Specialist Seating

Specialist seating for complex needs

This section is concerned with specialist seating for individuals with complex needs. Generally, for the greatest comfort and stability, a chair should enable the user to have their hip joints and knee joints bent at 90°, with their feet resting flat on the floor. In this way, weight is distributed evenly through the buttocks and thighs, rather than being concentrated in the pelvic area. The seat should not be so wide that the armrests cannot be used comfortably, nor so deep that the user has to lean back in order to be supported by the backrest.

Poor seating can lead to increased pain, particularly in the back, hips and neck, and decreased mobility and independence.

A proper assessment of individual needs is important, in order to make sure that the correct piece of specialist seating equipment is chosen.

Click the links below to go straight to more information on:
Seating options to help with getting up and down
Reclining and leg support
Complex seating needs
Additional support
Pressure relieving chairs

Seating options to help with getting up and down

A chair with a high seat and firm armrests will be easier to get in and out of. Leg raisers can be used to increase the height of a chair by between 2″ (50mm) and about 5″ (125mm). If the higher seat means that the user’s feet don’t rest flat on the floor, then a footstool can be used.

More assistance in rising can be obtained from a chair lifter, either integral to the chair itself, or as a separate, portable product. There are manual versions, powered by a spring or hydraulic mechanism, and also models that are electrically powered (right).

The manual ones have to be adjusted to suit the weight of the person using the chair – which could be a problem in a multi-user environment. If somebody much lighter uses the chair with the riser unit, they could be injured by the force with which it operates.

Powered lifters are more controllable in their operation, but need to be positioned near a power socket so that the batteries can be recharged.

With all chair raisers, it is important to make sure that any risk of entrapment is avoided.

Armchairs with an integral powered lifter are generally one of two main types: either the seat rises and tilts, leaving the frame, back and armrests in place; or the whole chair lifts and tilts. The first type can be useful if the user wants to transfer into an adjacent wheelchair, as the seat rises up above the level of the armrests. The second type is more usual, and is more convenient for most users, as it continues to give all-round support during the rising manoeuvre, and the armrests remain in a good position for pushing off against.

For users of small or extra large stature, some riser chairs are available in high and low versions, and some manufacturers will custom-make to exactly the right size and configuration to suit the user, with special features such as swing-away or drop-down armrests.

Some riser chairs have an anti-entrapment device fitted, either as standard or an optional extra.

Reclining and leg support in specialist seating

A chair that reclines may be useful for anyone who spends a good deal of time sitting, as it makes it easier to change position during the day. It can be helpful for users with a range of conditions, including muscle weakness, circulation problems, stiff joints and back pain.

There are manually operated chairs, with a lever / handle to release the recline mechanism, while the user leans back against the backrest and pulls back on the armrests. Powered recliners don’t require any active involvement in this way, just the use of a hand control equipped with buttons or rocker switches.

A single motor chair will move the backrest back and legrest out and upwards simultaneously, while a dual motor chair enables the two parts to be positioned independently: useful if, for example, the user needs to raise their legs while sitting upright. The dual motor chair shown above left has a high seat and long arm rests to make transfers safer and easier.

Some recliner chairs can be made completely horizontal, allowing them to be used for sleeping. Although generally speaking, sleeping in a chair in this way is not recommended, it can be useful on a short term basis, or if a person is completely unable to transfer between a bed and chair.

Many powered recliner chairs also incorporate the riser mechanism described above.

As an alternative to a reclining chair, a separate legrest or footstool can be used to support the legs in a raised position. A legrest is larger and taller, giving better support for more of the leg. A footstool is just big enough for the feet, and supports the feet and ankles a short way off the ground. Some legrests have a surface that can be adjusted to give the best angle for support.

Complex specialist seating needs

Anyone who is unable to keep a stable, comfortable position when they are seated will need a more supportive chair. It is essential that their needs are properly assessed by an OT or physiotherapist.

Chairs with adjustable angle seats and backrests can have the seat angled slightly down at the back, while the backrest is adjusted to maintain the most comfortable angle (90°), to assist anyone who tends to fall or slide forwards in their chair, or has difficulty holding their head up. Such a sloping seat, however, is difficult to get out of, and a hoist will almost certainly be required to facilitate transfers.

Multi-adjustable deep seat chairs can be individually tailored to meet the user’s needs, with adjustable head and side supports, as well as back and seat that can be altered in height, width, depth and angle. A tilt-in-space facility means that the chair can be angled backwards to provide a deep seat, then tilted forwards to a horizontal position to make it easer to get out of.

Modular seating systems, as the name suggests, are built out of various elements to meet the exact needs of the user. A common chair base is thus customised with components such as footrests, headrest, additional lateral supports, etc.

Chairs to meet the needs of users who are largely immobile often have pressure-relieving features built in (see below).

Additional support in specialist seating

For many people, a standard chair may suit them, with the addition of some specific support – often for the back and / or neck.

Back supports include lumbar rolls, which support the lower back specifically, and larger supports for the whole back area. They may be filled with contoured foam, memory foam (which moulds to the shape of the user), fibre, or air. The latter are adjustable to suit the user, as you pump them up to the desired degree of support.

A neck support – either inflatable, or filled with soft fibre or foam – will assist anyone who has difficulty holding their head up, or pain and weakness in the neck. The support is hung over the back of the chair and adjusted to the right height to suit the user.

Wedge cushions can assist in relieving back pain by improving the sitting angle, if the chair seat tends to slope down at the back, for example. They can also be used with the thick edge at the front of the seat, to help counteract a tendency to slide forward.

Pressure relieving chairs

Relief of pressure and prevention of pressure sores is an issue for anyone who remains seated for long periods and has difficulty changing their position. Choosing the right chair is an important first step, with a seat of the correct dimensions to distribute weight evenly.

Many specialist seating providers manufacture chairs that incorporate pressure-relieving features in the seat and backrest area. These may be based on cells filled with water, air or gel, often combined with hi-tech foam.

If the chair does not have pressure relief features, then a separate pressure relief cushion can be added, remembering that this will change the height of the chair seat, so a footstool may be required.

 

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Further reading and resources

There is more on pressure relief in seating here

Vivid Care is running a series of webinars on mastering seating assessments

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