Everyone knows that when a clinician identifies the root cause of a fall, the correct intervention will reduce future fall risk and eliminate the need for restraints. However, habit sometimes clouds critical thinking and thus blurs clinical reasoning. Below are 5 common interventions, and reminders of what to think through if you choose to use them.
Selecting the correct intervention improves positioning, reduces the risk of wounds, improves the patient’s ability to interact with their environment, and improves quality of life. Picking the incorrect intervention can increase the patients risk of injuries and create additional concerns.
To Elevate or Not Elevate?
Elevating leg rests- The idea behind elevating leg rests for a patient who continuously slides from their chair is that the leg rests will serve as a stopping point for the patient to reduce sliding. Again, this is not addressing the root cause of their sliding. If your patient has tight hamstrings, elevating the leg rests may increase their discomfort with this prolonged stretch. This position may actually PROMOTE a posterior pelvic tilt as the patient tries to scoot down to relieve the pressure/stretch.
Abduction pommels- Similar to elevating leg rests, the idea behind the pommel is to put a “stop” or “end point” to the person who is sliding out of their wheelchair. I don’t know about you, but I certainly would not want to be stopped from sliding by my genitals! Again, the pommel is not addressing the core reason that a patient would be sliding out of their chair. Using a pommel for the wrong reasons can place patients at risk for skin breakdown at their pubic symphysis and can increase risk for UTIs.
Using non-slip materials like Dycem to prevent sliding- The idea is that the traction from the non-slip material will prevent sliding. The PostureWorks’ Engage APOD and Matrix cushions are covered with a medical-grade fabric called Dartex. This material was selected so that the patient can sit directly on the cover, which is equally important as the cushion itself! The cover offers 4-way stretch to minimize friction/shear injuries, and it prevents hammocking over bony prominences that occurs in covers w/out a 4-way stretch. By placing something over this cover, the patient will not have proper immersion and envelopment into the cushion which will limit the cushion’s effectiveness and may put them at risk for skin breakdown.
Betting on a Belt!
Positioning belts- The idea with the positioning belt is that it will hold the patient in place in their chair. It can be considered a restraint when used inappropriately. An individual with a positioning belt applied to reduce sliding will often just slide right into or under the belt and still be at risk for falls. Additionally, tying your patients into their chair is not taking their dignity and quality of life into consideration.
A Word about the Wedge
Wedge cushions- The idea behind the wedge cushion is that decreasing the hip to back angle to less than 90 degrees, an individual can be “wedged” into the back of their chair. While the idea may be on the right track for a pt with high extensor tone (remember, with pts who have high extensor tone, as you flex their hips, it stops the abnormal pathway from promoting extension), it may not be a long-term solution for patients who don’t have enough hip ROM to tolerate being “wedged.” You may see them continue to slide into posterior pelvic tilt to relieve their discomfort. This may cause additional concerns such as wounds from friction/shear. A benefit of picking the Engage APOD® over a “traditional” wedge is that the Engage APOD has a pelvic well to reduce the risk of shear/friction injuries. and it prevents sacral sitting and sliding.
Improving Clinical Outcomes
If you have a patient who you are struggling to find the correct intervention for give The PostureWorks a call at (866) 860-5200. We love to chat about patients with difficult seating and positioning needs and can send you some products to trial with your patient to ensure that we find the correct intervention.