Wheelchair Seating: The Mat Assessment

Editor’s note: This text-based course is a transcript of the webinar, Wheelchair Seating: The Mat Assessment, presented by Michelle Lange, OTR, ABDA, ATP/SMS.Learning OutcomesAfter this course, participants will be able to list three components of a mat assessment.After this course, participants will be able to describe the appropriate steps in assessing available hip and knee flexion for a seated position.After this course, participants will be able to describe where postural support is required in a wheelchair seating system based on the mat assessment.Thank you very much Fawn, and thanks for all your guys support with all these wonderful continuing education courses. I know I appreciate it as a presenter, and I'm sure that the participants appreciate that as well. So today we're going to be talking about the mat assessment. This is a critical piece of wheelchair seating. I think it's a easy piece to kinda skip over because of time constrains, but if we try to take that shortcut oftentimes we don't cheat the outcomes that we want to. And so we're going to dive into this topic here today. We have the following learning outcomes as this a CEU approved course. We have the participants will be able to list three components of a mat assessment. The participants will be able to describe the appropriate steps in assessing available hip and knee flexion for a seated position. And finally the participants will be able to describe where postural support is required in a wheel chair seating system based on the mat assessment. Now this is what we're going to be covering during this course. We're going to talk about just what the mat assessment is in the context of wheelchair seating evaluation. We're going to discuss the goals of the mat assessment, the components of that, and the actual evaluation of the client in supine and in sitting on the edge of that mat table where they're going to talk about translating those findings into seating recommendations. And we'll do so with two brief case studies. Now I want this to be an interactive session. We do have quite a large amount of people on this call today, which is fantastic. So feel free to type questions in it anytime or comment. If I don't answer it right away, it's because perhaps I know I am gonna be covering that information shortly, but I will attempt to answer each of those questions and address any comments. I'd love learning from each other. Always good to start with a definition. So just what is a mat assessment. You might have heard this called a mat exam, a mat eval. Basically we're looking at assessing a number of things during this mat evaluation where placing the client in supine generally and sitting on the edge of the mat table and looking at these key components. So ideally the starting point of a wheelchair seating assessment is to take the client out of their current seating system, put them on the mat, and look at these particular parameters. It's very important to look at available range of motion, the postural tendencies of the client outside of their wheelchair seating system or other seating system, postural support needs, the seated angles that are going to be required for this person within their seating system and then any orthopedic asymmetries that we see that we may need to accommodate. In terms of the goals of the mat assessment, we're trying to determine specific criteria as they relate again to a seated posture. So we need to make sure the client has available range for a seated posture. If there's range limitations, we need to make sure those are respected within the recommended seating system. We need to determine where support is required and what angle is going to work best for the client. In general, what we can support with our hands the seating system can support as well. So here you can see on the left we have a young man who is not in a great seated position. You can see his arms are up in the air. He's trying very hard to maintain an upright position. Even though you don't have an x-ray of him here, it looks like the left side of his pelvis is higher than the right. He's got a curvature in his trunk and his head is coming forward and to the side. So I'm looking at what is his posture on the edge sitting on the edge of the mat table and then how can I correct that just using my body. So I'm scooted up against him. My front has become his back support. And I have slipped some hands in on the side of his trunk on the right side and by the left side of his head. We're also giving him a little posterior head support. And you can see that already his arms have come down. He's much more relaxed. Still has a little bit of collapse in that trunk but we're starting to get a sense of what type of support he's going to require in a seating system to maintain a more aligned position. So here are the key components of a mat exam that we need to include. We need to look at muscle tone for the client, muscle strength, range of motion, reflexes. particularly those primitive reflexes and how they might be impacting someone's body position, movement patterns that we see within that client and overall postural control. If there's not a lot of postural control then we need to recommend that support to accommodate that. So once we have a client on that table, we need to describe what reflexes we're seeing and the influence of those on body movement and posture. That becomes part of our documentation and it drives where we're thinking the seating system needs to go to meet those needs. We need to describe muscle tone, is it high, is it low, do we have...