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Configura Bariatic Chair

CLINICAL JUSTIFICATION

It is important to note that 2 people with the same diagnosis will present differently. The below clinical justifications are a guideline only of how the Configura Bariatric chair is an appropriate seating option for different client groups. To be used always in conjunction with a comprehensive seating and risk assessment.


Justification by: Features   |   Conditions

FEATURES

The configura bariatric has a weight capacity of 254kg or 317kg. This includes a weight capacity of 127 kg on the leg rest which is necessary due to the weight of the legs but also secondary weight of the pannus which sits on the legs when a person is sitting.

The width on the Configura® Bariatric can easily be changed by fitting different armrests to the chair. The seat widths available are 28” (711 mm), 26” (660 mm) and 24” (609 mm). This is especially beneficial for service users whose weight might fluctuate, and in this way the chair can easily be adapted for them.

The seat depth is vital for correct seating to maintain pelvic stability and avoid sacral sitting. The ability to adjust the seat depth allows one chair to be adjusted to suit a wide user group and to accommodate changing seating requirements. This is ideal for multi-user environments and situations where a chair may be recycled.

Correct seat height is also important in correct seating. The ability to adjust the seat height allows one chair to be adjusted to suit a wide user group and to accommodate changing seating requirements. This is ideal for multi-user environments and situations where a chair may be recycled.

By maintaining the same angle at the hips (i.e. the same angle between backrest and seat base), and tilting the whole chair back, the user can achieve a relaxed position whilst maintaining pelvic stability. Maintaining the position of the pelvis promotes good sitting and reduced the user’s susceptibility to developing poor posture. As more weight is transferred through the trunk and less through the base, a larger seating footprint is achieved and pressure is distributed over a wider area, thereby reducing the risk of pressure sores in the sensitive sacral and ischial tuberosity areas. The ability to have the user’s ankles higher than the hips can also aid circulation and reduce fluid build-up in the legs. When hoisting, tilt-in-space enables gravity to assist in correct positioning of the user’s pelvis at the back of the chair.

Heat sensitive memory foam moulds to the user providing maximum support and pressure reduction. Suitable for users who are at risk of pressure damage. 25 stone (160kg) weight capacity.

Leg rest elevation helps the user to relax and can help reduce fluid build-up in the legs. It is essential for users with oedematous legs although care must be taken to ensure the chair has a sufficient weight capacity to take the extra weight. The leg rest capacity on the Configura® Bariatric is 127 kg (20 stone), which will meet most service users’ needs

Heat sensitive memory foam moulds to the user providing maximum support and pressure reduction. Suitable for users who are at risk of pressure damage. Available for 190 kg (30 stone) or 254 kg (40 stone) weight capacity.

Please note: users under 190 kg (30 stone) may find the 254 kg (40 stone) cushion too firm.

Castellated, pressure reducing cushion for users who cannot tolerate Visco foam. Similar in performance to the Visco cushion. Available for 190 or 254 kg (30 or 40 stone) weight capacity.

Powered alternating air cushion which provides excellent comfort, stability and pressure relief. 317 kg (50 stone) weight capacity. Appropriate for users who have developed pressure injuries. Easily set up through the pump.

Each pillow is height adjustable and filling can be customised to the user. Offers mild to moderate postural support, and is highly effective for users with a kyphosis or a scoliosis. To accommodate space for "gluteal shelf" remove lowest cushion stuffing to the user’s needs.

These fit underneath the backrest pillows to provide lateral support combined with the comfort and adjustability of the Multi adjustable pillow backrest.

Suitable for users with reduced head control. Fits over the shoulders.

Provides side support on leg-rest to avoid leg abduction and reduce risk of legs falling off leg rest.

The standard level of rise. This provides a person with a small degree of lift to assist standing transfers. The angle of the chair in rise assists a person to move feet further back for a more ideal centre of gravity for standing.

This level of rise is more suitable for clients with reduced core strength and balance who find the standard rise setting to push them forward.

