5th Nordic Seating Symposium

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5th Nordic Seating Symposium

22–24 may 2012 in Stockholm conference book

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Table of content

3 Welcome to the Nordic Seating Symposium 5 Symposium activities

6 Presymposium workshops 10 Symposium Moderator

11 Symposium programme Tuesday, May 22 12–14 Presentations in Room M2 Tuesday, May 22 16–17 Symposium programme Wednesday, May 23 18–25 Presentations in Room M2 Wednesday, May 23 26–34 Presentations in Room M1 Wednesday, May 23 35–42 Presentations in Room E4 Wednesday, May 23 44–48 Presentations in Room E8 Wednesday, May 23 50 Symposium programme Thursday, May 24 51–54 Presentations in Room M2 Thursday, May 24

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room m2

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Welcome to the Nordic Seating Symposium

T

^he^first^nordic^seating^symposium was held in Stockholm in October 2001. Since then it has been held in Oslo, Copenhagen and Reykjavik and now the fifth Symposium is to be held in Stockholm. On this occasion the venue will be Kista mässan where in conjunction with the Symposium an exhibition, Hjultorget, will be held for two days of the three day event.

This is a symposium for professionals and will focus on seating and positioning for persons with disabilities. Welcome to participate in several interesting presentations and workshops held by speakers from all the Nordic countries, Europe and USA. The main purpose of the symposium is to share experiences, increase knowledge and form new friendships and networks. Presentations and workshops are based upon practical experience, research as well as ideas.

Four workshops were held prior to the symposium. These workshops gave the participants an opportunity to go in depth into particular subjects.

During the first day, May 22th, and the third day, May 24th, all lectures will be given in plenum.

During the second day, May 23th, participants can choose between four different parallel sessions.

We hope that the programme for this year’s Nordic Seating Symposium will create new insights and inspire you in your daily work. There will be plenty of opportunities both to obtain the latest knowledge in the area and to meet colleagues in informal exchanges of experiences across the Nordic countries.

We warmly welcome you to Nordic Seating Symposium 2012 in Stockholm!

The Swedish Institute of Assistive Technology Organizer of the symposium

Jan Grönlund Director

Swedish Institute

of Assistive Technology – SIAT

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Symposium activities

Below you can read more about the different activities that will take place during the Nordic Seating Symposium.

Nordic Seating Symposium, 22–24 May

Lectures during the Symposium will take place both in plenum and in parallel sessions. Almost all parallel sessions will start and end at the same time, which makes it possible to alternate between them during the day. This means that it will be possible to go from one room to another during the day and therefore put together a programme shaped to suit personal interests.

An English description in the programme means that the presentation will be given in English.

A description in a Nordic language means that the presentation will be given in that specific language.

Poster exhibition

A poster exhibition will be arranged during the symposium at the lunch and coffee area.

Each exhibitor will give a five minute presentation during the coffee break on Thursday, May 24.

Exhibition Hjultorget

The Exhibition has been arranged by Rekryteringsgruppen Active Rehabilitation (RG) and The Swedish Association for Survivors of Accident and Injury (RTP). RG and RTP are both non-profit organizations.

RG focuses on motivating people with disabilities, especially those with spinal cord injuries, to lead an active and independent life. RTP concentrates on the promotion of participation and accessibility in society for the survivors of road traffic accidents, accidents in general and polio.

It will be possible to visit the exhibition parallel to the presentations at the Nordic Seating Symposium –due to breaks structures into the programme.

Activities at Hjultorget

A competition, open to all participants, will take place at the fair. This will consist of double poling ergometer, wheelchair basketball, shooting and armbike. Competition starts at booth C10. Participation in all of the events together with the submission of results ensures automatic participation in a prize draw.

During our breaks, why not take the opportunity to enjoy other attractions such as wheelchair dance and wheelchair basket. Why not challenge yourself to maneuver a wheelchair through a specially constructed apartment. The apartment is open all day and can be located at booth C12.

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Pre-SymPoSium workShoP

Rullstolens möjligheter

(In Swedish)

en PraktiSkt kurS där du får lära dig hur man som rullstolsanvändare kan leva ett aktivt liv med optimal livskvalitet. Utgångspunkten är rullstolen som möjlighet – inte en begränsning.

På kursen får du lära dig hur man som rullstolsanvändare kan leva ett aktivt liv med optimal livskvalitet. Utgångspunkten är rullstolen som möjlighet – inte en begränsning.

Kursinnehållet är optimerat så att du ska få tips och idéer om hur man kan lära ut körteknik med mera till användare samt hur man kan inspi rera till en aktiv fritid.

Genom kursen får du möjlighet att öka din kompetens, samtidigt som du får inspiration till ditt fortsatta arbete.

Kursinnehåll:

• Rullstolsteori manuella rullstolar

• Mekning manuella rullstolar

• Rullstolsmanövrering manuella rullstolar

John högberg RG aktiv Rehabilitering

Monday • May 21 • 9.00–16.00 kiStamäSSan

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The evidence basis of using

gait trainers to improve activity and participation

– in Infants, Children and Adults with GMFCS Levels IV and V

target audience: Intermediate, Participants should be familiar with body weight support gait training (BWSGT) and the concept of central pattern generators (CPG).

Much has been learned about BWSGT, but many clinicians are missing crucial information about the significance of transferring this approach to over ground in natural environments to improve activity and participation for infants, children and adults who are non-ambulatory (GMFCS Levels 4 and 5) This method of facilitating activity (NOT walking!) must be part of any and every 24 hour postural management program.

This course will begin with a systematic review of the literature (sorted by ICF cate

gory) . Videos and case stories will be used to show how the central pattern generator (CPG) can be used to facilitate activity and participation in nonambulatory children (GMFCS Level 4 and 5). GMFCS will be reviewed in the context of determining which child will be non-ambulatory and benefit most from this intervention.

Session objectives:

• (Knowledge) Participants will be able to describe the stimulus that triggers the stepping response (CPG).

