When it comes to assessment for posture and seating, it cannot be stressed enough that this must be personal to the individual. The beauty of the human race is in its diversity and no two people are the same in body structure, size, postural presentation and personal preference. We all have individual requirements for comfort, taste of aesthetics and priorities for lifestyle.
To provide a full and holistic assessment, we must understand the requirements in full. You may only have one hour with the person you are assessing, so it’s important to use it wisely to gain all the information needed. An ideal model of practice to guide us is the ICF .
The ICF was developed by the World Health Organisation (WHO) in 2001 as a framework for classifying definitions and measurements in health and disability which can be used internationally and across various disciplines and sectors. It was created to supersede the International Classification of Impairments, Disabilities and Handicaps (ICIDH) which was published in 1980 and historically seen as a medical model of classification.
The ICF provides a holistic framework to guide assessment by seeking to understand an individual’s medical condition, body structure and function, the activities they partake in, their level of participation, as well as the environmental and personal factors that will influence their choices. The ICF can be used as a tool to ensure that we capture all the elements of that person.
So, let’s explore how it can guide our assessment:
Medical Condition
Understanding a person’s medical condition or comorbidities can influence the seating we choose as we may need to consider future changes or specific supports. Sometimes, certain diagnoses can present with similar postural presentations, for example people with Spina Bifida often have an anteriorly tilted pelvis and people with advanced Multiple Sclerosis often have a posteriorly tilted pelvis or children with Cerebral Palsy can have hip dysplasia. Over time, we come to recognise patterns of common postural considerations, and this can guide our thinking when choosing the required seating. It is also necessary to consider whether the person has had any specific surgery or are due to have further surgeries and whether they take medications that influence muscle tone, such as baclofen, if they’re on a treatment regime, e.g. a course of Botox injections for muscle tone will impact posture.
Body Structure and Function
Once we know the medical history that affects a person’s body, we can then consider more individually how it affects them specifically. This is where we need to ensure we complete a hands-on assessment on a firm surface, ideally a plinth. This is to ensure that we truly capture the body’s abilities and limitations both in lying and sitting. What are their joint ranges and measurements? This information is crucial in identifying the correct supports for that individual. For example, if they have a scoliosis, where do the lateral supports need to be to support spinal alignment? In addition to posture, we must also take a full history of their pressure care needs and consider their risk factors for developing pressure ulcers. This goes beyond just a waterlow score – have they had a previous ulcer, when, where, what was the treatment? Is their skin currently intact or being treated? Do they have a 24-hour postural care regime? What clothing do they wear and how do they transfer? Can they complete pressure-relieving leans independently or do they need support and reminders? How do they manage their continence? These things all help to build a picture of that individuals specific needs and circumstances, which all informs the attributes of seating that is chosen – the pressure relief properties of the cushion, the material and breathability etc.
Activities
This is where we begin to understand more about the person and what they want to do. How long during the day will the seating be used for, what do they need to do whilst seated, what is important to them. How do they eat and drink? (e.g. do they have good head control for a safe swallow function, are they fed via PEG and therefore do we need to consider placement of a harness or postural supports, do they need to be tilted at a certain angle to prevent reflux).
Participation
How much is the person currently able to participate in daily life and the activities they want to do? Are they satisfied with that level of participation, or could things be improved with better support? If their pelvic and trunk stability is increased, does this allow them better use of their hands to complete tasks? Do they need more support to hold their head up to expand their visual field?
Environmental Factors
Once we are clear on the support that is required within the seating, we also need to consider the environment where the seating will be used. What is the access like (door widths, flooring surface, steps/ramp etc). Is there adequate temperature regulation? Does the seating come in parts that are assembled in the room or will it need to go in through the door as a complete unit?
Personal Factors
What is their taste and preferences? I meet so many people who like to match their wheelchair and seating colours to their favourite football team. Or if it’s seating within the home, what fabrics and colours might match the existing decor? What else is important to them as an individual?
So, you can see, as we move through the different areas of the ICF, we build a picture of an individual and all the different facets that make that person unique, as well as gathering the information required to inform seating choices for postural control. Perhaps next time you complete a seating assessment, you could use the ICF to guide your assessment?
Written by our guest blogger, Lauren Osborne, an Independent Posture & Wheelchair Specialist Occupational Therapist.
[1] World Health Organization (2024) International Classification of Functioning, Disability and Health (ICF) [Online] URL: https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health (Viewed 27.08.24)
