Presenter Sharon Sutherland, PT got married to Scott Sutherland - PDF document

10/7/15 ¡ The Other Seat! Where else is Skin Integrity preservation and postural management a critical consideration for the wheelchair-seated client? …. In the bathroom of course! Sharon Sutherland (Pratt), PT Seating Solutions, LLC sharronpra@msn.com http://www.seatingsolutionsllc.com Presenter — Sharon Sutherland, PT – got married to Scott Sutherland and changed name from Sharon Pratt, PT J — I am the Mum of 2 beautiful daughters: age 21 and 18… Jennifer and Sarah — Specialized in the field of Seating and Mobility for over 27 years in Canada and the USA — Experience includes clinical assessment through prescription; funding policy, product design and development; clinical education and consultation worldwide — Graduated from Trinity College, Dublin, Ireland. — Presently lives in Colorado, USA 2 2015: Sharon Sutherland, PT 10/7/15 1 ¡

10/7/15 ¡ Disclosure — I am the owner of Seating Solutions, LLC — The opinions expressed in this program are based upon 27 years of working specifically in the field of Seating, Positioning and Mobility — I do clinical consulting for Ottobock Mobility and Raz Design. — Pictures/graphics used throughout with permission from Individual clients/patients and clinicians 3 2015: Sharon Sutherland, PT 10/7/15 Abstract A lot of time and resources are invested on skin integrity preservation and positioning strategies to help reduce the incidence of sitting acquired decubitus ulcers and postural deviations while sitting in manual and power wheelchairs. Regrettably, these clients are still at significantly high risk of the same seating challenges if they are using improperly configured and poorly adjusted rehab shower commode chairs. This presentation will review the clinical and functional needs of rehab users in conjunction with the seating and positioning attributes of rehab shower commode chairs. 5 2015: Sharon Sutherland, PT 10/7/15 2 ¡

10/7/15 ¡ Learning Objectives 1. Identify the Skin Integrity needs of Clients using rehab shower, commode chairs 2. List the Postural and functional needs of clients using rehab shower, commode chairs 3. List 2 critical product parameters that should be considered when prescribing/selecting rehab shower, commode chairs 6 2015: Sharon Sutherland, PT 10/7/15 Discussion points — Important clinical considerations for the clients at risk for skin integrity issues - when they are not in their wheelchair /seating mobility device - where are they and how is their skin being protected? — How can best practice guidelines for skin integrity preservation be implemented when using RCCs — When faced with prescribing or selecting a RCC - what are the top 3- 5 considerations? — Interface pressure mapping- Can it be helpful in the selection of Rehab commode chairs? 7 2015: Sharon Sutherland, PT 10/7/15 3 ¡

10/7/15 ¡ Who Benefits from a Rehab Shower/ Commode chair? (RSCC) Persons presenting with; - Spinal Cord Injuries - Traumatic Brain Injuries - CP , MS, ALS, - Bariatric and/or Elderly profiles with functional limitations - A mobility impairment - Prolonged bowel / hygiene routines and at risk of pressure sores 8 2015: Sharon Sutherland, PT 10/7/15 WHAT CAN A RSCC DO FOR YOUR CLIENT? • Provide safe transport for non-ambulatory or barely ambulatory users • Provides safe positioning and skin integrity preservation for users who are at risk of decubitus ulcers from bowel and bathing programs lasting one to three hours • Eliminate unnecessary transfers – Very important • 2 nd most important mobility device! It is indeed the “other seat” 9 2015: Sharon Sutherland, PT 10/7/15 4 ¡