• (Comprehension) Participants will be able to understand why it is important to stimulate the CPG early and often

• (Application) Participants will be able to apply BWSGT research to

their decision making process for frequency, speed, assistance/ postural support, bracing and amount of unweighting to all brands and models of gait trainers

• (Analysis) Participants will be able to assess any gait trainer for its ability to accomplish or adapt to the desired clinical parameters to optimize the child/

adult’s activity and participation in a natural environment

• (Synthesis) Participants will be able to incorporate new information presented into their current understanding and approach to using gait trainers to increase activity and participation in natural environments

ginny Paleg dScPT, MPT, PT Physiotherapist

Montgomery county infants and Toddlers,

Maryland, USa

E-mail ginny@paleg.com Tel: 001-301-452-4656

Tuesday • May 22 • 9.00–12.00 room e7

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Sensory Processing, Sensory Integration, Seating and

Independent Task Engagement and Performance

SenSory ProceSSing and utilizing sensation in an integrated mode is how the human body interprets and utilizes postures to support active task engagement or managing tasks and work.

Without active control and movement and an active relationship with gravity (vestibular processing), the human body can only move with range of motion, (tactile processing) lacking power, intention and strength.

Seating systems created for skeletal symmetry only can actually prevent task endurance, and in children, task attention. Symmetry does relax the body, but a relaxed body cannot work it can only relax. We need seating systems which allow bodies to work, to gain endurance, and to function within the gravity our planet and our postures require.

Currently, seating systems are created from an anatomical perspective with the focus on managing the body’s skeletal system, particularly “controlling” or “aligning”

the spine and pelvis with the same plane, creating the “right” and “optimal” postural position. When providing seating systems, especially for children, who are growing and changing, it is vital that seating be created from a neurophysiological perspective.

Learning objectives:

• define the two primary sensory modes of processing: tactile processing and vestibular processing.

• identify the seating postures of their AT users as to positions of rest and tactile processing or positions of active engagement or vestibular processing.

• identify seating equipment as to its “postural management” (tactile processing) vs. “postural control” capabilities (vestibular processing).

• perform a “feature/match” with a comparison and contrast of equipment, both for

“access” and for physical configuration and its features to match the needs and skills of their children.

• apply and implement assessment and treatment strategies for the the use of AT equipment including access to AAC, powered mobility and computer use which will include adequate seating with sensory processing.

Karen M. Kangas oTR/l

Nationally certified and State licensed occu pational therapist Seating, Positioning, and Mobility Specialist, assistive Technology Specialist, clinical Educator, consultant Tel: 570-644-1032;

Email: kmkangas@ptd.net

Pre-SymPoSium workShoP Tuesday • May 22 • 9.00–12.00 rooM e6

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Posture management and clinical assessment

PeoPle with PhySical disabilities may have a reduced ability to align and stabilize the body against gravity. An asymmetric posture increases the risk of tissue adaptation and contractures.

This workshop will guide you through a clinical assessment of posture and postural ability in order to provide appropriate support throughout a 24 hour cycle.

eliSabet rodby bouSquet Physiotherapist E-mail: elisabet.rodby _bousquet@med.lu.se department of orthopaedics, lund University

centre for clinicial research, Västerås

guðný JónSdóttir Physiotherapist

Endurhæfing – Rehabilitation centre of excellence

E-mail: gudny@endurhaefing.is Tel: +354 4144500

www.endurhaefing.is

atli ÁgúStSSon Physiotherapist

Endurhæfing - Þekkingarsetur www.endurhaefing.is E-mail: atli@endurhaefing.is

Tuesday • May 22 • 9.00–12.00 room e5

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Gunilla Hammarskiöld Occupational Therapist

E-mail: gunilla.hammarskiold@hi.se

Symposium Moderator

G

^unilla^hammarskiöld is an occupational therapist who has worked in the field of assistive technology during forty years. She has always had an interest in seating and positioning for people with disabilities and held many seating courses at the Swedish Institute of Assistive Technology. In 1995, Gunilla Hammarskiöld and Bengt Andersson initiated “Sitnet Sweden”.

They also arranged the first Nordic Seating Symposium in October 2001, together with the Nordic partners.

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12.00

Registration for the Nordic Seating Symposium 13.00

Opening of the Nordic Seating Symposium

Jan Grönlund, Director, Swedish Institute of Assistive Technology, SIAT A CP good life

Jonas Helgesson, Author, Sweden

Sensory Processing, Sensory Integration, Seating and Access, an Introduction

Karen M. Kangas, Occupational Therapist, USA 15.15

Coffee, exhibition and show 16.00

Windsurfing for all– Increasing participation and accessibility through equipment modification

Kati Karinharju, Senior Lecturer Satakunta University of applied sciences 17.00

Closure

Programme tueSday, may 22

5th nordic Seating SymPoSium

room m2

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Tuesday • May 22 room m2

JonaS helgeSSon author, Sweden E-mail: info@jonas helgesson.se

www.jonashelgesson.se

A CP good life

JonaS iS 33 years old and speaks about his life with cerebral palsy. What is it like to be treated as different? How can the right attitude help to live life to the fullest? Why is respect better than kindness? Jonas speaks personally and with great sens of humor. He is a popular speaker in Sweden and author of two books about his life.

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room m2 Tuesday • May 22

Karen M. Kangas oTR/l

Nationally certified and State licensed occu pational therapist Seating, Positioning, and Mobility Specialist, assistive Technology Specialist, clinical Educator, consultant Tel: 570-644-1032;

Email: kmkangas@ptd.net

Sensory Processing, Sensory Integration, Seating and Access

an Introduction

SenSory ProceSSingcontrols visual convergence, focus, attention, postural control and isolated, graded movement. Its subsequent sensory integration must be supported within the structural components of seating systems, if we intend to provide seating for task engagement. The support of movement, not simply skeletal symmetry must be provided in seating systems.

Sensory processing is how the body interprets and uses its relationship to gravity to support task involvement. Seating systems have focused on skeletal symmetry, which does not support independent functioning.

To assist these children in wheelchairs in developing and using “access” to AT devices, we must also better understand how their bodies work functionally, (rather than pathologically) and what different seating equipment is needed.

I will share strategies and equipment which work and which provide children opportunities to use their sensory processing so that increased, consistent access to AT can be supported and become efficient.

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room m2 Tuesday • May 22

Windsurfing for all

Increasing participation and accessibility through equipment modification

the SataeSteetönproject responds to the needs of a society and supports everyone to have an independent and unrestricted life in every stage of their life.

Yyteri for all was part of this project and its objective was to examine and develop accessibility and increase participation in the area of the Yyteri beach in Pori, Finland. This research presents the ways of developing wind surfing suitable for persons surfing in the seated position.