Dual motor operation allows independent adjustment of the leg rest elevation and backrest recline. This enables infinite positioning for maximum comfort and support for users with more complex requirements. A dual motor chair has four buttons on the handset.

CONDITIONS

It can be very difficult to find the correct seating option for clients with dementia. The reasons for this and potential solutions of the configura comfort chair are outlined below:
  • Risk of falls/ wandering behaviour – the Configura Comfort can be set at a suitable height to promote independence with transferring out of the chair and mobilising. This reduces the risk of falls during transfer from a chair.
  • Poor posture/risk of slipping out of chair – a key difficulty for people with dementia is the ability to maintain an upright posture and the risk of slipping forward out of the chair due to this poor posture. A person with more advance dementia will lack the initiation to self-correct these potentially dangerous positions. The configura comfort chair can be aligned into tilt in space to provide stability at the pelvis to support a more appropriate posture in midline and negates the possibility of slipping forward in the chair. Lateral supports can be used for users who tend to lean heavily to one side.
  • Behaviour patterns (agitation, restlessness, repetitive/involuntary movements) – the soft, durable material used to cover the seat, backrest and armrests are appropriate to protect the client against injuries during these periods.
  • Operating handset – The handset can be easily changed over to a 2-button handset (comes as 4 button standard) for client groups who are relatively independent however have difficulty with the cognitive/thinking skills required to operate the handset effectively. For clients who have more advanced dementia and pose a risk by having the handset available to them the handset can be easily placed behind the seat and out of access.
  • Incontinence – for users likely to suffer from incontinence the fabric of the configura comfort is waterproof, breathable and easy to clean. As well as providing pressure relief for people at risk of developing pressure injuries.
  • As all the above clinical difficulties are possible to cause issues for a person with a diagnosis of dementia the configura comfort chair will be the most suitable option from the onset of symptoms throughout the progression of their symptoms to the more advance stages.

For users with a BMI over 30 (or 160kg weight) they will need a larger chair than the standard configura comfort. The configura bariatric range is ideal for these users due to the following features:
  • User weight: There are 2 options of sizes for the bariatric range the first one has the capacity of 254kg. And the second one has a maximum user weight of 317kg.
  • Leg-rest maximum weight: the maximum weight capacity of the leg rest is 136kg to accommodate the weight of the abdomen resting on the legs and the potential of leg swelling which increases the weight of the legs.
  • Correct fit for body shape: the pillows of the configura comfort chair are set up in a way which allows them to be easily removed and reapplied for the comfort of the client. Due to the gluteal shelf of bariatric clients it is recommended the lowest pillow stuffing is removed completely to accommodate for this space at their buttocks. This allows for suitable depth of the chair and prime pressure distribution and posture.
  • Leg rest channel: can be fitted easily around the leg rest to provide side supports and avoid leg abduction and risk of slipping off the leg rest.
  • Backrest recline & tilt in space: these features are especially important for bariatric users who are at risk of respiratory and circulation problems if positioned in an ill-fitting chair, resulting in a stooped over posture. The configura bariatric range allows a person to sit upright but also with the correct degree of recline and tilt will reduce the amount of weight on their chest and improve their breathing and circulation.
  • Sit to stand with knees at 90 degrees: the space behind the legs at the calf can often reduce a bariatric user’s ability to bend their knees sufficiently for a safe sit to stand. Using the rise function the chair is tilted forward and provide enough space to get feet into the correct alignment for a safe and independent stand from the chair.
  • Advice and guidance for correct measurement and prescription of bariatric users to the most appropriate seating option is advised and welcomed.

