Best Practices in Seating and Mobility Assessments

Hello all!

Conducting a thorough assessment is vital to ensuring an optimal seating and mobility prescription for a client, but what are the best practices in seating and mobility evaluations? A study conducted by Mary Isaacson, EdD, OTR/L, ATP, published in Assistive Technology, sought to answer that question.¹

Gathering data from occupational therapists and physiotherapists experienced in seating and mobility assessments, and considered experts in their field, Isaacson wanted to find out the therapists' perceptions on the skills required for such assessments, what constitutes best practices in this area, and how the skills for best practices are acquired and maintained.

The following concepts were found to be necessary for best practices in seating and mobility assessments: experience, hands-on techniques, skills, technology, resources, self-directed learning, follow-up, and consumer relationships.¹

Let's take a look at each of these concepts.

Experience differentiates the novice from the expert. Those with experience can draw on their knowledge to use relevant information to solve problems. In the book, Evidence-Based Rehabilitation: A Guide to Practice, Law and MacDermid note that evidence-based practice is a balance between research and clinical judgment.² Reflecting and learning from experience helps one to remember, reason, and problem-solve.

With experience, hands-on techniques improve. Not only do the techniques improve, but the ability to draw information and to understand what "feels right" when conducting the assessment also improve and become easily identifiable.^{1 (p. 17)}.

Several skills were identified as being necessities in best practices for seating and mobility evaluations¹. These included skills in:

• Conducting a mat assessment. If you are uncertain on how to conduct a mat assessment, or would like a refresher in this area, please see a previous Clinical Corner posting on The Hands On Assessment, which includes links to YouTube videos that demonstrate how to conduct the hands-on assessment in both supine and sitting.
• Simulation/trial. It is important to be able to trial recommended equipment or simulate positioning as much as possible. Although not all sizes, configurations, and equipment are possible for trial, the simulation/trial of equipment that is available provides important information to help guide the final prescription.
• Pressure mapping. It was recognized that pressure mapping may not always be needed.¹ For therapists working in areas where pressure mapping is not available, the use of clinical skills of observation and touch, and listening to client feedback, can also provide needed information.
• Applying biomechanical anatomical knowledge. Understanding biomechanics and movement can help to configure a wheelchair and seating system for efficient propulsion.
• Environmental assessment. Study participants pointed out that an environmental assessment may not be required for someone living in an accessible environment, such as a long-term care facility. Trial of equipment and feedback from the client and/or caregiver can help to inform suitability of recommended equipment, such as seat to floor height relative to table heights, if an environmental assessment cannot be completed.
• Interview. It is important to conduct an interview that allows the client to express her own perspective. Evidence-based practice includes a balance of client values and needs, in addition to clinical expertise and external clinical evidence.²

Having an understanding of the technology available, both "old technology" and "new technology", and the strengths and weaknesses of the technologies, allows the therapist and client to establish realistic goals based on the application of the most appropriate technology for the individual. ^{1 (p. 18)}

It is considered best practice to know and evaluate relevant resources available. For example, manufacturer representatives and vendor representatives have knowledge of current equipment available. Other therapists experienced in seating and mobility are also resources for clinical problem solving.¹

Self-directed learning is a way to acquire and maintain skills in seating and mobility assessments. This includes attending continuing education courses, using peer mentoring, applying trial-and-error, attending trade shows, and reading.¹ Being a lifelong learner is key. In fact, evidence-based practice is based on a self-directed learning model.²

Follow-up is important to confirm the recommendations and the plan worked. Both formal and informal follow up were identified. Informal follow up included contacting the client through telephone or email to determine if any problems existed or informally questioning the client at the next appointment, while formal follow-up included questionnaires to determine client satisfaction.¹

Consumer relations is important to partner with the consumer as the client brings the perspective of his own experience, skills, and knowledge of needs.¹ Evidence-based practice supports a client-centred approach.²

Despite the best intentions to conduct a seating and mobility assessment based on best practices, there can be barriers to be overcome. The study cites time restraints, limited funding, unavailability of equipment for trial, and limited access to complete the environmental environment.¹ Creativity allowed therapists to overcome these barriers. For example, using technology and available human resources helped to overcome time restraints. Funding problems were overcome by using service organizations and loaned equipment. Borrowing equipment from manufacturers and equipment suppliers helped to overcome the barrier of unavailability of equipment. For therapists seeing clients in clinic or in hospital, having the clients/caregivers take pictures, videos, or measurements of the home environment helped to ensure the fit and function of the equipment in the environment.¹

Best practices in seating and mobility assessments are dependent upon a number of different factors and it is important to remember that any barriers to best practices can be overcome with creative solutions.

References

1. Isaacson, M. (2011). Best practices by occupational and physical therapists performing seating and mobility evaluations. Assistive Technology, 23, 13 – 21.
2. Law, M. & MacDermid, J. (2008). Evidence-based rehabilitation. A guide to practice. (2nd) Thorofare, NJ: SLACK Incorporated.