Adapted windsurfing pilot courses were organized on summer 2010 and 2011 at the Yyteri Surfcentre. The purpose of these pilot courses was to create and modify appropriate equipment for surfing in a seated position and to test these modifications for wheelchair users. Equipment modifications are necessary when surfing in the seated position. These modifications increase the opportuni

ties of physical activity for people with disability.

Moreover, this presentation shares ideas of different adapted summer and winter activities and modifications created during the project.

kati karinharJu Senior lecturer, MSc Satakunta University of applied Scienses, ltd faculty of Social Services and Health care Pori, finland

Mobile: +35844 710 3868 Email: kati.karinharju

@samk.fi

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bEacHy/flickR

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9.00

The effect of a shaped wheelchair cushion and a detachable lumbar support Anna-Karin Hansson

Effect of a Dynamic Seating Surface Erna Rosenlund Meyer and Lisa Trew

10.00

Relationship between “tilt in space” wheelchair function and risk of pressure ulcer development Christian Gammelgaard Olesen

Evaluation of the suitability in which anti - de cubitus cushions meet defined user needs Gunn Limandvik

12.00 Lunch 13.00

Sit as you are, drive as you can Elin Berg

Use of manual and powered wheelchair in children with cerebral palsy

Elisabet Rodby Bousquet

Powered mobility practice-A gate to tool use learning

Lisbeth Nilsson 15.00 Coffee 15.45

Accurate seating measures and size of wheelchair optimizing function in everyday life Lotte Wemmenborn

17.00 Closure

9.00

”Sid godt” – oplysningsmateriale fra Hjælpemiddelinstituttet i Danmark Else-Marie Hansen

Får du formidlet dine budskaber, så de forstås af modtagerne?

Conni Schmidt 10.00

Sitt och ryggstödets inverkan på äldre personers sittande i rullstol

Marina Timm

Hur äldre rullstolsanvändares drivteknik påverkar sittpositionen och vice verca Maria Amnell

12.00 Lunch 13.00

Är rullstolskörande med viss abduktion i höften möjligt och önskvärt för barn med cerebral pares Eva Jönsson och Karin Thews

Sittande hos barn med funktionsned sättning som får korrigerande korsett

Annika Blomkvist och Kristina Olsson Siddestillningnsanalyse og rehabilitering Mette Hornbäck Söderberg

15.00 Coffee 15.45

Spasticitet, påverkar det sittandet?

Britt-Marie Rydh Berner

Exhibition and activities at Hjultorget 17.00

Closure

room m2 max 600 room m1 max 400 5th nordic Seating SymPoSium

Programme wedneSday, may 23

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Programme wedneSday, may 23

9.00

Evaluation of a Clinical assessment tool for posture and postural ability

Elisabet Rodby Bousquet Supine lying support Atli Agustsson

10.00

Developing an elearning Module for Allied Health Professionals:

benefits, problems and reflections Paul Hewett and Jo Jex

A tool to find the appropriate assistive product Mary Petersen

12.00 Lunch 13.00

Clinical uses / appropriate uses of secondary positioning systems

Bart Van der Heyden

On an equal footing: “Adults accounts of the experience of using assistive devices for standing”

Birgitta Nordström

Landing in the chair from a standing hoist Mary Petersen

15.00 Coffee 15.45

Sitting on a horse make a change in life Charlotte von Arbin, Margareta Håkanson, Ulrika Stengard Olsson, Pia Tillberg

17.00 Closure

9.00

Seating Interventions for Users with Amyotrophic Lateral Sclerosis (ALS) Bart Van der Heyden and Anni Bank Agger

10.00

Sit properly! Experiences in use of seat cushions for children and adolescents with sensory integration dysfunction Lotte Wemmenborn

Adaptive seating in work rehabilitation Karen Lyng

12.00 Lunch 13.00

Influences on the Seated Position Menno van Etten

Exhibition and activities at Hjultorget

15.00 Coffee 15.45

Clinical practice project from Norway Kari Borgen, Henriette A. Sjølett, Britt Tornes and Rikke Damkjær Moen

17.00 Closure

room e4 max 200 room e8 max 120

5th nordic Seating SymPoSium

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anna-karin hanSSon Physiotherapist

Sjukgymnastiken rehabiliteringsmedicinska kliniken, Universtitets sjukhuset i lindköping Tel: 013-22 15 48 E-mail: anna-karin.hansson

@lio.se

wednesday • May 23

The effect of a shaped wheelchair cushion and a detachable lumbar support

on underseat pressure, estimated comfort, and pelvic rotation

in order tooptimize independence for clients with seating and mobility needs it is most important to get a wheelchair individually fitted and adjusted. We know that load on the spine will increase with a kyphotic or scoliotic posture and that a deformity might reduce lung function, cardiovascular function as well as ROM in the upper extremities. As therapists, one responsibility is to optimize an assistive device with the objective to prevent future complications.

A shaped wheelchair cushion is often used to support a neutral pelvic tilt, together with a lumbar support this might be the best way to give the client a good support but what about comfort?

Learning Objectives:

• Be able to identify relevant seating outcome variables.

• Be able to understand the connections between pelvic rotation and under-seat pressure.

• Be able to identify the importance of assessing; posture, pressure and comfort and how to prioritize among those when necessary.

room m2 TARGET GROUP: ALL

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erna roSenlund meyer

Senior lecurer, MSc, PT University collegue of Northen denmark www.ucnorth.dk E-mail: erm@ucn.dk Tel: +4572690954

liSa m trew Physiotherapist

E-mail: lisa.trew@gmail.com Tel: +45 29493122

TARGET GROUP: ALL room m2 wednesday • May 23

Effect of a Dynamic Seating Surface

Postural Control, Function and Activity in Children and Young people with Cerebral Palsy Experiences gained and lessons learned using SPCM, pressure mapping, videography and AMPS

develoPing Seating systems for disabled persons is of great importance as they can be used to increase levels of postural control and function which will have an impact on daily activities and participation. This study takes its start point in a seat back and base made of a dynamic material and analyzing changes in postural control.

The purpose of the study was to investigate if a new dynamic seating surface improves postural control, function and activity in youths and children with cerebral palsy. No significant statistical results were gained from the quantitative methods used: Seated Postural Control measure (SPCM), Force Sensitive Applica

tion System (FSA) and Assessment of Motor and Process Skills (AMPS) though there was slight increase in mean pressure distribution. A supplementary subjective evaluation of movement quality showed no clear trend.

