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Complex seating - solving some puzzles at PMG 2017

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Edward Perry

Rehabilitation Engineer


21 December 2017


As a novice seating clinician/rehabilitation engineer, I had a really wonderful time at the PMG Conference 2017. The presentations were very informative, and I genuinely think I could have watched every single parallel session were I able to bend the laws of space and time! Thankfully, I’ll be able to catch up, because they’re now published online.

Being a contoured seating provider, I found the session on body/skin temperature in seating very interesting, and Sarah Greasley’s presentation on reducing temperature at the seat-patient interface was particularly relevant to my work.  Her development of a testing method for analysing temperature at the patient-seat interface, and subsequent investigations into both passive and active seat ventilation, seemed thorough and well thought out. The results showed that open cell foam and passive ventilation reduced temperature by around one degree, with open cell foam and forced ventilation achieving a maximum of four degrees of cooling. Although we have used passive venting in foam contoured backrests during my time at the medical engineering department in Salisbury, we did not undertake experimental work to provide evidence of its effectiveness. Sarah’s study - specifically the revelation that the heat is concentrated at the skin/cover interface - will alter the way these vents are incorporated, because any passive ventilation holes/slots need to be as close to the surface of the seating as possible. Some questions were raised regarding my own work:

  • Is the open cell foam we currently use for seating too restrictive to airflow for effective passive ventilation?
  • Do we have to consider active ventilation?
  • Is this best achieved by designing our own system, or perhaps by integrating a commercially available system such as the one subsequently demonstrated by Matthew Eveleigh and manufactured by Sunrise Medical?

As someone who regularly encounters wheelchair users with postural asymmetry, I found the session A person-centred approach to the protection and restoration of body shape by Tess Ellis and Helena Poulton very useful.  The explanation of their approach to the protection and restoration of body shape dealt with some of the realities of providing 24-hour postural management.  The description of how deformities develop and their methods for restoring body shape, or protecting people from further deterioration, were easy to follow.  As a contractor who sometimes only sees a snapshot of a client during appointments, it is another piece of knowledge to help develop a fuller picture of a client’s situation.  It was also a reminder about the importance of collaborative work in postural management when aiming for user-centred goals, especially when working with other services to provide holistic care.  Until recently I was probably guilty of focusing purely on solving the postural problem that presented during an assessment, rather than thinking of the deeper issues that may be causing the deformities to develop. This presentation was another reminder to dig deeper during postural assessments, and try to develop a better understanding of a client’s overall needs. 

Professor Amit Gefen’s presentation on the effects of cell deformation on tissue viability was fascinating.  I had not appreciated the impact of deformation on cell function; my understanding having focused on the effects of ischemia.  Professor Gefen’s explanation of how the deformation of tissue leads to the distortion of cell structures, and the resulting damage to the cell and tissue, was a revelation. Hearing someone with so much knowledge talk about his area of expertise gave context to the interface pressure measurements that I often encounter.  It’s another piece of the puzzle to consider for complex clients who often require a delicate balance of postural management and pressure relief.  I may not have the time or facilities to perform a magnetic resonance imaging (MRI) scan, or a finite element analysis of a client’s pressure area, but I can certainly use this new knowledge to understand why a pressure area has appeared on a client’s skin.  Professor Gefen’s presentation will improve my ability to visualise what is happening at a seating interface.

Another highlight of the conference for me was Hans Candeborn’s presentation on advanced matrix seating - it was a such a delight to see a highly skilled clinician creating such beautiful seating.  It was an example of how subtle differences in assessment and fabrication can result in a great product.  Perhaps this is the theory of marginal gains in action. 

Hans clearly has an enviable array of skills across different disciplines, and it was a privilege to see his work.  The presentation did exactly what the title described - Advanced matrix seating: what can be achieved using matrix - and opened my mind to what is possible with matrix seating.   Direct casting and horse hair padding are obvious methods for Hans, but definitely raised a few eyebrows in the audience.  His seating seems to be minimalist, highly functional, and aesthetically pleasing all at once, whereas component seating can often seem only functional. Hans’s use of hinged supports, apparently as the norm rather than the exception, really inspired me, and his case studies were excellent examples of user-centred seating.

The proceedings were only part of my PMG Conference 2017 experience; it was also great to talk to other people in the field, from NHS therapists through to product specialists.  It’s sometimes easy to get stuck in a bubble but, at the PMG conference, there was the sense of a wider community with common goals.  There will always be challenges in the discipline, and it was refreshing to hear other people’s perspectives.

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