Seating, Positioning, and Mobility

Seating, Positioning, and Mobility

Key Takeaways

What is Assistive Technology (AT) for Seating, Positioning, and Mobility?

  • The need for seating, positioning, and mobility devices is often medical in nature and typically customized to a patient by a healthcare provider.
  • Seating and positioning AT devices support or improve mobility and assist in postural support and pressure management.
  • Seating and positioning AT devices aid in head support, stability, and in the positioning of other devices.
  • Seating and positioning AT devices may also improve attention to task.
  • Mobility devices aid movement in space and over distance.

Common No-Tech and Low-Tech Seating, Positioning, and Mobility AT Solutions:

  • Ensure a person has access to all parts of the environment by arranging furniture to meet ADA accessibility standards
  • Ensure seating/positioning is appropriate:
    • Feet resting on the floor
    • Knees flexed 90 degrees
    • Hips flexed 90 degrees
    • Hips back in chair
    • Shoulders relaxed
  • Be well-rested/conserve energy (extra time/breaks between tasks)
  • Remove carpet/rugs to prevent falls
  • Alternate seating positions with movement activities
  • Use an angled writing surface such as a binder or slant board to aid in writing ergonomics
  • Use positioning stabilizers (non-slip material, rolled towels, TheraBand, and cushions) to prevent slipping out of chairs
  • For lateral supports use a chair with arms

Who, When, and Where is AT for Seating, Positioning, and Mobility Appropriate?

  • This AT is appropriate for anyone who needs assistance achieving and/or maintaining a comfortable position that enables them to participate in daily activities.
  • This AT enables individuals to move independently in one’s environment.
  • Seating, positioning, and mobility AT may be needed in all environments.

Why is Seating, Positioning, and Mobility AT Important?

  • Reduces or eliminates the need for human assistance for daily activities
  • Minimizes the effects of abnormal muscle tone
  • Provides body stability
  • Lessens a person’s fatigue
  • Allows a person to transition from one environment to the next

Situations for Seating, Positioning, and Mobility AT:

School Environment

  • Sitting on the floor during circle time
  • Working at a desk within the classroom
  • Entering/Exiting school rooms and buildings
  • Participating in recreation in the gym or on the playground
  • Eating lunch in the cafeteria
  • Performing in and transitioning during events/musicals
  • Activities of daily living in the restroom

Work Environment

  • Standing at a register or in a manufacture line
  • Working at a computer desk
  • Entering/Exiting work rooms and buildings
  • Eating and resting in the break room
  • Using an elevator
  • Working outdoors on various terrains

 Home Environment

  • Watching T.V.
  • Gaming with friends
  • Sitting on the patio
  • Eating family meals
  • Showering or bathing
  • Activities of daily living
  • Cooking meals
  • Entering/Exiting rooms and the home

Community

  • Attending outdoor/indoor venues
  • Playing at the park
  • Riding in a car
  • Shopping
  • Eating at a restaurant
  • Banking indoors
  • Transitioning to/from and in/out of the car
  • Playing at the splash pad/park
  • Maneuvering through the farmers’ market
  • Sitting at church
  • Navigating a movie theater and sitting

Commonly Asked Questions about Seating, Positioning, and Mobility AT:

  • Q – Who can help an individual match with appropriate seating, positioning, and mobility AT solutions?
    • A – Most seating, positioning, and mobility devices are specific to one person, it is best to consult a physical therapist, occupational therapist, or an AT seating specialist when determining the best AT.
  • Q – What is a neutral seating position?
    • A – A neutral seating position is when the body is aligned with no stress added to the body structure. Knees should be kept at a ninety-degree angle position, hands, arms and wrists are in line and parallel to the floor, feet rest completely on the floor (unless a footrest is used), the head faces forward, elbows are kept close to the body and bent at an angle of ninety to one hundred and twenty degrees, the back is supported by a lumbar cushion, and thighs and hips rest comfortably on a padded seat parallel to the floor.
  • Q – Why is proper posture and positioning so important?
    • A – Poor posture can cause numerous problems such as difficulty breathing, problems swallowing, poor digestion, urinary tract issues, decreased upper extremity use, poor balance, and safety risks.
  • Q – What are some questions to consider when deciding on a type of seating, positioning, and mobility AT device?
    • Can the device be used to navigate typical environments?
    • Is more than one kind of device needed to get around typical environments?
    • Where will the device(s) be used?
    • Does the condition vary from day to day requiring needed devices to change?
    • How will the device be obtained?
    • What abilities and limitations need to be considered?
    • Is the mobility device comfortable when using?
    • Does the device safely meet seating, positioning, and mobility needs?

