When prescribing seating and mobility equipment, seating professionals will evaluate a client’s skeletal alignment, joint range of motion pertinent to seating, muscle strength and tone, reflex activity, sensory limitations/issues and skin integrity. They will also take into account the active movement strategy and capability. Included in the later is the capability of head and trunk control. An upright posture in sitting aids head control, visual regard, fine motor development, feeding and speech.
First the pelvis will need to be anchored correctly and then the trunk needs to be addressed. There are numerous options available with a Convaid chair to handle mild to more complex trunk control.
For milder clients, without structural skeletal distortion or significant tone, the EZ Rider, Cruiser or Safari could be considered with soft adjustable lateral supports (double or single pad). The double pad system provides bilaterally trunk support to promote midline stability. This will reduce mild scoliotic tendency or leaning to one side. The single pad support (either L or R) will support the trunk on one side. The adjustable chest strap can be pulled to the opposite side for additional correction. Both of these systems are adjustable and detachable.
For the moderate to more complex client demonstrating higher tone, primitive reflex activity, skeletal changes, and less effective movement strategies more aggressive trunk support maybe needed. The Rodeo and Trekker, both with adjustable tilt (0-45) and recline (90-120 Rodeo and (80-170) Trekker) can service the more involved client who needs pressure relief, assistance with positioning for oral feeding, G-tube feeding, management of tone and transfers. The Trekker has the option to add adjustable, firm lateral thoracic supports which mount to the telescoping back shell. They are adjustable in height and width, without the use of tools, and are available in several sizes.
Both the Rodeo and Trekker offer the option to add, adjustable, swing-away, firm lateral trunk supports with subtle curve, which are available in several sizes. These can be mounted to the back and are height and width adjustable without tools. These laterals provide firm support to the trunk with stronger scoliotic tendencies or progression secondary to abnormal tone or reflexes, muscular or endurance issues. The subtle curve allows the front of pad to wrap around front edge of chest for greater control of trunk. The swing-away laterals allow easy transfer of a dependent client in and out of their chair. It allows for easy adjustments in their chair for repositioning to ensure the pelvis and/or spine are completely back in the chair and aligned properly. It also allows for effective positioning of the anterior chest strap.
When specifying the size of the lateral trunk support, the client’s chest depth is used to determine the length of the pad. The client’s chest depth is from the front of the chest at nipple line to the back of the client. To wrap around the front edge of the chest, the length of the pad is usually 1” longer than the client’s actual chest depth at the nipple line. If using a flat pad, one can subtract 1” or 2” from the actual client chest depth to arrive at effective pad length. The dimensions of the pad are also considered with regard to pressure distribution. For a client loading into a trunk pad near the apex of the scoliosis with significant force, a slightly larger pad in height and length can spread pressure over greater surface area and reduce pressure and increase comfort. A client’s seat to axilla or underarm measurement provides the seating specialist with the available range of height adjustment when placing the lateral pad on the chair. This will also be used to determine the height of the pad.