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

Tabatha James is an occupational therapist with Numotion in Tennessee. She has worked with assistive technologies for over 10 years and is also active in the Clinician Task Force and RESNA. She recently shared her significant understanding of Dynamic Seating, as well as Suspension.

Tabatha, how would you explain Dynamic Seating?

Dynamic Seating components are valuable seating and mobility tools to support clients who experience involuntary movements and increased muscle tone that needs to be expressed, not contained. The translation of movement/force into dynamic components provides an energy transfer that does not exist in wheelchairs designed with static, immoveable parts.

How would you compare Dynamic Seating and Suspension?

Dynamic components should not be mistaken for suspension components – suspension components are intended to dampen vertical displacement created from the wheelchair moving over varied terrain (i.e., long-distance trucker seat suspension). While some clients do require suspension components, the purpose and implementation are vastly different from the need and clinical indicators of dynamic components.

“Unlike suspension components, dynamic components have the ability to capture forces that occur in non-vertical directions.”

When individuals experience involuntary movements and increased muscle tone, the force from this muscle activation may be strong and unrelenting. Unlike suspension components, dynamic components have the ability to capture forces that occur in non-vertical directions. For instance, from a seated position dynamic components can support forceful posterior movement from a client who pushes backward into their back support and/or head support. This type of extensor tone presents through the neck and torso in the horizontal plane, and it presents through the lower extremities in a downward diagonal plane from the hip and knee. Suspension components are unresponsive to this type of movement as these are designed to buffer gravitational forces, not human forces.

Which clients may benefit from Dynamic Seating?

Extensor tone is common in children and adults with Cerebral Palsy, Traumatic Brain Injuries, Spinal Cord Injuries and other neuromuscular disorders that cause involuntary increases in muscle tone and movements, and it’s possible even for a small child to exhibit forces strong enough to break hardware.

What are some of the consequences of NOT using Dynamic Seating, when appropriate?
Without dynamic components to capture this energy and motion, these forces have nowhere to go, and the client’s body and the equipment may take the brunt. Fitting a dynamic body into a static wheelchair is detrimental to the end user. Muscle strain, pressure injuries, pain, decreased sitting tolerance, decreased quality of life, increased caregiver burden, and equipment abandonment are a few major issues created when products are not designed to meet the specific needs of the user.

“Fitting a dynamic body into a static wheelchair is detrimental to the end user.”

For these individuals, broken, worn, warped hardware magnifies these stressors for the client and their caregivers and renders their mobility products temporarily useless. When hardware breaks, a service and repair order must be completed, which is an inefficient process within our industry that currently frustrates a high volume of end users. The demand for repairs is high, wait times are long, schedule coordination is a challenge and, in the meantime, an end user does not have access to their medical device for safe seating and mobility. This is troublesome and onerous for the client, the family, school/work staff, and the service delivery team, and, plainly, can be avoided. Dynamic components are designed to withstand the unique forces exerted by these individuals, creating a layer of durability and safety.

What are your thoughts on Funding?

The provision of Dynamic Seating is a cost-effective solution for utilization management. Researchers, designers, mechanical engineers, and clinicians have created an innovative tool to address a niche but very serious issue for individuals whose bodies cannot tolerate or conform to standard static seating or regular hardware. The individual pre/post comparison of seating benefits should be evaluated as the barometer for successful use. Improper coding and policy decisions made with limited understanding create situations of medical negligence and negative health outcomes for wheelchair users that can be avoided.

“Researchers, designers, mechanical engineers, and clinicians have created an innovative tool (Dynamic Seating) to address a niche but very serious issue for individuals whose bodies cannot tolerate or conform to standard static seating or regular hardware.”

Dynamic seating components achieve their intended purpose by maintaining user safety, enhancing product durability, and lessening service and repair needs. Dynamic seating components smartly address disease management for individuals who are highly complex with unique challenges.