Educational review: A clinical day with Sharon...
Our educational team travels all over the world to share the knowledge we have. In order to give you an idea of some of the things we do in our educational program we’d like to give you an insight into one of our seminars. Keep on reading for a peek into a day with Sharon Sutherland-Pratt…
The setting
As our educational consultant Sharon gives seating and positioning seminars that often also include a hands-on part in which she conducts a physical examination. On this particular day she visited Heliomare in Wijk aan Zee the Netherlands. Sharon always starts her examination with a interview to become familiar with the situation. This day’s client is an 11 year old girl that suffers from a brain injury caused by an early birth (28 weeks): periventricular leukomalacia. It’s a brain injury that disrupts the working of muscles and in this girl’s case affected the functioning of her lungs. As a consequence she also suffers from bronchopulmonary dysplasia (a chronic lung disease) and cerebral, bilateral and spastic paresis. The paresis shows itself in a loss of function in her hands and spasms in her arms and legs. The girl’s spasms show in her adductors, hamstrings and calfs. Whilst seated in her chair she has a slack posture, a kyphosis in her back and protraction in her shoulder blades. Being in her teenage years the girl’s body is in a growth process and continuously changes.
The problem
From the conversation with Sharon the problem arises, the positioning in the wheelchair is inadequate which results in pain and sliding. Due to the loss of strength in her muscles she is unable to properly hold herself up even when supported by the back system from her wheelchair. It’s concluded that after approximately 15 minutes in her current wheelchair, she slides forward and to a side, doesn’t feel this change and is also unable to correct it herself. The challenge is to find a position in which she has enough support and can also sit actively in her wheelchair taking all her limitations into account.
Sharon's analysis
A key feature of Sharon’s approach is to establish if the mobility issues that a client shows in seated position can be confirmed in a physical mobility examination. This is key in the process of establishing whether one is dealing with a physical limitation or inadequate seating. The physical analyses starts with a supine examination on a plinth. In this examination she assesses the mobility of the client, her hips, knees, lower back etc. By going through this, Sharon concludes that there is a limited mobility in the girl’s hips and knees and comes to an important conclusion, namely that she has shorter hamstrings. After the assesment on the plinth, the assessment is continued in seated position. Here in Sharon establishes how the girl can sit with and without support and again the hamstrings prove to be an important factor, most likely being the cause of her instability.
Sharon's advise
In order to address the question of providing more support and facilitating an active position, Sharon offers several solutions. She suggests that it would be better to follow the contours of the body with a back support rather than a flat back support surface. A possible solution to the limited movement in the girl’s hips can be a saddle seat.
She also mentions that if the girl’s feet were to be placed further backwards, sliding forward would be limited, creating a more stable position. She also recommends an alternative solution to accommodate the limited mobility in the hips: instead of tilting the entire power chair, she suggests adjusting just the seating surface into a forward tilt. Creating a diagonal surface to accommodate her hips, together with the feet placed backwards this should provide a better, non-sliding position. In this the hips must be positioned higher than the knees.
Conclusion
The clinicians from Heliomare took Sharon’s advice to heart and will take the suggestions for the back, seating surface and feet positioning into account when a new wheelchair will be fitted to the girl as she grows. Hopefully resulting in a better and more stable position.
The response from the audience
“Sharon’s presentation is very informative and inspirational. She really is a passionate speaker and it is eye-opening to hear of her views for the physical examinations. She stresses the importance of really taking time for the passive (laying-down) assessment and not moving on to seated too quickly. As we saw today it can provide important insights. Her way of handling the client is open and feels like an advise you take to heart without ever being compelled to do so. If you ever have the chance to join one of her seminars, I would highly recommend that you’d do so!”
– Lonneke Oppeneer, children’s fysiotherapist, Heliomare, the Netherlands
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