seating for tone management March 4

1 ISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists1 seating FOR TONE MANAGEMENTJO-ANNE CHISHOLM AND JOANNE YIPACCESS COMMUNITY THERAPISTS JO-ANNE CHISHOLM AND JOANNE YIP DO NOT HAVE AN AFFILIATION (FINANCIAL OR OTHERWISE) WITH AN EQUIPMENT, MEDICAL DEVICE OR COMMUNICATION ORGANIZATIONTHE CONTINUUM OF NORMAL 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists2 WHAT IS TONE? mus cle tone (m s' lt n) internal state of muscle-fiber tension within individual muscles and muscle groups. of muscle tension or resistance during rest or in response to stretching. Hypertonia abnormally increased muscle tone or strength, increased resistance of muscles to passive stretching Hypotonia condition in which there is a loss of muscular tonicity, and muscles can be stretched beyond their normal limits Medical Dictionary for the Health Professions and Nursing Farlex 2012 ABNORMAL TONE Hypotonic Low FloppyMixed FluctuatingSpastic High Hypertonia COMMON ADULT DIAGNOSESA bnormal ToneCerebral PalsyTraumatic Brain InjuryStroke (Acquired Brain Injury)Spinal Cord InjuryNeurologic Disorders (MS, Parkinson s,)

2 ISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists3 ABNORMAL HIGH TONE CAN BE HELPFULT ransfer, standing, turning in bed, weight shifting and repositioningABNORMAL LOW TONE FLEXIBILITYABNORMAL TONE OFTEN PROBLEMATIC HIGH TONELOW TONE ISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists4 seating AND POSITIONING CHALLENGES Difficulty staying in position in the wheelchair Pressure, friction, shear Injury to self Damage to equipment Postural deformityPAIN AND LOSS OF FUNCTIONWHERE TO START? OPTIONS FOR SPASTICITY MANAGEMENTI nclude in seating planISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists5 ALWAYS DO A seating ASSESSMENT Wheelchair Scan Supine AssessmentSimulationSET UP AND TRY IN EQUIPMENTHIGH TONE - BROCKISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists6 HOW BROCK MOVES:BROCK SUPINE ASSESSMENTBROCK SITTING SIMULATIONKey points.

3 Hip flexion, abduction, left internal rotation, control left hip forward thrust, anterior trunk pressure, arm support in flexionISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists7 BROCK COMPLETED SYSTEMKey Parameters:- Rigid pelvic control- Full contact system- Dynamic components- Abdominal support- Arm supportLOW TONE - JEFF Young man with high paraplegia Injured as toddler Wants to live independently Would like to drive a vehicleJEFF SUPINE ASSESSMENTISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists8 JEFF SITTING SIMULATIONKey Points:- Anterior trunk control - Accommodate pelvic obliquity- Accommodate lack of hip extension- Accommodate tight hamstring length- Orienation in spaceJEFF EQUIPMENT SIMULATIONJEFF COMPLETED SYSTEMKey Parameters.

4 - Dynamic tilt- Reverse recline- Abdominal support- Accommodate deformities ISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists9 JEFF MIXED TONEJEFF ASSESSMENT FINDINGSJEFF SITTING SIMULATIONISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists10 JEFF S COMPLETED SYSTEMSEATING STRATEGIES Break up tonal patterns Accommodate for temporary range limitations Create postural stability break up tonal patterns Rigid, firm materials Angular design 3 points of control Lever length Full contact Effective use of gravity to align body Orientation in space Allow controlled movement through dynamic components Prevent injury Create self- management options Include adjunctive therapies in seating planBREAK UP TONAL PATTERNSISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists11 BREAK UP TONAL PATTERNS BREAK UP TONAL PATTERNSACCOMMODATE TEMPORARY RANGE LIMITATIONS Determine range that spasticity kicks in accommodate shortest rangeISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community

5 Therapists12 CREATE POSTURAL STABILITY Rigid Firm Angular Long lever Full contact CREATE POSTURAL STABILITY HIGH TONECREATE POSTURAL STABILITY LOW TONE ISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists13 CREATE POSTURAL STABILITY HIGH TONE 3 POINTS OF CONTROLEFFECTIVE USE OF GRAVITY -ORIENTATION IN SPACE WITH DYNAMIC TRUNK SUPPORTEFFECTIVE USE OF GRAVITYISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists14 USE GRAVITY FOR POSTURAL ADVANTAGEB ring head in line with gravityUSE DYNAMIC COMPONENTSPREVENT INJURY OR HARMPROVIDE POSTURAL STABILITY, OVER PAD COMPONENTS, ALLOW MOVEMENT ISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists15 CREATE SELF- management OPTIONS HIGH TONESELF management OPTIONS LOW TONESELF management MIXED TONE Flush mounted single footplate Low seat to floor height Full contact seat base planar, strong Tall contoured backrest Lower armrest hold Belt loop holds Wide armrest adding right trough Sturdy controls monster joystick.

6 Sturdy tilt switch Crosses lower legs to stabilize on footplate ISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists16 SELF management ARM STRAPS LIMITING MOVEMENT TONE management ADJUNCTS TO seating Medication Injections (Botox) Intrathecal Baclofen Pump Surgery; tenotomies/lengthenings, rhizotomy, other Alternative therapies transcranial magnetic stimulation, whole body vibration, shockwave therapy, acupuncture etc. Other interventions behavioural approaches for anxiety, ensuring underlying conditions that increase/decrease tone are managed (bowel and bladder issues, dysphagia, pressure injuries, medications, etc.)

7 INCLUDE ADJUNCTIVE THERAPY IN seating PLAN2 months post-injection combination of Botox, bracing and seatingISS 34 seating for Tone management March 7 2018 Chisholm/Yip Access Community Therapists17 THE seating PROGRESSION Old SystemNew SystemBotox R neck?REVIEW of normal tone, abnormal tone can harm or can of tone is part of the typical seating simulation key in understanding tone & developing management strategies up tonal tone-related range limitations postural of management treatments JOE