Especially the consequences of adapting the Seated Postural Control Measure (SPCM) had our interest. SPCM is described as being able to compare seating systems.

Our experiences in modifying the measure, use of videography, body markers and computer software goniometry for scoring presented various challenges, giving rise to questions about SPCM, the seating system tested and the relevance of experience and training. We believe our study comprises important areas of interest, especially in SPCM development, adaptive seating, and future studies using videography.

• A new dynamic seat base and back surface, being tested for use in adaptive seating systems and studies associated with this system.

• Challenges associated with the use of alternative methods for clinical assessment using a modified Seated Postural Control Measure: how videography, computer software and pressure mapping for can be or not be beneficial.

• Experiences during testing and ideas for use in further studies.

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chriStian

gammelgaard oleSen assistant Professor The anybody Group, department of Mechanical and Manufacturing Engineering, aalborg University, denmark

E-mail: cgo@m-tech.aau.dk Tel: +45 9940 3355 Mob: +45 3033 4553

Relationship Between

“Tilt in Space” Wheelchair Function and Risk of Pressure Ulcer Development

it iS well acknowledged that sustained mechanical loading of soft tissues causes pressure ulcers.The wheelchair adjustments affect the tissue loading in the sense that the tissue stresses, and thereby the risk of ulceration, change when the seated posture is adapted. This study focuses on a basic wheelchair adjustment called the “TiltinSpace” function, which many wheelchairs are equipped with.

The tiltinspace function enables the cushion and backrest to incline while the angle between the cushion and backrest is kept constant. When the tiltinspace function is used, the cushion and the backrest reaction forces change, which causes a change in tissue deformation under the buttocks.

Preliminary results show that the reaction forces between the seat and the buttocks change, and this leads to a change in buttocks tissue deformation.

The results indicate that the “TiltinSpace” function found on many wheelchairs is not optimal, with respect to risk of developing pressure ulcers.

• Engineering perspective on wheelchair development with PU focus.

wednesday • May 23 room m2 TARGET GROUP: ALL

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gunn limandvik Senior adviser/o.T.

The Norwegian labour and Welfare service (NaV) E-mail: Gunn.limandvik@

nav.no Tel: 22 07 09 64 Mob: 909 61 998 www.nav.no

Solveig baardSgaard Head of section/nurse NaV centre for Sssistive technology Nordland E-mail:Solveig.

baardsgaard@nav.no Tel: 75 42 67 00 www.nav.no

kari-anne lorentzen Senior adviser/o.T.

NaV centre for Sssistive technology Møre og Roms- dal

Tel: 70 32 19 50 www.nav.no

Evaluation of the suitability in which antidecubitus cushions meet defined user needs

Comparison of the vendors and the Norwegian Labour and Welfare service (NAV)’s evaluation of antidecubitus cushions

nav haS recently awarded contracts for antidecubitus cushions after an open tender procedure. NAV’s tender notice described the different user needs the cushions should meet and the award criteria was “How well suited are the cushions to meet the described user needs?”

We will show the types of cushions that were offered to meet different user needs, how vendors described the cushion and it’s suitability to meet the user needs and NAV’s assessment of the same. NAV’s team assessed the actual cushion, and compared it to the vendor’s description of its suitability to meet the described needs.

The vendor’s description of the coverage of user needs was usually consistent with the cushions appearance and properties. In some cases, the NAV team disagreed with the vendor’s description and decided to make an independent assessment. We will demonstrate examples of how the NAV team and vendors evaluated the cushions differently and which features NAV consider are necessary to meet the user requirements.

The lecture is the result of a cooperation between the team members but will be presented by a single member of the team.

• Examples of how you may be able to find out if the descriptions of the cushions correspond to how they appear.

• Examples on which qualities we found were most important to meet the user needs.

TARGET GROUP: ALL room m2 wednesday • May 23

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elin berg

occupational therapist The Norwegian labour and Welfare Service (NaV) E-mail: Elin.berg2@nav.no Tel: +47 41575135, +47 21069944

unni norheim

Seniorrådgiver/ergoterapeut NaV (arbeids og

Velferdsetaten) E-mail: unni.norheim

@nav.no

Tel: +47 21069700, +47 21069942 Mobil: +47 917 62 403

Sit as you are, drive as you can

About seating positioning in an dynamic activity where safety comes first

Introduction:

This is a presentation from practise, and we invite the participants of this lecture to join the discussion of what we see and observe in the videos from driving situations. We are working and cooperating with people with complex disabili

ties who are driving their own car from an adapted carseat or from their own wheelchair. They all have that in common that they have a serious degree of physical handicap and an adapted seating position. Driving demands up and downhill affection, breaking and accelerating characteristic, road structure and topographic curves are all aspects which are affecting the seating position, and therefore the quality of driving a car. We have observed different sitting positions and the consequences of lack of support when it comes to driving.

For the Seating symposium we would like to systematize our findings to share our experiences with other clinical workers.

Background:

In our daily work we choose and recommend advanced driving equipment for persons with complex and serious degree of disabilities. The work is most often based upon very well prepared seating postures. Our work is based on evidence, experience and clinical reasoning and within both medicine and Assistive Technology.

Conclusions:

There is no science on this matter and we do not conclude in this presentation.

The videos speak for themselves. Can we learn something about positioning by studying the driving activity? The other way around: We have learned about adaptation advice for advanced driving equipment by studying the driving activity and the videos we here present

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wednesday • May 23 TARGET GROUP: ALL room m2

eliSabet rodby bouSquet Physiotherapist E-mail: elisabet.rodby _bousquet@med.lu.se department of orthopaedics, lund University centre for clinicial research, Västerås

gunnar hägglund department of orthopaedics, lund University

Use of manual and powered wheelchair in children with cerebral palsy

mobility iS important for the cognitive and psychosocial development of chil

dren. Almost one third of children with cerebral palsy (CP) are nonambulant.

Wheelchairs can provide independent mobility, allowing them to explore their environment. Independent mobility is vital for activity and participation and reduces the dependence on caregivers. The purpose of this study was to describe the use of manual and powered wheelchair indoors and outdoors in relation to the degree of independent wheelchair mobility or need for assistance in a total population of children with CP.

A cross-sectional study was performed including all 562 children aged 3-18 years with CP living in southern Sweden during 2008. Data was extracted from a reg

ister and national health care programme for children with CP (CPUP). Informa

tion on the child’s use of manual and powered wheelchair indoors and outdoors and the performance in selfpropelling or need for assistance were analysed.

