Dynamic Seating
Dynamic seating is movement which occurs within the seat and/or wheelchair frame in response to force from the client. Dynamic components absorb force which, in turn, assists the client back to a starting position. https://www.seatingdynamics.com/2016/04/20/dynamic-seating-definition/
Dynamic seating is often used with clients who have increased muscle tone. The dynamic components absorb extensor forces that could otherwise lead to client injury, equipment breakage, decreased sitting tolerance, increased agitation, decreased function, further increases in extension and quite a bit of energy exertion.
https://www.seatingdynamics.com/2016/05/11/clinical-indicators-dynamic-seating-overview/
As dynamic seating is often used by clients who have increased muscle tone, clients with the following diagnoses often benefit from this technology:
- Cerebral palsy
- Traumatic brain injury
- Spinal cord injury (when spasms are present)
- Huntington’s Chorea
- Other diagnoses where increased tone is present
As dynamic seating is also frequently used by clients who seek out movement, clients with the following diagnoses may benefit as well:
- Cerebral palsy
- Developmental disabilities
- Sensory processing disorder (when a wheelchair is also required)
- Other diagnoses where the client seeks out movement
https://www.seatingdynamics.com/2016/12/05/why-movement-helps-people-with-brain-injuries/
https://www.seatingdynamics.com/2019/08/20/dynamic-seating-for-people-with-cerebral-palsy/
https://www.seatingdynamics.com/2019/09/30/dynamic-seating-for-persons-with-spinal-cord-injury/
https://www.seatingdynamics.com/2019/10/15/dynamic-seating-for-people-with-huntingtons-disease/
Dynamic seating is appropriate for children and adults who would benefit from movement within the wheelchair. Please refer to “Who would benefit from using dynamic seating” above.
Clinical goals include:
- To protect the client from injury
- To protect wheelchair and seating hardware from breakage
- To increase sitting tolerance and compliance
- To provide vestibular input
- To provide active range of motion
- To increase alertness
- To decrease agitation
- To increase function
- To increase strength and postural control
- To reduce active extension
- To reduce energy exertion
https://www.seatingdynamics.com/2016/07/12/using-dynamic-seating-diffuse-force-reduce-overall-extension/
https://www.seatingdynamics.com/2016/06/01/dynamic-seating-prevent-equipment-breakage-part-1/
https://www.seatingdynamics.com/2016/06/15/dynamic-seating-prevent-equipment-breakage-part-2/
https://www.seatingdynamics.com/2016/08/15/dynamic-seating-provide-vestibular-input-part-1/
https://www.seatingdynamics.com/2016/08/30/dynamic-seating-provide-vestibular-input-part-2/
It is important to ensure the client can return to upright after activating the dynamic component. If not, the component resistance can be changed. If this is not adequate to return the client to upright, dynamic options may not be appropriate.
It is also important to ensure the client return to an appropriate posture. For example, a client may return to upright after extending at the hips, but assume a posterior pelvic tilt. Individual manufacturer’s dynamic components work differently and may vary in ability to return the client to an optimal posture.
Some clients may experience increased extensor tone and/or postural insecurity and anxiety in response to dynamic movement. Decreasing the amount of movement may help.
Research has been done on dynamic seating and we have a literature review available. More research is needed and Seating Dynamics is collecting case studies at this time.
https://www.seatingdynamics.com/category/dynamic-seating-research/
Dynamic seating may allow movement at the hips, knees and neck into extension. The dynamic components then assist the client back to a more upright position.
https://www.seatingdynamics.com/2019/03/12/using-multiple-dynamic-seating-components/
The client should be able to move the component and readily return to a starting position. If the component does not move, less resistance may be required. If the component moves, but does not return to a starting position readily, more resistance may be required.
https://www.seatingdynamics.com/category/determining-resistance/
Some dynamic seating systems are a part of a dedicated wheelchair and cannot be moved to another wheelchair frame. Other dynamic seating is modular and is offered as separate components that provide movement at one body area. One component or several can be used on one wheelchair frame to match a client’s needs at one or more body areas. These modular components typically can be used on many types of wheelchair frames. Seating Dynamics components are modular.
The webpages for the Seating Dynamics Rocker Back and Dynamic Footrests include a list of compatible wheelchair frames. The webpage for the Seating Dynamics Dynamic Head Support Hardware includes a list of compatible head support pads.
Dynamic seating is a relatively new area of wheelchair seating. We have a number of resources available on this website, including links to articles, recorded webinars and a bi-monthly blog (see the Resources Tab above). You may also contact us for further information and product specific training needs.