We suggest you look at the Configura Advance Chair (coming soon)

Falls and the effects of falls are one of the costliest services for our health system. The first thing we often turn to influence the risk of falls is environment and assistive technology. Many falls happen because of the lack of appropriate equipment regarding mobility and transfers. The configura comfort chair is appropriate in the prevention of falls for the following reasons:
  • Promotes independent transfers: for the more mobile/independent clients, an appropriate seating option will provide the correct posture and position during transfer. The configura comfort chair can be used either by providing an appropriate initial height for standing, using the full effort and strength of the client to transfer from hips, knees at 90 degrees to a full stand. Alternatively, for clients who require a small amount of physical encouragement to stand the rise function can be used to increase the height of the chair and provide some forward tilt to help a person get into a standing position.
  • Compatible with transfer aids: for less mobile users who require equipment and assistance of a carer to stand and transfer the configura comfort chair is designed to compatible with all aids (i.e. oxford switch, oxford Up, oxford journey). The design has a horseshow shaped sub frame, allowing clear space to push the aid very close to the chair when in a raised position. If a person with reduced mobility/balance feels they were slipping forward with the amount of tilt provided in the chair - the medium or vertical rise function can be fitted. The chair is also appropriate for use with standing hoist and floor hoists.
  • For users who are at risk of slipping out of their chair due to poor posture – A chair which is too deep or not deep enough will instantly create poor posture and the risk of stooping/sinking into the chair and therefore risk of falling out. The configura comfort can be prescribed to the most suitable size dimensions for the client. The postural supports of the configura comfort chair like tilt in space and lateral support, leg elevation will eliminate the risk of falling out of the chair by using gravity.
  • Inbuilt pressure care – many falls are caused by slipping forward on a chair or through difficulty when transferring and this is made even more risky when a pressure cushion is placed on top of a chair. The inbuilt pressure relieving properties of the configura comfort chair reduces the need for an external pressure relief and reduces the risk of these falls occurring.

A Kyphosis results in an excessive outward curve of the spine and an abnormal rounding of the upper back often associated with the position of the pelvis in posterior pelvic tilt (tilting forwards). It can often be difficult to find an appropriate and comfortable seating option for these clients. The reasons for this and potential solutions of the configura comfort chair are outlined below:
  • Inability to lift head for social interactions – A person with kyphosis with their head and neck positioned against the support of the cushions can be positioned using tilt and recline to create alignment of their eyes with the rest of the room and importantly with people they need to interact and socialise with.
  • Comfort – Adjusting the waterfall cushions of the configura comfort chair to be orientated in a vertical position rather than horizontal will provide a person with kyphosis the comfort they need by providing a well for their back to rest in.
  • Poor neck control – For a higher level of head and neck support the alternate head cushion can be used which provides an extra level of head control.
  • Risk of pressure injury – The pressure relieving properties of the waterfall cushions and their material will provide a good amount of pressure relief to reduce the risk of pressure injury along the length of the spine at the areas of bony prominence often associated with a kyphosis.
  • Respiratory, digestive and swallowing difficulties – the tilt in space and recline function can be used to position a person in a more appropriate posture for breathing, eating and swallowing more effectively.

A scoliosis results in an "S" or "C" shaped curve in the back. This may present where a person leans to the side, has uneven shoulder height or protruding ribs to one side associated with obliquity at the pelvis. A scoliosis can impact a person greatly and the configura comfort chair can be used to optimise seating and posture of a person with scoliosis in the following ways:
  • Pain and Discomfort – This can be alleviated by supporting a person to sit in an optimised position. The waterfall backrest can be adjusted either by changing their orientation or reducing their stuffing to create a comfortable sitting and reclining position for a person with scoliosis.
  • Postural management – Due to the unaligned position of the pelvis and spine a person with a scoliosis requires external factors to correct these. The tilt function can be used to provide pelvic stability and allows a person to rest their head and neck in a neutral position. For people experiencing more severe spinal conditions the lateral supports can be placed in the appropriate positions for that person to stabilise the trunk in a straighter position. The lateral supports can be easily removed and reposition to suit a person’s changing needs.