Of these children, 29% used a wheelchair indoors and 41% outdoors. A majority using manual wheelchairs needed adult assistance (86%) while powered wheel

chairs provided independent mobility in most cases (86%). To achieve a high level of independent mobility, both manual and powered wheelchairs should be considered at an early age for children with impaired walking ability.

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liSbeth nilSSon Phd, specialist in occupational Therapy associated to lund University barn- och ungdoms - habiliteringen, Gällivare sjukhus E-mail: lisbeth.nilsson

@med.lu.se

lisbeth.nilsson@kiruna.nu Tel: +46 705838596 www.lisbethnilsson.se

Powered mobility practice

A gate to tool use learning

Practice in a powered wheelchair may have effects other than independent mobility. These effects may be essential for people with cognitive disabilities, a population frequently excluded from access to powered mobility.

The research project Driving to Learn focused on what could be achieved if children and adults with profound cognitive disabilities got access to practice in a joystickoperated powered wheelchair. The project engaged a total of 126 participants: 45 with profound cognitive disabilities, 64 with milder degrees of cognitive disabilities and 17 infants with typical development.

The findings involved: development of a one-for-all powered wheelchair for practice; identification of an eight-phase process of learning joystick-use;

identification of strategies facilitating learning powered mobility use; a tool for assessment of phase in the process; and a grounded theory of de-plateauing.

Eight of the 45 participants with profound cognitive disabilities reached control of steering and 33 reached control of onset of movement.

Focus for this session: important characteristics of the one-for-all powered wheelchair for practice; how seating characteristics influence on activity;

general effects of practice other than independent mobility; and necessary properties for deplateauing.

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lotte wemmenborn leg sjukgymnast/

Physio therapist fysionord ab

E-mail: lotte@fysionord.se Tel: +46 (0)730- 32 92 99 www.fysionord.se

Accurate seating measures and size of wheelchair optimizing function in everyday life

a workShoP on measuring body size with a proper technique and choosing the right sized wheelchair, which is basic knowledge but not as simple and obvious as you would wish. If the wheelchair is poorly adapted in size it affects comfort, body control and activity level. Reduced stability and balance affects head control and function in upper limb. There will be an increased risk for developing pressure ulcer in the improperly fitted wheelchair. Concentration, stamina and communication are other affected body functions.

The workshop will share examples on how patients with various sitting ability have different effect from an improperly sized wheelchair. It highlights some issues told by both experienced and novice prescribers: how to measure safely and correctly, how much space you should calculate for clothes, how much you should press soft tissue around the hips, how the pelvic position affects the depth of seat. Different measuring techniques will be shown.

• Identify the most important body measures for choosing a wheelchair in optimum size.

• Identify level of sitting ability and relate to choice of wheelchair model.

• Techniques of measuring body size.

• Describe the risks with an incorrect size of wheelchair.

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elSe marie hanSen konsulent, ergoterapeut, MPk

Hjælpemiddelinstituttet/

Socialstyrelsen E-post:emh@hmi.dk www.hmi.dk

http://www.hmi.dk/sidgodt

= Sid godt (på dansk) http://www.hmi.dk/

page2581.aspx = Sitt bra (svenska)

Sid godt – Har du tjekket

kørestolen og siddestillingen i dag?

Informationsmateriale om siddestillinger

rigtig mange menneSker i samfundet har brug for viden om, hvordan ældre kørestolsbrugere skal sidde i deres kørestole for at opnå størst mulig funk

tionalitet og forebygge, at der opstår skader på deres kroppe. Men typisk er det eksperterne, der har den viden, og som bliver tilkaldt, når noget er gået meget galt. Det behøver dog ikke at være sådan, for meget viden kan kanaliseres ud til brugere, deres hjælpere og plejepersonalet, så mange flere kan være med til at forbedre de ældre menneskers funktion i deres kørestole.

For at udbrede kendskabet til emnet, har Hjælpemiddelinstituttet i Danmark udarbejdet et informationsmateriale. Materialet består bl.a. af to plakater – ”Sid godt! Har du tjekket kørestolen i dag?” henvender sig især til brugere og pårørende, mens plakaten ”Sid godt! Har du tjekket siddestillingen i dag?”

henvender sig til sygeplejesker og plejepersonale. Til brug for intern under

visning på fx plejehjemmet findes et slideshow med en uddybende og let

tilgængelig beskrivelse af emnet. Det enkelte slide suppleres af teoribaserede forklaringer, som den kørestolsansvarlige terapeut på plejehjemmet kan bruge i undervisningssituationen. Dette oplæg vil dels beskrive, hvordan materialet blev skabt og dels præsentere det for deltagerne på Nordisk Siddesymposium Learning objectives:

• Hvordan man kan fremstille et materiale, der er teoribaseret og mål rettet til at løse en bestemt problematik.

• Hvordan materialet konkret kan bruges til at forbedre ældre menneskers siddestillinger i kørestole.

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conni Schmidt fysioterapeut

center for Hjælpemidler og kommunikation i Sønderjylland E-post: cs.chk@

aabenraa.dk www.chksyd.dk

Får du formidlet dine budskaber så de forstås af modtagerne?

Overvejelser og tiltag i forhold til formidling af siddestillingsanalysens resultater

en SiddeStillingSanalySe kan betragtes som en del af en Rehabiliteringsproces, der kendetegnes ved at være en tidsbestemt samarbejdsproces mellem borger, pårørende og forskellige aktører. Udbyttet af en siddestillingsanalyse er fuld

stændig afhængig af hvordan samarbejdet mellem de forskellige aktører fun

gerer, og hvor godt det lykkes at få implementeret de foreslåede tiltag i borgerens hverdag.

En meget vigtig aktør i siddestillingssager er borgerens hjælpere. Fra egen prak

sis oplever jeg, at selvom der er givet en instruktion i anvendelsen af kørestol o g tilbehør, ser vi ofte, at tilpasningerne på kørestolen ikke bruges hensigtsmæs

sigt, og at borgeren er placeret forkert i den specialtilrettede kørestol. Ergo og fysioterapeuter bør således overveje, om der er brug for en mere systematisk tilgang, når hjælpere omkring borgeren skal undervises, for at sikre at alle – uanset uddannelse forstår de foreslåede tiltag og kan anvende dem i praksis.

