This article has been edited and published with permission from Careflex. Original author is CareFlex Clinical Specialist, Rebecca Dunstall BSc Physiotherapy (Hons). CareFlex has been manufacturing specialist seating since 1995. They strive to balance posture and pressure management with the individual’s own goals, whilst promoting comfort, independence and a meaningful life.
During the current coronavirus (COVID-19) pandemic, adhering to important government guidelines to stay at home means we may be sitting and lying more than usual. Individuals with conditions that affect their movement, especially those who have difficulty changing their own position, could therefore be at an increased risk of postural deterioration. Ultimately, this will impact on their physiological function and increase their risk of developing pressure injuries.
Why is postural management still important now?
The benefits of postural management are extensive, from promoting independence and function to improving comfort and enabling social interaction. These are essential to quality of life but, given how coronavirus (COVID-19) affects the human body, one of the most important objectives of postural management right now is to achieve optimum respiratory function.
Social distancing and self-isolation can also mean that individuals with more complex needs will be receiving modified care. They may not be getting the regular and optimum support they need to change position throughout the day and night; therefore, increasing their risk of skin breakdown.
What seating considerations are needed?
In order to encourage optimum physiological function and reduce the risk of developing pressure injuries, it is vital that the individual is sat:
- As upright and stable as possible.
- With their pelvis at the back of the chair.
- As symmetrical as possible.
- With their head supported.
- With their chest and shoulder girdle opened up.
- With their upper and lower limbs, including their feet, supported.
How can specialist seating help?
Specialist seating aims to correct or accommodate a person’s posture, depending on the outcome of their assessment. Ultimately, their body segments will be fully supported and their body weight distributed evenly throughout the chair.
Many aspects of a specialist chair, which are far superior to standard seating, will offer the support necessary to encourage optimum respiratory function:
- Adjustability throughout ensures that the chair dimensions can be set-up for the user, as correct seat width and seat depth are critical to pelvic stability.
- Contoured seat cushions further enable pelvic stability and symmetry.
- A range of trunk support options, from contoured back cushions to lateral support pads, can ensure optimum trunk alignment.
- Different head supports that are both supportive and comfortable can encourage a safe midline head position.
- The tilt-in-space function can utilise gravity to open up the chest and shoulder girdle, when safe and appropriate to use.
- Specific chair functions can also help reduce the risk of skin breakdown during periods of prolonged rest:
Tilt-in-space can encourage pressure redistribution. Tilt-in-space and back angle recline when used in combination can be effective in providing both muscle and skin perfusion at the ischial tuberosities1. Integrated pressure relief, such as CareFlex WaterCell Technology, can provide a reliable and dynamic solution for individuals at risk. It enables the user to achieve a stable and functional posture without compromising on pressure management and comfort.
AutoTilt actuation can enhance the standard pressure management functions already built into chairs by moving them through small degrees of tilt at short intervals to redistribute pressure.
How can specialist seating address infection prevention and control?
Infection prevention and control (IPC) is another highly relevant key objective and is crucial to reducing the risk of transmitting contagious diseases. To help in hospital settings or multi-user environments, where attention to IPC is critical, CareFlex are able to offer infection control covers including Dartex® for support surfaces which is the optimal material to prevent the spread of infection2. Velcro has been replaced in all exposed areas with plastic profile fittings and zips, and minimised exposed seams.
Additionally, the Shield Plus™ anti-microbial technology on the Careflex vinyl range has already been through independent testing against the spread of the COVID-19 coronavirus strain, to reassure clients and clinicians of its effectiveness against the rise of new contagious diseases. Shield Plus™ anti-microbial protection literally attracts microbes (viruses, fungi and bacteria) and physically destroys them immediately on impact. It has the broadest spectrum of effectiveness against bacteria, including C. diff, and viruses, including COVID-193.
What about lying posture during the COVID-19 pandemic?
Research advocates a regular change of position through the use of different equipment to achieve different postures. However, during this unprecedented event individuals with increased care needs may be spending more time lying or become confined to their bed, especially if they sadly contract the virus.
In these instances, it is essential that the individual’s respiratory function is maximised by being supported as best as can be in lying with:
- Their head and chest elevated.
- Their trunk as symmetrical as possible (pillows can be used to support them in midline).
- Maximum contact with the supporting surface.
- Should the individual present with tight hamstrings or fixed knee contractures pillows or sleep system supports under their knees can be used to limit windsweeping. If the individual is only able to be positioned in side-lying, a pillow can be placed between their knees to reduce the risk of further postural deterioration and pain.
Is there anything else that can help?
Do not forget the positive effects of interaction, whether face-to-face or digitally – during these testing times laughing with loved ones can not only help the spirit but can improve respiratory function too!
This article is intended to give general advice relating to specialist seating. Further updated information on coronavirus (COVID-19) can be found via https://www.health.gov.au/
- 1Jan YK, Crane BA, Liao F, Woods JA, Ennis WJ (2013) Comparison of muscle and skin perfusion over the ischial tuberosities in response to wheelchair tilt-in-space and recline angles in people with spinal cord injury Archives of Physical Medicine and Rehabilitation 94(10):1990-6
2Dartex® (2020) Area of Care Available from: http://www.dartexcoatings.com/area-of-care/
3Panaz (2020) Shield Plus – Effective Against COVID-19 Coronavirus Strain Available from: http://www.panaz.com/en/news/2020/02/shield-plus-effective-against-covid-19-coronavirus/