10/7/15 ¡ Thoughts from colleagues I have interviewed over past several months — Must have flexible/multiple access areas for client and/or caregiver in commode seats/chairs — If possible make postural supports removable or swing away to make washing body parts easier — Assess postural support needs if possible in the shower...especially if the user is able to do part of the activity themselves. Support in the right place can make the difference between being able to wash some body parts independently or not. Also you will see the impact the water has on muscle tone. — “Must contain the splatter!” — Need to get over all toilet heights and yet manage lateral stability… “Sometimes we get so high we tipple over laterally” 10 2015: Sharon Sutherland, PT 10/7/15 Thoughts from colleagues I have interviewed over past several months — Surface must be firm enough for transfer - soft enough for skin protection — Access right or left side of body -needs flexibility — Self access – client has to hook and reach - — Tilt often recommended for higher level quadriplegia C5 and above or those with problems with blood pressure and /or tone — For clients who function at level C6/7 will often recommend self propel as opposed to tilt — Remember best practices for weight shifting while on these seats 11 2015: Sharon Sutherland, PT 10/7/15 5 ¡

10/7/15 ¡ Thoughts from colleagues I have interviewed over past several months — Bowel and bladder program best way to get reimbursement – Miami as opposed to focusing on shower for example — Can be on toilet for up to 3 hours- it can be fatal if client gets impacted — Sitting - prepping and waiting ... Bowel program — Then shower program — Sitting tolerance over time (comfort) — Client often will go home with attendant and then move on to independent - need to factor that in when prescribing — “I always order a pelvic positioning strap and a chest strap - as a minimum ” 12 2015: Sharon Sutherland, PT 10/7/15 Shorter rehab programs in the US.. Rehab programs are now only 3-6 weeks in the US ... This means decisions are being forced before the client is ready.. Not accepting of the long term need Biggest challenges are — 1. acceptance — 2. getting home environment ready — 3. affordability of the mods 13 2015: Sharon Sutherland, PT 10/7/15 6 ¡

10/7/15 ¡ Home Environment — Home environment detail is critical - just as for wheeled mobility assessment — Layout of bathroom - 20" wide door likely cannot self propel — Home mods necessary for most who self propel — Consider tub or lip on shower versus roll-in — Turning radius very important for home visit assessments — Detailed existing bathroom measurements must be taken — Consider whether client will be self propelling or have attendant push 14 2015: Sharon Sutherland, PT 10/7/15 Some Basics …. Today we will be focusing more on the positioning and skin integrity needs of the clients who use RSCCs as opposed to the home environments details Lets review some critical facts about posture: skin and positioning 7 ¡

10/7/15 ¡ The process of sitting in general To sit we need to — flex our hips — get our buttocks back as far as possible on the seat — weight bear through both of the ischial tuberosities and/or undersurface of the great trochanters, posterior thighs and feet with the knees flexed. — Ideally the trunk and head will be upright up and balanced above the pelvis. ( spinal stacking concept) 21 2015: Sharon Sutherland, PT 10/7/15 The process of sitting on a toilet seat: western style We need to — flex our hips — get our buttocks centered over the hole/aperture in the toilet seat — weight bear through undersurface of the greater trochanters, posterior thighs and feet with the knees flexed — Ideally the trunk and head will be upright and balanced above the pelvis or leaning forward as necessary 22 2015: Sharon Sutherland, PT 10/7/15 8 ¡

10/7/15 ¡ The process of elimination from a postural viewpoint A Guide to Better Bowel Care: A Complete Program for Tissue Cleansing Through Bowel Management , chiropractic physician and nutritionist Dr Bernard Jensen identified the sitting toilet as a health threat to mankind: — "It is my sincere belief that one of the bowel's greatest enemies in civilized society is the ergonomic nightmare known as the toilet or john." 25 2015: Sharon Sutherland, PT 10/7/15 The process of elimination from a postural viewpoint — The ideal posture for Defecation is the full squat, which provides the abdominal muscles with the proper support during the expulsion process, as contrasted with the familiar “sitting on a chair” posture that is so commonly assumed on a standard raised water closet or toilet seat. In the “sitting on a chair” posture the person trying to empty the bowel is essentially passive and unable to aid the body’s natural mechanism of evacuation. 26 2015: Sharon Sutherland, PT 10/7/15 9 ¡