Pressure injuries occur when there is an interruption to the supply of oxygen to an area due to lack of blood being able to circulate resulting in cells and tissues dying in this area. Pressure injuries are preventable and treatable:
  • Pressure & posture – there is a direct correlation between postural management and pressure care. If a person is positioned in an ideal and optimised sized chair and postural management, their pressure care will too be managed in a more ideal way. The configura comfort chair’s adjustable features allows the chair to be fitted in the most ideal dimensions for a person in turn creating optimised posture management and alleviating pressure risk. Tilt in space is an effective way to adjust the centre of gravity of the chair and redistributing the pressure throughout a wider area and creating a larger pressure footprint.
  • Pressure relieving material – the vapour permeable fabric used on the backrest & armrests are ideal for pressure reduction in decreasing shear.
  • Pressure cushion options – The configura comfort chair comes as standard with a vicso foam for prevention of medium to high risk users. The pressure cushion at the base of the chair can be easily adjusted. The space is appropriate to be replaced with other cushions of dimensions of 445 mm x 445 mm x 76 mm. For a client with a developed pressure injury and an alternating air cushion is required this can be easily replaced and there is space to feed the tube to the back of the chair and connect easily to the pump.

Symptoms associated with multiple sclerosis include – loss of motor control, global weakness, reduced coordination of movement, involuntary movement of limbs & spasticity, loss of sensation/numbness, severe fatigue, reduced balance/dizziness, incontinence & pain. The positioning and posture of a person with MS can help manage a number of these symptoms. Due to the degenerative nature of the disease it is important to consider a seating option that can adjust as symptoms become more severe and function deteriorates. The configura comfort chair is an appropriate seating option for people with MS by providing the following features:
  • postural management - Tilt in space and waterfall cushions encourage pelvic stability and allows a user to rest in recline position when suffering from fatigue. For more severe postural needs – lateral support/lateral support backrest/adjustable lateral support backrest should be used to provide a sufficient amount of positioning through pelvis and trunk.
  • Pressure relief – A person with MS who is sitting for long periods of time is at risk of developing pressure injuries. Castellated cushion is recommended for MS users as a preventative cushion which can be replaced easily with the standard visco foam cushion.
  • Transfers – the configura comfort chair can support a large range of functional transfers and mobility needs. This ranges from someone newly diagnosed who can mobilise independently and needs a small lift to stand to someone who requires a floor hoist or ceiling hoist for transfers. For hoist users the flat rise function would be appropriate as it allows care staff to easily put a sling in place.
  • For clients who are not able to extend at their knees due to spasticity or weakness the configura comfort would not be the correct seating option because as the leg rest raises the chair base tilts. Other chairs within the configura range would be more appropriate.

Symptoms of Motor Neuron Disease (MND) include muscle weakness and loss of control, spasticity and high tone of muscles, involuntary movement (spasms), difficulty with swallowing & saliva management, difficulty breathing, fatigue and pain. Due to the progressive nature of this condition it is important to consider assistive technology that can be adjustable along the length of functional deterioration. The configura comfort chair is an appropriate seating option for people with MND by providing the following features:
  • Postural management - Tilt in space and waterfall cushions encourage pelvic stability and allows a user to rest in recline position when suffering from fatigue or when unable to maintain upright posture. For more severe postural needs – lateral support/lateral support backrest/adjustable lateral support backrest should be used to provide a good amount of positioning through pelvis and trunk. The profiled headrest should also be used to provide head and neck support. The position of the body using the tilt in space and recline function are ideal for optimising vital functions (breathing, swallowing) through management of posture. The recline can be adjusted to a suitable position for feeding and eating. For those clients who need someone to help them eat the rise function can be adjusted to the flat rise for optimised comfort of the carer.
  • Pressure relief – A person with MND who is sitting for long periods of time without the muscle strength and control to reposition is at risk of developing pressure sores. Castellated cushion is recommended for MND users as a preventative cushion which can be replaced from the standard cushion. If a person with MND has developed pressure injuries a cushion-air alternating air cushion would be the most ideal to treat the pressure damage.
  • Transfers – the configura comfort chair can support a large range of functional transfers from someone newly diagnosed who can mobilise independently who may need a small lift to stand to someone who requires a floor hoist or ceiling hoist for transfers. For hoist users the flat rise function would be appropriate as it allows care staff to easily put a sling in place.
  • For clients who are not able to extend at their knees due to spasticity or weakness the configura comfort would not be the correct seating option as the leg rest raises as the chair base tilts. Other chairs within the configura range would be more appropriate.

