The central nervous system is the control centre of the entire body. Any damage to this control centre can cause several complications and difficulties to all functions we have. Unfortunately, there is a long list of neurological conditions which, due to damage to the brain, cause detrimental effects to a person’s abilities and their quality of life (1).
Some conditions (i.e. Stroke, brain injury, Spinal cord injury) might be an acute or sudden onset of symptoms and loss of abilities which is due to either bleeding in the brain or a blockage in an artery leading the brain, causing the cells to die (2.).
Other conditions (i.e. MND, Parkinson’s disease, MS) occur due to damage to the neurons, brain chemicals or plaques forming loss of signals between cells which through the progression of the disease and over a period sees the deterioration of bodily functions (3).
Symptoms may vary, based on the diagnosis and the area of the brain that has been affected. Some common neurological symptoms are muscle weakness, changes in sensation, changes to muscle tone (high – causing stiffness/spasticity & low – causing flaccidity of limbs), changes to cognition/perceptions, visual disturbance, severe fatigue, reducing speech and communication skills, detrimental impact on vital functions like respiration & swallowing (4).
Each of the symptoms, in varying levels depending on the severity of the condition, may make it difficult to find a suitable environmental set up for a person when choosing adaptive aids and assistive technology. A person’s clinical presentation at the time of the assessment and an OT’s knowledge of the progression of the disease is important in making the correct clinical decision about their needs ().
Regarding a person's seating, and positioning needs the factors to consider are endless. Some of the questions we might be asking ourselves are: what level of sitting balance does our client have, how does our client transfer in and out of the seat, how long can our client tolerate sitting out, does our client have passive/active range of motion at all joints, what is our client's pressure care needs, do they have a history of pressure injuries, does our client fatigue throughout the day, can our client reposition or do they need powered assistance and varied options of positioning, does our client suffer from muscle weakness to one side or global weakness to certain areas of the body, does our client stoop forward or lean to one side, how is our clients cognitive functioning… the list goes on.
Answers to the above questions will help guide the process of chair selection. By selecting the correct seating option for a person, we can improve a person’s quality of respiration, circulation, pressure care and relief, upper limb function, communication, swallowing, socialisation, and mood.
The configura range of chairs have been designed to accommodate many of these needs. Whilst not every person is suitable for the chair and a thorough OT assessment needs to be completed to properly prescribe the chair, for many people who have neurological symptoms this chair will be an ideal option. Crucially the configura chairs can be adjusted to change along the condition timeline based on a person’s changing needs. A person with Motor Neuron Disease for example – initially they may be prescribed a chair for its lift function to assist a person to stand. Over time as a person’s function deteriorates the configura chairs can be adjusted to support postural stability, pressure care needs and is compatible with transfer aids including hoists.
See clinical justification guide of conditions for an understanding of the key clinical features of the configura comfort chair that can support a person’s neurological presentation and difficulties.
Neuroscience, fundamentals for rehabilitation, (Book)
How we manage stroke in Australia (Report)
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Management of complex symptoms in multiple sclerosis. (2009). MS Australia Publication. www.msaustralia.org.au
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NICE guideline. (2016). Motor neurone disease: assessment and management. https://www.nice.org.uk/guidance/ng42/resources
Cheng, Hon Wai & Chan, Kwok & Chung, Yuen & Choi, Chun & Chan, Chun & Cheng, Shuk & Chan, Wan & Fung, Koon & Wong, Kar & Chan, Oi & Man, Ching. (2017). Supportive & palliative interventions in motor neurone disease: What we know from current literature?. Annals of Palliative Medicine.
National Institute on Aging (NIA). (2017). Parkinson’s Disease. https://www.nia.nih.gov/health/parkinsons-disease
Zijlstra et al.: Sit-stand and stand-sit transitions in older adults and patients with Parkinson’s disease: event detection based on motion sensors versus force plates. Journal of NeuroEngineering and Rehabilitation 2012 9:75.
Parkinson’s Symptoms. (2019). Parkinson’s Australia information sheet. https://www.parkinsons.org.au/information-sheets
Page, K. Oakley, L. Fisher, A. Flower, Z. Hill, P. (2016). OCCUPATIONAL THERAPY CLINICAL TIPS FOR HUNTINGTON’S DISEASE: Seating and Posture. UK HD special interest group for occupational therapists.
EnableNSW and Lifetime Care & Support Authority, Guidelines for the prescription of a seated wheelchair or mobility scooter for people with a traumatic brain injury or spinal cord injury. EnableNSW and LTCSA Editor, 2011, Sydney.
Stroke Foundation (2019). Clinical Guidelines for Stroke Management. Melbourne Australia.
Dworzynski, K. Ritchie, G. Playford, ED. (2015). Stroke Rehabilitation: Long Term Rehabilitation. Clinical Medicine, Vol 15.