Preventing Aspiration | The PostureWorks

Positioning CASE STUDY – ENGAGE APOD
Parke View Rehabilitation and Care Center, Burley, ID

Trent Gunnell, MHA, MS CCC/SLP, DOR

Patient: 86 year old male

Primary Diagnosis: Lewy body Dementia, DM, Behavioral disturbance, hyperlipidemia, dysuria,
HTN, glaucoma, depressive disorder, dysphagia

Existing Wheelchair Seating: Highback reclining sling seat wheelchair with foam cushion

Positioning / clinical Issues: Pt was in sacral sitting and sliding with right lateral lean. Pt had poor
intake (less than 25% of meal) with poor oral control/management and risk of aspiration and
subsequent pneumonia. He was unprepared for the act of eating with poor bolus management
increasing risk of aspiration and weight loss. He presented with oral dysphagia and demonstrated
anterior loss which was exacerbated by poor positioning. His diet texture was downgraded to pureed
by nursing. He was on thin liquids however demonstrated poor intake and a 9% weight loss.

PostureWorks Intervention: Engage APOD Medium Profile

Outcome: Pt now demonstrates improved upright midline trunk positioning with no sacral
sitting/sliding or lateral leaning and a midline head position. He demonstrates increased attention and
anticipation with intake because he is in an improved position which decreases his overall risk of
aspiration with improved bolus management. His oral intake increased to 50% or more with each
meal and decreased anterior loss. His diet texture was upgraded to mechanical soft. He now
demonstrates improved ability to manage thin liquids as his head is in midline.

Quality Outcome Measures Impacted by Intervention: QOL*

Feedback from Therapist: “As part of our intervention, the change in positioning when the pt was
placed on the Engage APOD had an immediate impact on my pts ability to anticipate the act of eating
and improve his intake and subsequent safety during the swallow.”

*QOL Studies indicate that 54% of all SNF admissions are malnourished; the range of malnourished elderly in
SNFs range from 20-87%. In addition, 60% of all residents experience an initial weight loss following admission.
Dementia places pts at a higher risk for weight loss and dehydration. Current statistics estimate that 60-80% of all
residents in long-term care have a dementia diagnosis. Dysphagia and Nutrition Management In Patients With Dementia:
The Role of the SLP, S.Curfman, MA, CCC-SLP May 23, 2005

Note: This is a representative example; actual user evaluations, and decisions regarding the appropriateness of a
particular product for a particular individual, should always be made by a qualified healthcare professional.

FALLS CASE STUDY – Engage APOD
Camelia Gardens of Life Care, Thomasville, GA

Shelbey Wise, OTR/L
Shelby Collins, COTA

Patient: 87 Year Old Male, LTC Resident, 6 foot 3 in and 174 lbs

Primary Diagnosis: Alzheimer’s Disease, Syncope, Weakness, Impaired
Coordination, HTN, CPOD.

Existing Wheelchair Seating: Patient seated in high back, reclining sling seat
wheelchair with standard foam cushion.

Positioning / Clinical Issues: Patient was in sacral sitting and sliding with (5)
falls from wheelchair over a 2 month period. Pt appeared to be in pain and was
repeatedly attempting to stand from his chair.
PostureWorks Intervention: Engage APOD (Advanced Positioning Orthotic
Device), High Profile

Outcome: Pt is now able to sit in an upright and midline trunk position after the
Engage APOD intervention was put in place. The pt stopped attempting to stand
from his chair and appeared comfortable and content. The Engage APOD
corrected the underlying pelvic obliquities which may have been the cause of his
pain, as well as his repeated attempts to stand that caused him to fall. The pt had
no further falls after the intervention of the Engage APOD .

Quality Outcome Measures Impacted by Intervention: QOL, Falls, Pain

Feedback from Therapist: “The Engage APOD prevented my patient from
falling and improved his QOL as he is no longer in pain.”

Note: This is a representative example; actual user evaluations, and decisions regarding
the appropriateness of a particular product for a particular individual, should always be made by a
qualified healthcare professional.

ENGAGE APOD TM

CASE STUDY

Improving Positioning, Reducing Pain, Reducing Falls

120 Bed Skilled Nursing Facility, Pennsylvania

Patient: Female (78) yrs / 195 lbs long term care patient

Primary Diagnosis: Toxic encephalopathy and dementia

Existing Wheelchair Seating: Patient had been issued multiple positioning
interventions without success. Most recently, patient was issued a pommel cushion
used with high-back reclining w/c and foot rests.

Positioning / clinical Issues: Patient presented with abnormal tone, specifically
increased hip extensor tone while in her wheelchair. The patient was demonstrating
pelvic thrusting that was so extreme that she tore the medial portion of the pommel
cushion from the base of the cushion.The combination of tone and decreased postural
control directly resulted in a history of falls while also placing the patient at risk for
pressure injuries and pain. The only position that prevented falls was a reclined position
where the patient was unable to engage with her environment. In addition, the patient
needed to be repositioned 2-4 times per day to ensure safety and comfort while in her
w/c.

PostureWorks Intervention: Engage APODTM Medium Profile 22×18

Outcome: Patient was issued an Engage Medium Profile cushion, which was
documented by therapy to eliminate forward sliding and promote upright, midline
posture. Utilizing the Engage APOD was an effective intervention that broke up the
abnormal tonal patterns and addressed the etiology of the positioning abnormality vs.
treating symptoms. The patient now presents with good posture 90% of time, and only
needs to be repositioned occasionally. The patient has not had any falls since the
Engage APOD has been in place and has also resulted in a decrease in time for nursing
interventions.

Quality Outcome Measures Impacted by Intervention: QOL, Pressure, Pain, Falls

Feedback from Dir of Rehab, COTA: “The cushion worked very well for the resident
and eliminated the forward slide (she presented with strong hip extension while in w/c,
and she actually pushed through a pommel cushion). She has been upright with no
sliding noted on the Engage APOD cushion.”

WHEELCHAIR SEATING CASE STUDY:
Improving Positioning & Decreasing Pain

150+ Bed Skilled Nursing Facility

Patient: 91 Year Old, Female, LTC Patient

Primary Diagnosis: Dementia, Repeated Falls, HTN, Hypothyroidism, Hx of
DVT, Hx of UTI

Existing Wheelchair Seating: Patient seated in standard sling seat wheelchair
with standard foam cushion.

Positioning / Clinical Issues: Patient presenting with sacral sitting and sliding,
forward head posture, and B rounded shoulders with L lateral lean. Pt was at risk
for skin breakdown given positional abnormalities. Pt reporting discomfort when
sitting for prolonged periods of time in chair.

PostureWorks Intervention: Engage APOD (Advanced Positioning Orthotic
Device), Low Profile

Outcome: Pt reported immediate elimination of discomfort when Engage APOD
intervention was placed into her chair. She is now able to sit in an upright and
midline trunk position and maintain this position. Pt no longer presents with
positional abnormalities, thus decreasing her risk of skin breakdown.

Quality Outcome Measures Impacted by Intervention: Pain , Skin Protetction,
QOL

Feedback from Patient: “I love this new cushion – it is more comfortable!”

Feedback from Treating Therapist: “My pt had an immediate improvement in
positional abnormalities and immediately reported being more comfortable when
transitioned from a foam cushion to the Engage APOD.”

Note: This is a representative example; actual user evaluations, and decisions regarding the
appropriateness of a particular product for a particular individual, should always be made by a
qualified healthcare professional.