• I mit oplæg vil jeg med udgangspunkt i en konkret siddestillingsanalyse fortælle om overvejelser i forhold til implementering af siddestillings

analysens resultater.

• Overvejelserne omfatter bl.a. et eksempel på en arbejdsmodel, der kan anven

des, når borger og hjælpere skal undervises i brugen af hjælpemidlet.

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marina timm

legitimerad arbetsterapeut/

hjälpmedelskonsulent Hjälpmedelscentralen Västra Götalandsregionen/

Skövde

Tel. 0500-499109 E-post: marina.timm@

vgregion.se

www.vgregion.se/hmf

Sitt och ryggstödets inverkan på äldre personers sittande i rullstol

antalet äldre har under de senaste årtiondena mer än fördubblats. Till åldrandet hör en rad kroppsliga förändringar så som att lungfunktion och hudens egen

skaper förändras. För många äldre ökar bröstkyfosen vilket i sin tur innebär en ökad risk för nedsatt lungfunktion. Studier visar att en ”dålig” sittposition i rullstol ökar risken för felställningar, ryggsmärtor, trycksår, nedsatt lungfunktion och cirkulation. Rullstolens sittenhet och därmed bäckenets position, har sanno

likt en stor inverkan på hur dessa komplikationer uppkommer.

Under hösten 2011 genomfördes en studie på friska äldre män och kvinnor i åldrarna 67–85 år (n=40).

Syftet med studien var att studera hur friska äldre individer påverkades av en manuell rullstols sitt och ryggstöd avseende tryck, bäckenrotation, lungfunk

tion samt upplevd sittkomfort. Två manuella rullstolsfabrikat tillsammans med tre olika rullstolsdynor utgjorde fyra rullstolsuppställningar. Datainsamlingen skedde med hjälp av tryckmatta (FSA) bäckenrotationsmätare, Micro-spirometri samt frågeformulär om upplevd sittkomfort på varje rullstolsuppställning.

Resultatet av mätningarna visade på signifikanta skillnader både vad gäller maxtryck och bäckenrotation. Inga signifikanta skillnader kunde uppmätas vad gäller vitalkapacitet (VC) eller forcerad expiratorisk volym (FEV) i någon av de testade rullstolsuppställningarna. Däremot kunde vissa tendenser ses till mins

kad lungvolym.

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maria amnell leg arbetsterapeut och utbildningsledare på Etac E-post:

maria.amnell@etac.se www.etac.se

Att sitta rätt och rulla lätt

Hur äldre rullstolsanvändares framdrivningsteknik påverkar sittpositionen och vice versa

en rullStol är ett rullande förflyttningshjälpmedel och ska ställas in för bästa möjliga sittposition och aktivet vilket innefattar förflyttning. Är rullstolen inte individuellt optimerad för framdrivningen, kommer det att påverka sitt

positionen negativt.

En äldre person har inte samma förutsättningar vad gäller aktivt sittande och framdrivning som en yngre rullstolsburen person. Avståndet skuldra – hand på drivring, räckvidd, grepp om drivring, och för fotframdrivning; stegisättning och steglängd är några exempel på parametrar som man måste tas hänsyn till.

Men det räcker inte med rätt inställningar, framdrivningstekniken måste tränas.

Att börja använda rullstol är omvälvande i sig. Att få möjlighet till träning gör att rullstolsanvändaren känner sig tryggare. Att göra en rullstolsutprovning ställer höga krav på våra analytiska och tekniska kunskaper samt att kunna omsätta dem i praktiken. Hur bra är du på att köra rullstol?

Föreläsningen behandlar följande:

• Äldre personers rörelsemönster

• Nödvändiga rullstolsinställningar

• Anpassning för handframdrivning

• Anpassning för fotframdrivning

• Körteknik

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karin thewS Physiotherapist MSc Tel: 0704 837873 E-post: karin@thews.se

eva JönSSon occupational therapist karolinska universitets- sjukhuset

Tel: 08-517 77531 E-post: eva.b.jonsson

@karolinska.se

Är rullstolskörande med

viss abduktion i höften möjligt och önskvärt för barn med cerebral pares?

barn med cerebral PareS (CP) har ofta ökad muskeltonus i vissa muskelgrupper.

Det kan t.ex. innebära att benen förs ihop och korsas både då man ligger, sitter, står och går med försämrad motorisk funktion som resultat. Med tiden kan detta också leda till ökad migration i höften och risk för höftluxation.

I sjukvården och habiliteringen arbetar man aktivt för att öka/bibehålla moto

risk funktion och om möjligt förhindra höftluxation. Regelbunden klinisk undersökning utförs av sjukgymnast och arbetsterapeut. Höftröntgen utförs också enligt program (www.cpup.se).

I behandlingen av barnen strävar man efter att hålla en god höftrörlighet, bland annat god abduktion för att minska risken för ökad migration i höften.

God abduktion i sittande ger också större understödsyta och därigenom kan arnet få bättre balans och motorisk funktion.

Vi tror att man skulle kunna arbeta mer med hur barnet sitter i sin vardag. Vi ser ofta barn sitta i rullstolar där möjlighet till abduktion inte finns. Förklaringen till det är att rullstolar som barn kan köra själva är konstruerade så att de är lätta att köra, men alltför trånga i sitsen vilket gör att man sitter tätt ihop med benen.

Presentationen kommer att visa resultat av intervjuer med professionella inom området och slutsatser från litteratursökning.

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annika blomkviSt leg sjukgymnast E-post: annika.blomkvist

@vgregion.se

kriStina olSSon leg arbetsterapeut E-post: kristina.l.olsson

@vgregion.se

Sittande hos barn med

funktionsnedsättning och korsettbehandlad skolios

SkolioS är vanligt förekommande hos barn som saknar gångförmåga. I Västra Götalandsregionen är korrigerande korsett av typ modifierad Bostonkorsett en vanlig behandlingsform för barn med skolios och neurologisk funktions

nedsättning. Under inprovningen undersöks hur sittförmågan påverkas av korsetten. Systematiserad tryckregistrering på bänk ingår i analysen.

Studien genomfördes som en retrospektiv granskning av journaler hos 122 barn som provat in korrigerande korsett.

Syftet var att beskriva hur sittförmågan påverkas av korrigerande korsett och identifiera för vilka grupper sittandet förbättras.