  AT Solutions at ABLE Tech:

Visit ABLE Tech’s Seating, Positioning, and Mobility AT Inventory

Visit ABLE Tech's Seating, Positioning and Mobility AT/DME Reuse/Exchange Inventory 

Helpful Links and PDF Resources:

Guides and Articles:

Video/Webinar/Podcast Resources:

  • Podcast: Mobility Management
    Stakeholders share their insight, predictions, and hopes for complex rehabilitation technology (CRT)
  • Webinar: Dynamic Seating
    This course looks at product options and discusses clinical indicators and contra-indicators for dynamic seating components
  • Webinar: AT 101
    How do I know if the student is positioned adequately in their mobility base?

 

Education

Case Studies of Individuals with Seating, Positioning, and Mobility AT Needs and Recommendations 

Case Study #1

4-year-old preschool student, hyperactive, difficulty sitting still, no personal boundaries, loves circle time, and group activities

The preschool student participates in a half-day preschool. The teacher has expressed difficulty keeping the student in circle time during calendar and story time. The student runs in and out of the circle, lays in the floor wriggling around, or is unable to stay in his personal space. The teacher would like to increase his ability to sit in one place for 3 minutes.

Possible Recommendations:

The recommendation is to teach the student personal space and boundaries. This can be taught by designating a specific seat for each activity then have the student sit and stay on that assigned seat when completing activities like calendar, reading, or crafts. Explain the assigned seat represents their personal space and the space they are to occupy when working completing activities. This will help the child develop an understanding of how to stay in each designated area. Specific seating and positioning AT may be used to provide comfort and assistance in helping the child stay focused, attend to task, and maintain personal space.

Goals and Outcomes:

The 4-year-old preschool student will use seating and positioning AT to sit in one designated spot for 3 min to complete a classroom activity.

SETT Framework for feature-matching forms based on the Student, Environment, Tasks, and Tools model.

Case Study Forms – SETT Framework
Sample Solutions:

Case Study #2

7-year-old with an acquired brain injury, unable to complete self-care, non-verbal, decreased postural control, minimal head control, delayed processing of information and uses specialized wheelchair

The student acquired a brain injury from meningitis and has returned to school in a tilt-in-space wheelchair. The teacher has noticed the student grumbling and groaning during group activities. The teacher feels the student wants to be more included and on the other peers’ physical level. The teacher would like alternative seating for the child to participate in group activities.  

Possible Recommendations:

The recommendation is to use safe, alternative seating that is facilitates the student’s participation in desired activities. Consider alternative seating that has lateral supports, a chest strap, head supports, and enables the student to be on peer level.

Goals and Outcomes:

The student will use alternative seating to increase classroom engagement with peers.

SETT Framework for feature-matching forms based on the Student, Environment, Tasks, and Tools model.

Case Study Forms – SETT Framework

Sample Solutions:

Case Study #3

13-year-old student, 8th grade, maintains academic excellence, enjoys soccer and art, has mood fluctuations, distractibility, inattentiveness, and poor organization

The student has difficulties focusing, sitting still, and attending in class; however, he hyper-focuses on some activities of interest. He is restless in the classroom and often requires reminders to stay on task. The student is described as "constantly running around" and presents with difficulties listening and following instructions. He often blurts out answers and interrupts other students in the classroom.

Possible Recommendations:

The recommendation is to use alternative seating that allows for movement to increase sensory regulation and processing. The best solution would also be age appropriate and discreet.

Goals and Outcomes:

The student will complete one assignment in class without distracting others with the use of alternative seating devices.

SETT Framework for feature-matching forms based on the Student, Environment, Tasks, and Tools model.

Case Study Forms – SETT Framework

Sample Solutions:

Employment

Case Studies of Individuals with Seating, Positioning, and Mobility AT Needs and Recommendations 

Case Study #1

A 19-year-old living with cerebral palsy, minimal movement with upper extremities, uses a speech generating device (SGD) and a power wheelchair

The 19-year-old works at a fast food restaurant delivering food to patrons who place orders within the restaurant. The employee uses an iPad and app as an SGD mounted on a fixed straight arm bar. The employee has discovered the SGD covers his face when interacting with customers while delivering food. The employee would like a mounting device for his SGD that is independently adjustable for appropriate social interactions.

Possible Recommendations:

The recommended position of an adjustable wheelchair mount would be on the side of the wheelchair. The employee would like to be able to independently adjust and readjust the position of his SGD to be out of the way during interactions/activities in any environment. The mount needs to be sturdy and stabilized with each position.

Goals and Outcomes:

The employee will use a positioning device to adjust his SGD according to his environment and social situation to meet his communication needs.