The symptoms of Parkinson’s Disease (PD) which are relevant to seating may include: tremors, rigidity and stiffness of movement, slow movement, pain, muscle weakness and fatigue. Due to the progressive nature of this condition it is important to consider assistive technology that can be adjustable along the length of functional deterioration as with the configura comfort chair. The above symptoms can all impact on mobility, transfers, posture and pressure which can be managed through the configura chair:
  • Transfers/mobility: the configura comfort chair by using the rise function can initially be used for clients who have weakness, reduced balance and rigidity of muscles making it more difficulty to stand upright. The level of tilt in the rise function can be altered to suit a person with PD who might have reduced balance and strength. The medium rise or vertical rise function would be most suitable for PD clients as there is a lower level of tilt. For a patient whose mobility has deteriorated, and a standing aid is required the configura comfort chair would continue to be the appropriate seating option for them due to its compatibility with all transfer aids. Further deterioration may result in the use of a hoist for transfers which is compatible with the configura comfort.
  • Postural management – Clients with PD may be at risk of sliding forward in their chair due to tremors and limited core strength therefore would benefit from the tilt in space and recline of the chair. This will allow them to rest backward whilst providing adequate support through the pelvis for stability despite body tremors. People with PD are also likely to develop poor posture due to muscle rigidity so would benefit from lateral supports, positioned behind the cushions to ensure they are soft and not causing further harm during involuntary movements or tremors. People with PD are also likely to develop a rounding at the shoulder and stooped posture at the neck, similar in presentation to a kyphosis which can also be managed through the configura comfort chair.
  • Pressure management – involuntary movement and tremors can cause shear and friction on the surface that the body is moving on. The fabric of the configura comfort chair reduced the amount of shear and as such reduces the risk of pressure damage. Rigidity of movement can cause difficulty with repositioning which is why the configura comfort chair is ideal for pressure care management of a person with Parkinson’s disease as the cushions can be adjusted to suit a person at higher risk of pressure injuries or for someone who has already developed a pressure area.

Arthritis can be an extremely debilitating disorder which results in pain, swelling and stiffness in the joints (most commonly the knees, hands, hips and back). Poor seating can exacerbate these symptoms of arthritis. The configura comfort chair is an appropriate seating option for someone with arthritis for the following reasons:
  • Transfers and Mobility – arthritis can make transfers from seated position extremely difficult, especially if someone is experiencing pain in legs and hands. The configura comfort chair can be used to provide a more appropriate height for standing transfer. Furthermore, the rise function is an appropriate aid in relieving pressure exerted through joints during a standing transfer.
  • Size – the size of a chair is of paramount importance, especially for someone who experiences pain for most of their day. The size of the configura comfort can be fitted and then adjusted according to the user to ensure prime positioning for transfers and comfort.
  • Comfort during prolonged seating – the waterfall backrest can be adjusted to suit the comfort needs of the user; this often involves removing some of the cushioning to suit their needs. Tilt in space and recline should be used to allow a person to relax back in the chair comfortably and to relieve pain and pressure through the joints.
  • Posture – prolonged pain can cause muscle fatigue which can lead to poor posture in people with arthritis. This may lead to a stooped posture and risk of falling forward in their chair. The configura comfort chair should be used to support midline posture use tilt in space and allows a person to change their posture regularly and easily.

Vascular disease includes any condition that affects the circulatory system and if impaired can cause severe swelling in areas of the body. Lymphoedema results in the swelling of legs/arms due to poor drainage often due to damage to the lymph nodes. Complications of vascular diseases can include very heavy limbs impacting mobility, restricted range of movement, aching and discomfort & skin infections (cellulitis). The configura comfort chair is ideal for use with users who experience leg oedema for the following reasons:
  • Adjustable size - due to excess tissue in areas of swelling it can often make it difficult to prescribe an appropriately sized chair at the correct dimensions for a person with lymphoedema. The configura comfort chair and its modular nature can be used to adjust the size easily to suit the needs of someone experiencing lymphoedema.
  • Amongst other forms of treatment one way of reducing the swelling due to lymphoedema include elevating the limb above the level of the heart to promote draining through circulation. The recline & tilt function of the chair allows for extended time with legs elevated above the level of the heart and in turn reduces the swelling in the legs.

