Imagine that you’ve gone to visit your physician. She enters the exam room, stands at the door and says, “Looks like those glands are swollen. You must have an infection, here’s a prescription for antibiotics. Let me know if you have any more problems.” She never physically examined you … how does she know what’s wrong just by looking?


An overview of the importance of a CRT evaluation process was covered in Nu Digest article, The Purpose and Process of a Seating Evaluation for Complex Rehab Tech Devices. An integral part of that complex seating evaluation is the hands-on mat evaluation. This is the time that the therapist physically examines the client relative to their ability to obtain and maintain a functional seated posture. This examination allows the clinical team to:
  • Determine which postures are reducible vs. non-reducible, beginning at the pelvis.
  • Determine how much support is needed and the locations of those supports.

There are three important guidelines for this part of the evaluation - look, listen and feel. Feedback from the client, both verbal and non-verbal, is essential. It is useful to have a mirror of some sort so that client’s expressions and body language can be viewed as the therapist is working with them on the mat. It’s also a good idea to keep an eye on the expressions of caregivers and family, and listen to their feedback.

Ongoing conversation during the mat evaluation can be an efficient way of gathering the needed interview information to make decisions, especially with limited evaluation time.
 
The ATP/supplier, under the therapist’s guidance, can participate in this. What better way to understand how to match equipment to the client’s needs? As the evaluation is performed, consider:
 
Where are you putting your hands?
  • This is likely where supports needs to be placed.Look at the shapes created by the client’s body.

Look at the shapes created by the client’s body.
  • Those shapes should ultimately match the shapes chosen for the seat and back supports.

How much force are you using?
  • Feeling limitations in range of motion, as well as the effects of abnormal tone and movement disorders on posture and function, allow a more realistic assessment of how much and what kind of support you can provide, while still allowing the client access to rear wheels, powered mobility controls, augmentative communication devices, etc.
  • Your client can only tolerate so much force on their bodies; this allows you and them to feel what it would take to be positioned in a certain posture.

If you cannot do it with your hands, you cannot accomplish it with equipment.
  • Seating systems do not “lift” or move when and where the client moves. They are static or mildly dynamic systems. Someday we may have “smart” seating systems that act like a therapist’s hands, moving and knowing where to support the client, but not yet!

Even if you can provide corrective forces, if it throws off your client’s balance or ability to function, then you cannot do it.
  • The client may say, “I think that feels ok,” but the expression on their face says, “I could sit this way for about 2 minutes, and that’s it.” It’s best to realize what is realistic now, rather than later.
  • Maintenance of function is the ultimate goal, and is sometimes at odds with “ideal” positioning or clinical goals.

From this mat evaluation come linear and angular body measurements, taken by the ATP/supplier. These ultimately assist in setting up the equipment properly. The next step is to try out equipment that you think will work based on what you have seen, listened to, and felt during the mat evaluation – and then make final decisions. The mat evaluation contributes to the end result for any seating and mobility intervention - success for our clients.


References
Lange, M and Minkel J (eds) Seating and Wheeled Mobility: A Clinical Resource Guide. Slack: 11/17.
Susan Johnson Taylor, OTR/L

Author

Susan Johnson Taylor, OTR/L

Susan Johnson Taylor, OTR/L is an occupational therapist who has been practicing in the field of seating and wheeled mobility for 35 years, primarily at the Rehabilitation Institute of Chicago. Susan has published and presented nationally and internationally, has consulted on product development for manufacturers, and has actively participated in a variety of research studies at the Northwestern Sensory Motor Performance Program. Susan is both a member and fellow with RESNA, and in the past has served on the Board of Directors. She is a member of the RESNA/ANSI Wheelchair Standards Committee and the Clinician's Task Force. Susan joined the Numotion clinical education team in 2015 as the Manager of Training and Education.

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