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Old 27-10-16, 12:51 PM   #7
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Join Date: Sep 2012
Location: Hastings, East Sussex, UK
Posts: 1,153
Default Re: Toppling to one side

Hi everyone

The following OT document has a good section on Posture: Occupational Therapy for People with Huntingtonís Disease: Best Practice Guidelines
and the Specialised Wheelchair Seating National Clinical Guidelines has Checklists and Risk Assessment details throughout.

Postural Management

For occupational therapists aiming to promote improvements in posture and comfort in sitting for people with Huntingtonís disease it is recommended that:

An assessment of sitting ability and posture

Points to consider:
  • Assess the dimensions of a personís current chair/seat to ascertain whether it is the correct size and offering adequate support.

  • Assess whether the pelvis, trunk, neck, head and arms are adequately supported.

  • Ensure the personís feet are fully supported. Footwear that provides grip may assist.

  • Consider whether a cushion will provide additional postural support and whether pressure relief is required.

  • Where people are unable to sit comfortably or safely consider the need for specialist lounge and/or wheelchair seating.

  • Additional positioning devices may be considered to maintain position and/or safety. For example, head support, lateral trunk supports, positioning belts, a table or lap tray to provide upper body support.

  • Least restrictive positioning methods and adaptations should be trialled first before deciding upon using a harness as a positioning aid. Where seating adaptations restrict freedom of movement (e.g. tilt in space, positioning harness) legal aspects regarding restraint must be respected. Consent should ideally be obtained from the person. Where this is not possible, the therapist should assess a personís capacity and where this is lacking they may need to act in a personís best interest. All such decisions need justifying and documenting as to the reasons for them. Consider whether a contoured backrest may also provide additional trunk support.

  • Any seating system needs to be robust to withstand heavy transfers.

  • Requesting brakes on all 4 casters may make transfers safer.

  • Regular maintenance and checks of any seating/chair is necessary, as clips and screws can become loose.

  • A modular seating or wheelchair system that can be adapted to increase its longevity can be useful where the individualís condition is changing frequently.

  • Consider breathable materials to enhance comfort and wipe clean material due to continence and spillage issues.

  • It is essential that a personís positioning and comfort should be regularly reviewed over time, as presentation will change. These options should be assessed in situ over time to assess whether they enhance posture and function.

  • Training should be provided to either the person with Huntingtonísí disease and/or their carer on how to use any seating system/ adaptations, this should also be documented.

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