A good place to start is to seek out a wheelchair seating evaluation with a team of clinicians and suppliers who are familiar with dynamic seating options and applications. If you can’t find resources in your area, give us a call and we will be happy to help you identify someone in your area.
https://www.seatingdynamics.com/2019/04/30/evaluation-simulation-and-dynamic-seating-trials/
If the medical change has resulted in a difference in how the dynamic seating responds to the client, then re-evaluation is indicated. For example, a client who has started or changed a tone management program may require an elastomer with less resistance.
Call us at 303-848-3838 and we can give you contact information for suppliers in your area.
This, of course, depends on the funding source. However, with proper justification, dynamic seating is often approved. Access sample justification wording.
Medicare is a nationwide payer and funding dynamic components can be difficult. Please contact your local supplier or ATP for up-to-date funding requirements and assistance.
Medicaid varies from state to state and pays for dynamic components in many cases. A prior approval is often required before the product is ordered.
Insurance companies vary by company and specific plan. Dynamic seating is a rehabilitation product which many insurance carriers are not familiar with. Therefore you should contact a supplier who is familiar with your insurance requirements and can provide necessary documentation.
https://www.seatingdynamics.com/category/funding-dynamic-seating/
Dynamic Rocker Back interface (DRBi)
Compatibility:
Currently there are over 50 different manual and power wheelchair models on which we can install a DRBi. For a full list of compatible wheelchairs, please click here.
Yes, we can supply a DRBi on some power wheelchairs. For a full list of compatible wheelchairs, please click here.
Yes, a DRBi is very often installed on wheelchairs which are not new.
https://www.seatingdynamics.com/2019/05/28/dynamic-seating-a-cost-benefit-analysis/
No. A recliner back and a DRBi cannot be used together.
Yes. DRBis are used very often on tilt-in-space wheelchairs.
https://www.seatingdynamics.com/2018/02/06/much-much-choosing-resistance/
The back of the seating system must move separately from the seat in order to activate the DRBi. If the molded seating system is available in two pieces, this can be used with a DRBi. The Aspen Seating Orthosis is available with a limited recline to accommodate a DRBi.
https://www.seatingdynamics.com/2016/12/19/oil-water-molded-backs-dynamic-seating-mix/
A molded back can generally be used with a Dynamic Rocker Back Interface for two reasons. First, the seat to back angle only opens approximately 10-15 degrees. This amount of movement leads to a minimal amount of shear, allowing the client to remain in alignment with the contours of the back. Second, the Dynamic Rocker Back is mounted with a pivot point that further reduces shear, again, allowing the client to remain in alignment with the contours of the back.
https://www.seatingdynamics.com/2016/12/19/oil-water-molded-backs-dynamic-seating-mix/
Yes. Custom seating is frequently used for clients needing a dynamic back. The DRBi allows for the seating back to be mounted approximately 7” above the seat rail. This measurement varies slightly, depending on the model of wheelchair for which the DRBi is installed.
https://www.seatingdynamics.com/2019/06/11/wheelchair-seating-surface-cushions-dynamic-seating/
No. Due to the necessity for strength and durability clients using a dynamic back need, the non-folding dynamic back is necessary.
Installation and Adjustment:
Depending on the wheelchair model, installation usually takes an hour or less.
Yes. The seat to back angle is adjustable through the wheelchair manufacturer brackets, if this is a standard or added feature. If Seating Dynamic brackets are used, the seat to back angle can be adjusted 80 – 120 degrees, depending on the base.
No, a DRBi is flush with the front of the back post.
No, the armrests which attach to the back canes (flip-up) must be removed. These can be replaced with a single or dual post armrest.
Yes. New back canes need to be ordered either from the wheelchair manufacturer or from Seating Dynamics, after which the DRBi can be installed.
The elastomers last approximately 2 years, depending on the frequency and forces applied. We have a “re-build kit” which includes upper and lower elastomers, as well as plastic caps for the top of the elastomers. These can be purchased and installed by your wheelchair supplier.
https://www.seatingdynamics.com/2016/12/19/oil-water-molded-backs-dynamic-seating-mix/
Call or visit your supplier.
Elastomers:
The DRBi includes a range of elastomers to change the resistance without having to order more equipment. The elastomers should allow the client to move the back and then assist the client back to an upright position. The least amount of resistance is the Yellow (soft) elastomer. The strength of the elastomer initially installed in a new DRBi is Clear (Medium). If the client is able to completely compress the clear (Medium) elastomer, then the Blue (Firm) should be evaluated. The next step is to evaluate the green (Extra Firm) elastomer.
https://www.seatingdynamics.com/2018/02/06/much-much-choosing-resistance/
An extra firm elastomer may not provide enough shock absorption and movement. Some clients who have started with too firm of an elastomer calmed upon changing to the correct elastomer.
We have an easy to follow instruction guide on how to change the DRBi elastomers. To access this guide, click here.
