Often the most appropriate chair requires further adaption to achieve the optimum position for the patient. Unfortunately the only chair available on the ward is the green chair which will now require further adaptation to achieve an optimal seating position for Mr McTavish.
To assist Mr McTavish to achieve a good seating position, you must now select appropriate equipment from the following items.
To optimise seating and positioning multi disciplinary team working is important to establish the right chair and support.
Mr McTavish needs to be seated in a position which affords the following benefits:
- Maintains stability
- Relieves pressure
- Protects weak arm
- Reduces the risk of choking
- Provides potential to be functional
Correct options
Table
Positioning Mr McTavish’s arm properly can protect it from injury and prevent muscle shortening and tightness. Where this equipment is not available, pillows and rolled up blankets can be used to support the arm in a similar position. In all cases, avoid positioning the weaker arm in front of the body. It should be parallel to the chair arm.
Arm trough
Positioning Mr McTavish’s arm properly can protect it from injury and prevent muscle shortening and tightness. Where this equipment is not available, pillows and rolled up blankets can be used to support the arm in a similar position. In all cases, avoid positioning the weaker arm in front of the body. It should be parallel to the chair arm.
Contoured cushions
Contoured cushions would accommodate the additional pressure from Mr McTavish’s bottom (ischial tuberosities), hips (greater trochanters) and sacrum (tailbone), by providing a concave shape to these areas. The enveloping property of some cushions with contour and liquid is beneficial for distributing pressure. Remember that all cushions add additional height to seating and can alter pelvic position and posture. This should be borne in mind for the patient getting in and out of the chair.
Hip supports
These can provide essential stability for Mr McTavish when the chair has room on either side.
Lateral supports
It is important to ensure that hips and legs are properly positioned first, then if Mr McTavish continues to slump to one side, lateral supports can provide added support to his upper body. Some specialised chairs have lateral supports as a feature. Pillows, rolled up towels, and blankets can be used in many standard chairs.
Steps
It is important to support Mr McTavish’s legs at the right height. If the chair is too high and his legs are not supported on the ground, too much pressure will be on the backs of his thighs. If the chair is too low (or steps too high), there will be too much pressure on his sacrum.
Use with caution
Air filled cushions
Although these cushions are effective for pressure relief, they are not as stable as many other cushions. Mr McTavish would require good positioning support if these types of cushion were to be used. Remember that all cushions add additional height to seating and can alter pelvic position and posture. This should be borne in mind for the patient getting in and out of the chair.
One way glide
One-way glide sheets can help a patient to maintain a good sitting position by preventing them from sliding forward in the chair. The one way glides will only slide in the direction of the arrows which are labelled on the sheets. These glide sheets should not be used on top of pressure relieving cushions and care must be taken to ensure that they are placed correctly.
Head support
This could be useful if Mr McTavish lacks head control. However, headrests are useful if the head is tilting back and not forward. When the head tilts forward, there is a logical tendency to tilt the chair back so that the head is supported by the head rest. While this may achieve a “head back” position onto the head rest, it can reduce the potential for Mr McTavish to be more independent. An alternative method includes giving the chair a slight tilt forward to stimulate his natural reaction to lift his trunk and head where possible.
Foot stool
Although elevating legs is useful to reduce leg oedema, be careful to use this for limited periods of time with someone who has decreased stability like Mr McTavish. Any sitting position with straightened knees will pull the pelvis into a position which increases pressure on the sacrum and contributes to sliding forward in the chair.
Pillow for positioning
In the absence of more specialist equipment pillows can be used to provide support and assist a patient to maintain a good seating position.
Not appropriate
Ring/doughnut
While this is commonly perceived as reducing pressure on the sacrum (tailbone), it would actually increase the pressure on all the areas in which it makes contact with Mr McTavish’s bottom.
Pillow for sitting on
Pillows are not designed for this purpose and when compressed by Mr McTavish sitting, could produce as much pressure (even more, potentially) than a regular chair.
Page last reviewed: 25 Feb 2021
