Page 89 - Handbook of Electronic Assistive Technology

76 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

Postural Management Goals
• To improve his independence and comfort.
• To establish a stable functional position to improve his independent mobility and free
up his right hand for functional activity.
• To increase seating tolerance by preventing sliding in the seat and therefore enable
increased participation in activities.
• To prevent reoccurrence of pressure areas on his sacrum through improved pressure
distribution and reduction in shearing damage due to sliding.
• To reduce shoulder pain in his right shoulder.

Identified Seating Requirements
It is identified that Alan’s seating needs to:

• Secure his pelvis to prevent sliding and falling into posterior tilt.
• Offer firm back support particularly to the posterior aspect of his pelvis; support
required up to shoulder height.
• Support around the lateral aspects of pelvis to maintain pelvic alignment and assist
with trunk alignment.
• Offer lateral support to his trunk to correct scoliosis.
• Have a simple head support for rest periods
• Offer support for his left hemiplegic arm.
• Be of an appropriate height to facilitate standing transfers.
Recommendations
• Liaise with medical team regarding pain management for his right shoulder.
• Liaise with nurses regarding monitoring of pressure areas.
• A two-part customised seating system is recommended; a seat cushion that provides
firm postural support with an ischial ramp and pressure relief, and a firm padded back
support with thoracic lateral supports, head rest, padded pelvic belt and arm support.
• Assessment in a powered wheelchair with right-hand joystick control and possible
seat riser to assist with transfers.

John’s Case Study (Paediatric)

John is a 10-year-old boy who has a diagnosis of dyskinetic/dystonic cerebral palsy with
four-limb involvement. His parents report that he is not really tolerating his current seat-
ing system, which is an off-the-shelf seating system with dynamic backrest, and appears
to be experiencing a lot of discomfort in his chair. His teaching assistant in school reports
that he is spending a lot of the day in school out of the chair due to distress in his seating.
This is impacting negatively on his participation in educational activities and also on his
social interactions. His parents and teaching staff feel that he has the cognitive potential
to access electronic assistive technologies, but this has not been possible as he is spending
too little time in his seat and a consistent access method has been difficult to ascertain.