No, the color/strength of the elastomers should be the same on each side. Having different colors/strength will cause possible failure or breakage of the back and the back seating system.
Latch (lock out):
The DRBi should be unlatched all the time, except when the wheelchair is being transported with the client in the chair. Remember to unlatch the back as soon as the wheelchair and client leave the vehicle.
Occasionally you may want to latch the DRBi when pushing a manual wheelchair over rough terrain to prevent excessive movement, but remember to unlatch as soon as possible to prevent breakage of the DRBi and to allow the client to benefit from the dynamic feature.
Education about the equipment and how and why it works is essential. A DRBi which is latched when not in transportation is not allowing the client to benefit from the dynamic feature.
The DRBi needs to be “un-weighted” in order to be latched / unlatched. If there is weight or pressure put on the DRBi, the elastomers are compressed and the back cannot be latched smoothly.
If you are still having difficulty, the DRBi may need adjustment. The supplier may need to adjust the bolt going through the elastomers.
If the DRBi is more than 2 years old, the elastomers may need to be replaced. We have a re-build kit for this, which may be obtained through the supplier. The re-build kit includes upper and lower elastomers as well as plastic caps for the top of the elastomers.
Other:
For some clients, knowing that movement is possible is enough to decrease the amount of resistance applied to the seating surfaces. As active extension is diffused, it may not persist when using dynamic components.
Yes. The pelvic positioning belt helps to maintain a neutral pelvic position during movement.
https://www.seatingdynamics.com/2017/11/15/bread-butter-dynamic-backs-pelvic-positioning-belts/
A positioning device, such as a pelvic positioning belt, is designed to maintain alignment with the support surfaces (i.e. the seat and back), provide stability and postural support and to promote function. A restraint is intended to limit movement to protect the client and/or others.
For specific restraint regulations and documentation requirements to allow provision of necessary postural supports, please refer to “Positioning vs. Restraint”.
https://www.seatingdynamics.com/2017/11/15/bread-butter-dynamic-backs-pelvic-positioning-belts/
Carrying any heavy object on the back or looped around the back canes will adversely affect the DRBi function and is not recommended.
If you are still having difficulty, the DRBi may need adjustment. The supplier may need to adjust the bolt going through the elastomers.
If the DRBi is more than 2 years old, the elastomers may need to be replaced. We have a re-build kit for this, which may be obtained through the supplier. The re-build kit includes upper and lower elastomers as well as plastic caps for the top of the elastomers.
Dynamic Footrests
- All dynamic footrests have dynamic telescopic movement. In other words, the footrests extend or get longer in response to force, up to 1.5”. When the force lessens, the dynamic footrest will return to its original length. The amount of the resistance can be changed by using different springs. All 3 resistance springs are included in the purchase. Using telescoping movement without knee extension is appropriate for clients who would need dynamic movement, but who may lose hip position when the knee extends. This can be an issue particularly with clients who have very tight hamstrings. This model is not available in the high pivot design.
- Dynamic knee movement which allows the wheelchair user to extend or semi elevate their knee up to 30 degrees. This allows the footrests to be set at a starting point of 90, 80, 70, 60, or 50 degrees of knee flexion. Each footrest can be adjusted separately to meet an individual client’s needs.
- Another option is dynamic plantar and dorsi flexion at the ankle. This option allows up to approximately 17 degrees of movement in either direction. This should not be used when the client has an AFO (ankle foot orthosis), as this will not allow the ankle to move.
- Extension at the knee which creates a pull between the seat frame and the footrest hanger. This could result in seat frame and/or footrest hanger damage.
- Downward pushing or banging of the foot on the footplate. This could lead to bending or breaking at the footplate, footplate attachment, the footrest hangers and/or the seat frame. This may be first noted as reduced clearance between the footrest / footplate and the front caster.
Static Heavy Duty Footrests
Sometimes a dynamic footrest is not appropriate due to a client’s lack of range or atypical leg and/or foot postures. Typically, a standard footrest hanger and footplate are appropriate. Occasionally, more specific and Heavy Duty designs are required.
Our Adjustable Knee upper footrest hardware provides a wider range of knee angles using hardware that is very durable and will not lose position due to the clamping method. Adjustment is accomplished using male/female steel splines.
Our Adjustable Windswept upper footrest hardware is designed to accommodate increased hip adduction on one side and increased hip abduction on the other side.
Our Adjustable Super Contracture upper footrest hardware is designed to accommodate significant knee flexion.
Seating Dynamics also provides adjustable plantar and dorsi flexion extensions.
Yes, our Adjustable Knee upper footrest hardware provides a wider range of knee angles using hardware that is very durable and will not lose position.
https://www.seatingdynamics.com/2016/05/11/clinical-indicators-dynamic-seating-overview/
Yes, our Adjustable Windswept upper footrest hardware is designed to accommodate increased hip adduction on one side and increased hip abduction on the other side. This hardware can also accommodate bilateral hip adduction or abduction.