Studien visar att korsett har en positiv inverkan på sittfunktion. Störst effekt syns hos barn som inte kan sitta utan stöd, de som har grav skolios och de som inte är gångare. Barn med CP påverkades mer positivt än barn med MMC.

Klinisk betydelse: Med korsett minskar behovet av stöd i sittande och ett mer upprätt sittande med förbättrad huvudkontroll ökar möjligheten till delaktighet. Tryckregistrering vid sittanalys kan identifiera behov av åtgärder som korrigering av stol eller korsett. Motivationen hos barn och familj att använda korsett och förståelsen för anpassningar ökas.

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mette hornbæk Söderberg Ergoterapeut

center for kommunikation og Hjælpemidler

E-post: Mette.soderberg

@soc.regionsyddanmark.dk Tlf: 79436060

direkte 79436022 www.ckhm.dk

Siddestillingsanalyse og Rehabilitering

mange årS PraktiSk erfaring har lært os, at det er vigtigt med rehabilitering i vores specialrådgivning indenfor siddestillingsområdet. Vi har på Center for Kommunikation og Hjælpemidler i Vejle set, at det er afgørende for et godt resultat, at rehabiliteringen når hele vejen rundt om personen samt de aspekter, der er tilknyttet siddestillingen. Man må i den enkelte sag vurdere, hvilke fagfolk og specialister, der skal inddrages.

Jeg vil i korte træk gennemgå, hvordan vi arbejder med rehabiliteringstanken i vores siddestillingssager, og jeg kommer ind på hvilke udfordringer, vi oplever.

Via case-eksempler vil jeg belyse, hvordan vi konkret har grebet det an i den enkelte sag.

Formålet med vores oplæg er:

• at få fokus på rehabiliterings-tanken i siddestillingssager.

• at gennemgå, hvilke aspekter man skal ind omkring for at komme i mål med et godt og helhedsorienteret resultat, således at siddestillingen fungerer i hverdagen.

• at belyse vores metode, og hvilke udfordringer, som vi har. Dette via case eksempler.

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Rick mccHaRlES/flickR

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britt-marie rydh berner

leg. Sjukgymnast Tonusmottagningen R61 Rehabiliteringsmedicinska Universitetskliniken Stockholm danderyds Sjuk- hus ab

karolinska Universitetssjuk- huset Huddinge

Tel: 08 585 822 02 Tel: 073 917 97 03 britt-marie.rydh-berner

@ds.se

Spasticitet, påverkar det sittandet?

SPaSticitet är en mycket komplex problematik som påverkar det mesta i en persons vardag. Många diagnosgrupper har denna problematik och dessa kan för oss behandlare förefalla mycket olika. Men då det gäller tonusökningen och spasticiteten finns det vissa gemensamma nämnare.

Så är det till exempel då det gäller spasticitet och sittproblematik. Finns det en spasticitet av betydelse så kan man vara säker på att den påverkar sittandet.

Det som händer i kroppen vid spasticitet är ju bland annat att det blir en obalans mellan muskelgrupper. Sträckare respektive böjare kan ta överhand i både armar och ben. En viktig del av vår kropp att få grepp om då det gäller sittandet är bäckenet och kring detta finns det ett otal muskelgrupper som kan påverkas av spasticitet. Till detta kommer ofta en skolios som även den kan ha uppstått ur samma problematik.

På vår mottagning – Tonusmottagningen tittar vi på spasticitet och hur den påverkar personer i vardagen. Där den ställer till med för mycket bekymmer kan vi hjälpa till på flera olika sätt för att minska den.

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wednesday • May 23 TARGET GROUP:ALL room e4

eliSabet rodby bouSquet Physiotherapist E-mail: elisabet.rodby _bousquet@med.lu.se department of orthopaedics, lund University centre for clinicial research, Västerås

guðný JónSdóttir Physiotherapist

Endurhæfing- Rehabilitation centre of excellence, E-mail: gudny

@endurhaefing.is Tel: +354 4144500 www.endurhaefing.is

ann-chriStin JohanSSon gunnar hägglund PhiliPPe wagner

Evaluation of a Clinical

assessment tool for posture and postural ability

there are Several professions working with the assessment for, and prescrip

tion of, equipment to support people with severe disabilities in sitting, standing and lying. There is a need for a valid and reliable clinical assessment tool to facili

tate assessment of posture and postural ability in order to provide appropriate support and evaluate therapeutic inter ventions.

To evaluate reliability and validity of a clinical assessment tool for posture and postural ability we performed a study using photos and films of 30 young adults with cerebral palsy born 1988–1991. The adults were categorized into five different groups using the gross motor classification system (GMFCS). Inter-rater reliability for the assement tool was evaluated by independent ratings of photos and films by three Physiotherapists. The internal consistency and homogenity of the instrument was evaluated using Cronbach’s alpha. The construct validity was examined through the ability to differ between known-groups (GMFCS levels).

The assessment tool is reliable and valid for assessment of posture and postural ability in people with postural deficits. It’s quick to administer and do not require any special equipment and therefor easy to use in a clinical setting.

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wednesday • May 23 room e4 TARGET GROUP:INTERMEDIATE

una birna guðJónSdóttir

rannveig baldurSdóttir

Supine lying support

in iceland children with severe and complex neurological disability, commonly use orthoses and custom made seating systems most of their life. However the majority seem to have developed severe deformation of the trunk, pelvis and hips, by the time they enter adulthood. The time children and adults spend in custom made seating systems and orthoses is much shorter than the time they spend not using it. Recently the focus of management has shifted more to the time individuals are not using their assistive devices.

The design principle behind the lying support is that the severe deformations of the trunk, pelvis and hips that are observed in individuals with complex neurological disability are a secondary complication to the original impairment, and as such can be prevented. In the supine position, gravity exerts uniform pressure on the trunk, the so called human sandwich effect. There are there fore no destructive external rotational moments present in the horizontal and sagittal planes. The lying support gives side support that stops destructive internal rotational moments in the frontal plane.

The long term goal of the lying support is to minimize these secondary complications.

The presentation will cover the design principle behind the lying support and the short terms effects of the use of the lying support. It will also cover the secondary versus primary complication associated with the original impairment, the biomechanical aspect of supine lying versus side and prone lying and its association to trunk symmetry.

Learning Objective

• Introducing a new type of lying support for supine lying.