A stroke can affect different people in very different ways depending on the area of the brain that has been disrupted. The physical changes often result in a one-sided weakness/paralysis/hemiplegia. This creates a difficulty in finding the midline alignment of the body and often results in a severe lean to one side or an inability to sit up at all. This leads to several different challenges especially when it comes to seating:
  • Transfers – a stroke can impact greatly on a person’s mobility and transfers. Some people post stroke might just need a small lift out of the chair from a high height due to mild weakness and impaired balance, this can be accommodated through the configura comfort rise function. However more severe stroke may result in the inability to weight bear through the weak side of the body and alternative equipment will be requires. For someone using a standing aid or hoist the configura chair would be an appropriate option as it is compatible with all transfer aids.
  • Posture – if a person does not have any movement to one side of their body, they will be unable to sit in an upright position without being supported. The tilt in space function of the configura comfort chair allows a person with instability and weakness in their core to be placed in a position that forms a 90-degree angle between the hips and spine and allows the pelvis to remain in midline. This will have a positive influence on the posture of the rest of the body, however it is also likely that further aids will be required. The lateral supports, lateral support backrest and adjustable lateral support backrest all provide varying degrees of postural support to ensure a person is sitting in midline.
  • Pressure – with a poor posture, reduced movement and often long periods sitting in one position the risk of developing pressure injuries is high. The tilt in space function of the configura comfort chair allows a person to distribute the weight more evenly and in turn reduce the risk of developing pressure areas. The vapour permeable fabric of the chair also contributes to a good amount of pressure relieving properties. The base cushion of the chair comes standard as a visco foam cushion however after a stroke this may be harder to tolerate due to thermoregulation properties so the castellated cushion would be recommended to prevent pressure areas.

Further research needed.

Orthopedics Following an orthopaedic surgery whether emergency or elective a person is faced with a whole range of precautions and changes to be made in their environment and to the way they go about their regular activities of daily living. The configura comfort chair would be a suitable seating option for someone post hip, knee, spinal surgery or following fractures which debilitate their mobility.
  • Transfers – a person who has suffered an orthopaedic injury will likely have a period of reduced mobility. This may result is needing a transfer aid or assistance through the chair to lift someone into a standing position. The configura comfort is compatible with all transfer aids due to its horseshow shaped subframe allowing space for aids underneath the chair. The chair can also be used to assist a person’s stand through the rise function – this can further be adjusted to a smaller amount of tilt for someone with reduced balance and strength for transferring and may find the standard amount of tilt to be too much. When sitting down we also want to reduce the impact to the affected area and the rise function can again be used to lower down into a seated position. Secondarily the chair would be useful in a rehab at home setting in allowing people to progress their strength and mobility over this functional range.
  • Size dimensions – due to the likelihood of precautions to movement in the affected area the chair can be adjusted to suit these precautions. For example, post hip surgery and hip flexion precautions the chair height can be easily increased for the precautionary period to ensure hips are above knees in sitting and adjusted back to standard following this period.
  • Pressure care – with reduced mobility and limited movement in a certain area a person is at risk of developing pressure injuries due to prolonged periods of sitting. The configura comfort chair has in built pressure relief for people at medium to high risk of developing pressure injuries. It also allows a person to adjust their positioning through the 4 controls of the chair by changing the amount of recline and tilt of the chair and so reducing pressure through one area. The soft waterfall cushions with vapour permeable fabric also provide an element of pressure relief for people with spinal injuries which aid in both comfort and healing of injuries.
  • Posture –It is important for a person following an orthopaedic incident to maintain a good posture and should avoid sitting in chair which are too soft and don’t provide support to sit upright. Tilt in space is appropriate as it maintains the angle at the hips and in turn is a good option for a person following a hip or leg surgery to abide by their hip precaution of 90 degrees at the hips whilst also allowing them to raise their legs and reduce swelling.