- Cerebral palsy
- Traumatic brain injury
- Spinal cord injury (when spasms are present)
- Huntington’s Chorea
- Other diagnoses where increased tone is present
As dynamic seating is also frequently used by clients who seek out movement, clients with the following diagnoses may benefit as well:
- Cerebral palsy
- Developmental disabilities
- Sensory processing disorder (when a wheelchair is also required)
- Other diagnoses where the client seeks out movement
https://www.seatingdynamics.com/2016/12/05/why-movement-helps-people-with-brain-injuries/
https://www.seatingdynamics.com/2019/08/20/dynamic-seating-for-people-with-cerebral-palsy/
https://www.seatingdynamics.com/2019/09/30/dynamic-seating-for-persons-with-spinal-cord-injury/
https://www.seatingdynamics.com/2019/10/15/dynamic-seating-for-people-with-huntingtons-disease/
Yes, our Adjustable Super Contracture upper footrest hardware is designed to accommodate significant knee flexion.
Yes, we do offer a one piece footboard that also flips-up for transfers. A one piece footboard provides a wider space to accommodate the feet where needed and also will not “sag” medially as many footplates tend to do over time and under force. This also prevents the feet from falling into the space between the footplates.
Dynamic Head Support Hardware
The Single Axis dynamic head support hardware provides approximately 8 degrees of movement posteriorly. The resistance can be changed using different elastomers.
The Multi Axis dynamic headrest provides movement posteriorly and laterally, allowing this to respond to rotational movement. If the client does not always extend directly in midline, but has some rotation to their movement, the multi axis dynamic headrest is indicated.
For a full list of compatible head pads, please click here.
Seating Dynamics offers two options:
First is a universal mounting bracket that is attached to the posterior surface of the back of the seating system.
Second, a spreader bar mount is available if the universal mounting bracket will not work, dependent on the type of back used. This is width and depth adjustable.
A quick release mount is available to easily remove the head support.
- Cerebral palsy
- Traumatic brain injury
- Spinal cord injury (when spasms are present)
- Huntington’s Chorea
- Other diagnoses where increased tone is present
As dynamic seating is also frequently used by clients who seek out movement, clients with the following diagnoses may benefit as well:
- Cerebral palsy
- Developmental disabilities
- Sensory processing disorder (when a wheelchair is also required)
- Other diagnoses where the client seeks out movement
https://www.seatingdynamics.com/2016/12/05/why-movement-helps-people-with-brain-injuries/
https://www.seatingdynamics.com/2019/08/20/dynamic-seating-for-people-with-cerebral-palsy/
https://www.seatingdynamics.com/2019/09/30/dynamic-seating-for-persons-with-spinal-cord-injury/
https://www.seatingdynamics.com/2019/10/15/dynamic-seating-for-people-with-huntingtons-disease/
Our Head Support Hardware does not include the typical ball used to connect to the occipital pad. Instead, we use an adapter which attaches directly to the pad. This adapter allows for full adjustment in multiple planes, but holds position much better than a round ball.
https://www.seatingdynamics.com/2018/10/01/maintaining-head-support-position-lets-do-the-math/
The elastomers can be switched to change the level of resistance. The hardware comes standard with Blue (medium) elastomers to provide movement and to return the client to a starting position. If more resistance is needed, Green (firm) elastomers are provided with the unit.
https://www.seatingdynamics.com/2018/03/06/determining-resistance-dynamic-seating-head/
https://www.seatingdynamics.com/2018/09/04/dynamic-head-support-tilt-and-recline-resistance/
If the head support is moving during tilt or recline without force from the client, try a firmer elastomer.
https://www.seatingdynamics.com/2018/09/04/dynamic-head-support-tilt-and-recline-resistance/
Static Head Support Hardware
The Static Head Support Hardware is designed to replace standard hardware with highly adjustable and durable hardware that maintains position. The hardware includes a mounting plate, three links to obtain the height and specific position required, and one interface adapter for common head support pads (pads not included).
https://www.seatingdynamics.com/2018/10/01/maintaining-head-support-position-lets-do-the-math/
Our Adjustable Knee upper footrest hardware provides a wider range of knee angles using hardware that is very durable and will not lose position due to the clamping method. Adjustment is accomplished using male/female steel splines.
Our Adjustable Windswept upper footrest hardware is designed to accommodate increased hip adduction on one side and increased hip abduction on the other side.
Our Adjustable Super Contracture upper footrest hardware is designed to accommodate significant knee flexion.
Seating Dynamics also provides adjustable plantar and dorsi flexion extensions.
