for the client and difficult for the caregivers who need reposition the client repeatedly.”

Dynamic Seating Benefits
“The advantages to our clients who require this technology include decreased agitation, injury while in a wheelchair, loss of position in relation to the seating surfaces, active extension, and fatigue. Dynamic Seating also increases the client’s tolerance to sitting in the wheelchair. This intervention improves vestibular input, active range of motion, alertness, function, strength, and postural control.”

Well said, Elaine! We so appreciate all that you do for the clients you serve and for our field! Keep up the good work!