See the attached HAAT Model form to see how to match the employee to needed AT.

Case Study Forms – HAAT Model
Sample Solutions:

Case Study #2

A 35-year-old, financial advisor, outdoorsman, all-terrain vehicle (ATV) accident, bilateral hip fracture 

The gentleman fractured both hips following an ATV accident resulting in a bilateral hip replacement. Recovery time will be three to six months. The employee would like to return to work remotely from the home for the three to six-month recovery time.

Possible Recommendations:

Considering a laptop table will help with seating and positioning for greatest access and outcomes. The recommendation is an ergonomic laptop table with correct body positioning recommended by the physician. Features needed include adjustable height, tilt option, compact, and lightweight.

Goals and Outcomes:

The employee will use an ergonomic laptop table to return to work remotely from his home.

Case Study Forms – HAAT Model

Sample Solutions: 

Case Study #3

A 59-year-old, real estate receptionist, obese, sedentary, has diabetes, has pressure sores/ulcers from laying for long periods of time

The employee has recent history of acute pneumonia and respiratory failure resulting in a lengthy ICU stay where she developed a pressure ulcer preventing her from sitting for long periods of time. The ulcer has been managed with wound therapy for approximately 7 weeks, and now the employee is ready to return to work part-time with precautions for long sitting periods.

Possible Recommendations:

The recommendation is to use an ergonomic cushion in the office chair to reduce pressure to the ulcer area. The cushion needs to allow for neutral seating position, be adjustable in size, and easily cleaned.

Goals and Outcomes:

The employee will use an ergonomic seat cushion to sit for two-hour intervals in an office chair to complete her daily job duties.

See the attached HAAT Model form to see how to match the employee to needed AT.

Case Study Forms – HAAT Model
Sample Solutions:

Community Living

Case Studies of Individuals with Seating, Positioning, and Mobility AT Needs and Recommendations 

Case Study #1

A 1-year-old with Failure to Thrive (FTT), unable to sit without assistance and fatigues easily, can roll over, has fair head control, is verbal and in foster care with a supportive family

Since 9 months old, the child has shown evidence of a global developmental delay and has been diagnosed with FTT. The child shows significant physical delays. She is unable to sit without support, unable to pull from sit to stand, and is not crawling or walking. The caregiver would like to begin working with the child on sitting while awaiting a referral for physical and occupational therapy. This will provide support during play and mealtimes.

Possible Recommendations:

The recommendation is to increase the child’s head control and core muscle strength. Tummy time is a vital building block for sitting. Tummy time builds the muscles of the neck, stomach, back, and shoulders while working on visual and sensory development. Consider using interesting and engaging toys as AT during tummy time such as infant safe mirrors, musical floor mats, or textured materials.

Goals and Outcomes:

The child will use AT to develop muscles and skills to sit unassisted during play and mealtimes.

See the attached HAAT Model form to see how to match the individual to needed AT.

Case Study Forms – HAAT Model

Sample Solutions:

Case Study #2

A 45-year-old in the construction industry, is a father, recent spinal cord injury resulted in  complete paraplegia, experiencing phantom sensations, uses a wheelchair

The gentleman is a stay-at-home dad taking care of his kids which includes driving them to and picking them up from school. He uses a modified vehicle with a ramp and hand controls but is having difficulty transferring in and out of the driver’s seat independently.

Possible Recommendations:

Consider AT that will aid in the transfer from wheelchair to vehicle and back and is also comfortable, lightweight, easily transferrable, and requires minimal assistance from others.

Goals and Outcomes:

The gentleman will use AT to transfer in and out of the car with minimal assistance.

See the attached HAAT Model form to see how to match the individual to needed AT.

Case Study Forms – HAAT Model
Sample Solutions:

Case Study #3

A 74-year-old retired teacher, traveler, moderate basal ganglia stroke, right-side neglect, poor balance, fatigue

The individual had a stroke during a family trip. She sits to complete daily living activities and requires minimal assistance. She can only stand for 10 minutes before fatiguing and is unable to walk long distances without dragging her foot. She used to enjoy walking at the mall and would like to incorporate the activity back into daily life. 

Possible Recommendations:

To support her in resuming this activity, it is recommended she use a wheelchair when fatigued or when endurance is lost. Using a lightweight, portable wheelchair, this would allow her to push the device when she is walking and use it when she needs a break.

Goals and Outcomes:

The individual will use a wheelchair when walking at the mall to safely incorporate a leisure activity back into her life.
See the attached HAAT Model form to see how to match the individual to needed AT.

Case Study Forms – HAAT Model
Sample Solutions: