A professional’s guide to static seating
by Ellie Burcher
This guide has been produced to assist Case Managers in understanding the importance of static seating and how the assessment of this key area can support your client in their rehabilitation process. The guide aims to provide insight into when a seating assessment should be commissioned, how correct seating can be used within a rehab programme and the key factors considered within the assessment.
There are more complex seating products available for clients who have a high level of postural or pressure need however in this guide we are considering those clients who may require seating in the shorter-term due to an incident or accident.
Why consider seating?
Seating is very frequently overlooked as ‘just a chair’ but as we all know ‘what’ we sit on can very much affect how we can function and complete tasks. For example, trying to eat a meal when sat on a large unstable beanbag is rarely successful!
Closer consideration of what your client has available to sit on may have a wider impact on your client’s short and long term needs as well as their progress through a period of rehabilitation.
Where clients have sustained injuries and they may be significantly less mobile during their recovery time and this is likely to mean that they are spending a significantly higher proportion of their time sitting than they normally would, suddenly bringing into sharp focus the options around seating they have available.
Clients who were previously independently mobile may suddenly be restricted in their ability to walk far and may even struggle to achieve an independent sit to stand transfer. They may also find that their existing furniture is too low to easily get on or off.
During recovery clients with some injuries are also advised to keep limbs elevated and may struggle to do this in their usual furniture.
When should a seating assessment be considered?
If your client has experienced a significant change in their transfer ability or mobility they may benefit from an assessment to ensure that the seating available supports and enables their comfort and progress with rehabilitation both in physical and other aspects.
Provision of chairs or alterations to an existing chair can support transfers and mobility and maybe key in facilitating a return to a functional level.
Clients who need to elevate their legs for long periods of the day can often experience low mood if the only way they can achieve this is to lie on their bed, as they are away from the hub of the home, impacting on their involvement and roles within the family unit.
What factors will be considered within the seating assessment?
Once a referral for a seating assessment has been received, the OT will contact the client or nominated person to introduce themselves and arrange the assessment. It is rare that a seating assessment would be completed on its own and it is highly likely that the OT would be involved to consider other factors affecting the client such as transfer issues and access to mobility aids or wheelchairs.
Key seating aspects include considering what the chair needs to support the client in doing – do we need the chair to support the client standing independently or would a chair with a rise function support the client to stand during their rehabilitation?
Clients undergoing a long rehabilitation programme may require more support with standing initially but alongside other input may reduce the level of rise support needed as they move towards independence.
Clients may have good seating already available but just find the heights too low to stand from. Short term or temporary equipment can often be fitted to a wide range of chair styles to increase the height to support easier and safer transfers. These items can often also be easily removed when the client has progressed through the rehabilitation process.
The type of rise function can also be important to consider by assessing the client’s normal movement patterns. Chairs can have a tilting rise where the client is supported forward into a standing position. However, some clients can feel unbalanced with this type of movement causing anxiety.
The vertical rise function, where the seat base raises higher, before tilting forward, can often enable the client to feel more stable with this motion and more confident in their standing ability.
The other features within the chair, such as back recline, leg rest movement, backrest design and tilt in space functionality are also important considerations to look at and they impact they would have on position, transfers and comfort.
The relevance and importance of all these factors for the client would be assessed by the OT, enabling them to build a picture of the type of products needed.
The space available within the home environment can influence the type of chair movements. A reclining chair needs space for the backrest to recline but in smaller spaces a wall hugger design limits the space needed for a chair to complete its movements.
The chair covering is an important aspect to consider and assess. If the client has incontinence, pressure or temperature control issues then the OT needs to factor this into their recommendations to ensure the chair covering meets all the clinical needs.
Clients are often concerned with the colour and look of the chair, especially if the new chair is going to be within their home environment. Therefore, choices of types of fabric, any specific fabric needs and colours are always an important part of the assessment and should always involve both the clinician and the client.
A client’s cognitive ability will need to be assessed to ensure that they are safe in managing moving parts within a chair. If the client is at risk of putting themselves in danger by using the chair then the OT will need to consider how to meet their seating and safety needs.
A well-fitting chair is also important in ensuring it meets the client’s needs fully. A chair of the incorrect dimensions will not fully manage the client’s needs and may cause additional issues:
| Measurement | Consequence |
|---|---|
| Seat height | Too high can cause the client to be unable to reach the floor, leaving them unsupported and sliding down the seat. Too low and the client can struggle to safely stand up from reduced height and puts additional strain on all joints and the cardiovascular system. |
| Seat width | Too narrow can cause skin shearing on the thighs and hips. Too wide and the client will lean to get support from the armrests. |
| Seat depth | Too long causes the seat cushion to push under the knee joint, restricting knee movement and cause rubbing and skin damage. Too short and the thighs aren’t fully supported, causing discomfort and instability. |