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wednesday • May 23 TARGET GROUP: ALL room e4

Developing an elearning Module for Allied Health Professionals

Benefits, problems and reflections

elearning can Provide significant benfits and flexibility to AHP professionals.

Modules are not difficult to develop, and can be successfully achieved with careful planning and decisionmaking, and with a clear vision of the scope.

Social media developments could be used to develop learner and professional networks, either new or existing.

In recent years, training budgets in the UK have become more tightly

constained, and professionals have found it increasingly difficult to incorporate the growing number of relevant courses and conferences into a hectic clinical schedule. It can also be difficult to put into practice new skills developed at conference or at a specific training event. Elearning can help to address some of these issues. We have developed an elearning module for the Chailey Levels of Ability Assessment Charts. This is a useful outcome measure that can be used to assess and record postural ability. It forms an important part of our twoday course, but delegates often find it is helpful to have a follow-up session once the measure has been used in practice.

Our second key decision was the ‘platform’ that would be best suited to deliver the content. We felt that a web page (html) based tool would be the most appropriate.

We will also briefly discuss delivery platforms that were excluded and why.

Learning Objectives

• To have a broad understanding of delivery platforms available for eLearning

• To understand some of the problems associated with developing an eLearning programme.

• Have a broad idea of the planning and decision-making required in developing content.

Paul hewett bSc MSc, industrial designer

active design ltd, Uk

E-mail: paul@activedesign.co.uk/

Tel: +44 121 326 7506 www.activedesign.co.uk www.posturalmanagement.com

Jo JeX

McSP SRP PGcert, clinical Educator, Physiotherapist active design ltd

E-mail: jo@activedesign.co.uk Tel: 07798842511

www.activedesign.co.uk

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wednesday • May 23 room e4 TARGET GROUP: ALL

mary PeterSen consultant, Physiotherapist Tel: 41 91 81 54

E-mail: mpe@hmi.dk

A tool to find the appropriate assistive product

assist data iS a web based data base on assistive devices on the Danish market.

Although AssistData is a data base of products on the Danish market the presen

tation will be of interest for all participants as a great portion of the products are sold both in other European and even overseas countries. In addition AssistData is now also available in an English version. AssistData has advanced search functions facilitating the sorting or filtering of products within the various types, e.g. wheelchairs, seating cushions etc.

By means of the various tools in the data base it is possible to filter among this vast amount of e.g. wheelchairs to gain a somewhat smaller portion consisting of all wheelchairs meeting the requirements set for the specific situation regarding properties, dimensions, equipment etc.

This presentation is an online demonstration of AssistData and the different entries for searching and other functions on the site.

• The focus of the presentation is a demonstration of the facilities for search and filtering where the participants will be shown step-by-step how to utilize AssistData to find appropriate products for a specific seating situation.

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Clinical uses/appropriate uses of secondary positioning systems

an intermediate to advanced level seminar designed for individuals currently working in the field of seating and positioning focusing on improving functional outcomes by controlling pelvic position, the trunk and head and the lower extremities.

We’ll go over a clinical examination and seating assessment in order to get an accurate understanding of the different aspects involved with common seating problems. The impact of single body segments on global posture will be discussed and illustrated with cases and examples of seating problems such as kyphosis, sliding, poor head control and scoliosis will be analyzed. The impact of spasticity has on secondary support systems will be discuss and illustrated with several case studies of children with Cerebral Palsy.

The biomechanics of the pelvis, trunk, head and lower extremities will be reviewed in relation to positioning of the pelvis, lower body and upper upper body.The correct biomechanical placement and the clinical indications of the following types of secondary support systems will be analyzed and discussed;

Hip belts, Sub ASIS (Anterior Superior Illiac Spine) Pads, Leg harnesses, Ankle fixation belts, Adjustable Angle Footplates, Calf panels and calf staps, Thoracic and shoulder harnesses and Chest Belts

• Understand how the anatomical placement of secondary support systems impacts the users postural ability, functional ability and comfort.

• Understand the applications of postural supports in order to control posture and obtain functional outcomes.

bart van der heyden Physical Therapist Seating and Wound care Specialist / consultant director Training &

Education The RoHo Group Europe

clinical advisor EU and ME bodypoint (US) & Xsensor (canada)

director, Training &

Education Europe The RoHo Group E-mail: bvanderheyden

@attglobal.ne

www.therohogroup.com

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wednesday • May 23 room e4 TARGET GROUP: ALL

birgitta nordStröm Physiotherapist/doctoral student at lTU

E-mail:

birgitta.nordstrom@ltu.se

On an equal footing

“Adults accounts of the experience of using assistive devises for standing” and a short summary of the use of standing devices for persons with disabilities.

today the PhySiotheraPiSt and/or occupational therapist prescribe the standing device mainly focusing on the physical/physiological body. Since there are largely absence of studies focusing on users’ experiences on standing in standing devices it is important to study this phenomenon further.

The aim of this study was to illuminate the adult users’ experiences of standing in standing devices. The participants in this study were older adults who had received a standing device and could be found in the register of assistive technology. Fifteen participants with diagnosis such as stroke, traumatic spinal cord injury, traumatic brain injury, cerebral palsy and multiple sclerosis were interviewed.

The results of study indicated that standing in standing devices for persons with severe disabilities seemed to be more than just a treatment of the biological body; it also affected the social interplay and contributed to a changed relations

hip to the outside world.

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mary PeterSen consultant, Physiotherapist Tel: 41 91 81 54

E-mail: mpe@hmi.dk

Landing in the chair from a standing hoist

vitSi – the interdiSciPlinary Evidence Generating Network for Seating has carried out a pilot study with the purpose of discovering which factors, when using a standing hoist, influence the quality of the seated position. The focus has been to point out to transfer instructors and occupational and physiotherapists the central aspects to be used in connection with the planning and dissemination of the information on adopting the sitting position by use of a standing hoist.

The conclusion of our study so far is that the distinctive characteristic of landing in a chair by use of a standing hoist, as opposed to e.g. a stationary hoist in the ceiling, is the fact that the user is changing his position from standing to sitting in the process of the transfer. This change of position is influenced by the person’s functional ability – incl. possible pathological patterns. In connection with the dissemination of the information to transfer instructors and therapists it is therefore important to include the fact that the assistant needs to possess knowledge on and, in the guidance of the user, take into account the individual and perhaps pathological patterns of movement in the user.

5th Nordic Seating Symposium