September often is thought of as a time for new beginnings. School begins for school-aged children. Depending upon where you live in the country, the leaves may be starting to change colour signaling the beginning of autumn. Registration is open for our next Cyber Series of webinars for therapists, therapist assistants, funders and vendors in Canada! The first webinar in our annual series is on "The Assessment Process" as the assessment is the beginning for all seating and mobility. A thorough assessment provides a solid foundation for what follows in seating and mobility prescription. This month, Clinical Corner will discuss considerations prior to the assessment – what should be on-hand to ensure optimal results from the physical assessment.
Preparation for the seating and mobility assessment is the key to obtaining objective, reproducible results. Eye-balling measurements will result in improper prescriptions that do not work effectively for the client. With this in mind, let's review the "tools of the trade" that help to ensure optimal measurements, recordings, and ultimately, optimal prescriptions.
Equipment and preparations that help to facilitate a good seating and mobility assessment include:
- A tape measure. A metal tape measure is preferable over a cloth tape measure to obtain accurate linear measurements. A cloth tape measure can wrap around surfaces, making it ideal to measure circumference when recording edema; however, the inability of a cloth tape measure to remain taut without being pulled may cause inaccurate measurements when measuring linear body dimensions.
- 2 clip boards. Measuring between 2 firm surfaces can help to obtain accurate measurements. For example, placing a clip board, or other firm, linear object, on either side of the hips when an individual is seated on a firm surface, and measuring the distance between the clip boards can offer a more accurate measurement of the hip width, rather than measuring with the hands directly on the hips. In addition, placing a clip board directly behind the buttocks perpendicular to the firm surface and measuring from the clipboard to the popliteal fossa can help to provide an accurate measurement of buttock/thigh depth (seat depth).
- Caliper. Although not a requirement for a seating and mobility assessment, a caliper is a "nice to have" piece of equipment for linear measurements if one is available. Like a metal tape measure, a caliper does not bend around a person. The "arms" of the caliper act like clip boards. The sliding arm of the caliper allows for the reading of the measurement.
- Goniometer. Angular measurements should not be eye-balled. A goniometer is required to obtain accurate measurements for body segment angles (joint range of motion) and for support surface angles (wheelchair and seating angles). A universal goniometer, with a fulcrum (centre or body of the goniometer), stationary arm and moving arm, may be used. If a traditional, plastic goniometer is used, the fulcrum should be small enough to measure all desired angles on the body. For example, a large fulcrum may not fit when placed on the ASIS to obtain the frontal pelvic angle (pelvic obliquity) in sitting. An alternative to the traditional, plastic goniometer is the use of a goniometer app or an inclinometer on a Smartphone.
- Assessment Form. An assessment form helps to guide the process of the assessment and helps to ensure that all required information is captured in an organized manner in one place. An assessment form may either be on paper or on a computer or tablet. Either way, without an assessment form key information may not be gathered or some measurements may be missed. While many organizations and health care centres have seating and mobility assessment forms, some places have not yet developed their own forms. If forms are not provided by an employer, it is still imperative to use an assessment form. Many seating and mobility assessment forms are available on-line to download and use.
- Firm surface. Using a firm surface is critical to evaluating an individual's posture and balance. Without a firm surface, inaccurate measurements may be taken and misunderstanding of the client's presentation and requirements may be made. While a plinth may be readily available for therapists working in a rehabilitation centre, finding a firm surface in the community or in some other clinical settings can be challenging. Some possibilities to provide a firm surface for the supine evaluation when one is not available are: a foldable massage table; a seat rigidizer, plexiglass square or transfer board positioned under the pelvis if using a bed for the assessment; a long coffee table that can support the weight of an individual; the floor, if it is safe for the client and therapist to transfer to/from the floor. For the sitting portion of the hands-on assessment, additional surfaces that may assist are: a stool without a back; a firm kitchen or dining room chair without arms (with the client sitting forward of the back support); a shower stool or bathtub transfer bench. Whatever firm surface is used for the assessment, safety of the client and therapist and anyone else involved in the assessment should be taken into account before proceeding.
- Another set of trusted hands. If possible, having a second person available to assist with the assessment can help in many ways. A second person can: assist with transfers when needed; assist with supporting the individual if required when assessing static and dynamic sitting balance; provide additional safety if the client has fluctuating tone; take photographs to document posture during the assessment; or to be a scribe if the client is on infection control pre-cautions.
Knowledge of how to do the hands-on assessment also is required! For a refresher on how to conduct the mat evaluation in supine, refer to this 6-minute YouTube video, Wheelchair Seating Mat Evaluation: Part 1. For a refresher on how to conduct the mat evaluation in sitting, refer to this 5-minute YouTube video, Wheelchair Seating Mat Evaluation: Part 2.
Preparation is an important step prior to conducting a seating and mobility assessment with a client!
As always, please provide your comments, questions and suggestions regarding Clinical Corner. Please email me at Sheilagh.Sherman@sunmed.com. I look forward to hearing from you!
Sheilagh Sherman, BA, BHScOT, MHM, OT Reg. (Ont.)
Clinical Education Manager
Sunrise Medical Canada
Note: The content of this article is not meant to be prescriptive; rather, it is meant as a general resource for clinicians to then use clinical reasoning skills to determine optimal seating and mobility solutions for individual clients. Sheilagh is unable to answer questions from members of the general public. Members of the general public are directed to their own therapists or other health care professionals to ask questions regarding seating and mobility needs.
This article is © Sunrise Medical, Inc., 2019 and cannot be copied, distributed, or otherwise reproduced in whole or in part without the express written permission of Sunrise Medical Canada.