Case Study (Phoenix): Finding a Chair for Ben – Kyphosis & Sliding in Chair
This case study is a real patient scenario. The images have been created from real photographs taken with permission. This is a real person in a real situation but illustrations have been used in order to protect their identity. Images & Content © Seating Matters 2024.
Background & Seating Issues
Ben is an 87-year-old male, with a history of stroke (CVA) and osteoarthritis. He had suffered from multiple problems due to inadequate seating, with a lack of head support and a fixed kyphotic posture. This made it difficult for him to lift his head or extend his neck.
Ben had a history of pressure injuries and spent up to 14 hours a day in his chair, using a patient lift for all transfers.
Ben’s field of vision was restricted due to the curvature of his neck and upper spine. He was often facing downward. The position of his head and neck caused issues with breathing and eating, giving him a high risk of choking or aspiration.
Ben would slide from his chair at regular intervals throughout the day, which caused him to develop red areas on his sacrum. This placed increased pressure on his caregivers, who were required to constantly re-position him.
Other significant postural issues included a pelvic obliquity, imbalanced weight distribution, pelvic rotation to the right, and a leg length discrepancy.
Background
- 87 years old
- Kyphosis, Osteoarthritis
- Previous Stroke (CVA)
- History of pressure injuries
- Hoisted for all transfers
- Approx. 14 hours per day in his chair
Seating Issues
- Little head support
- No tilt in space or gravity-assisted positioning
- Difficulty lifting head or extending neck
- Restricted field of vision
- High risk of aspiration
- Frequent sliding from chair
- Pressure injuries on sacrum
Caregiver Issues
Caregivers reported that Ben:
- Was difficult to position in his chair.
- Would regularly slide down the chair throughout the day. This increased the shear forces, and was strenuous for both Ben and his caregivers.
- Was very difficult to move through the home as there was no push handle on his chair.
BEFORE
Ben sitting in his old chair
AFTER
Ben sitting in the Phoenix™
Postural Issues
Marked spinal kyphosis:
This limited Ben’s vision and interaction. It made activities such as eating and drinking difficult.
Sliding forward in the seat:
The curved position of Ben’s spine combined with the inadequate seat depth was encouraging him to slide forward in his chair.
Pelvic obliquity:
Ben’s pelvis was uneven, with the right side lower than the left. This caused an imbalance in weight and pressure distribution.
Pelvic rotation:
Ben’s pelvis was observably rotated to the right. This was evident from the position of his lower limbs. He also had a leg length discrepancy.
Intervention: A Tilt in Space Kyphosis Chair
Following a Seating Matters Seating Assessment, it was recommended that Ben try a Phoenix tilt-in-space chair to improve his postural alignment, and reduce or prevent further kyphotic deterioration.
The Phoenix was chosen due to its extensive upper body and head support.
Upon being seated in the chair, the adjustable laterals, along with the head and shoulder supports, proved helpful in supporting Ben’s head and spine. The seating surface was adjusted to suit all of Ben’s physical dimensions, eliminating any pelvic obliquity and rotation. Tilt in space also worked in Ben’s favour as it placed his head and neck into a neutral position over his spine. This lead to improvement with his visual field (see image below) and placed him in a much safer position for drinking, feeding and breathing.
Functionally, Ben’s chair could now be moved throughout the home, allowing him to safely spend time in different environments, without compromising posture by transferring him into an unsuitable wheelchair. In addition, Ben did not fatigue as easily in unfamiliar environments and he could participate in activities for longer periods of time without becoming tired and strained.
Results
Qualitative Client Feedback
Ben expressed that he was more comfortable in his new Phoenix chair. He was better able to interact and communicate with others in the room.
Postural Changes
- The curved position of Ben’s head and spine was supported and accommodated using the Phoenix chair’s adjustable head and shoulder supports.
- The strain on Ben’s shoulder muscles was lessened due to the Phoenix chair’s arms being adjusted to suit his arm height.
- Tilt in space was used to change the position of Ben’s centre of gravity.
- Ben’s visual field was improved, and his head and neck were supported in a more extended and functional position. This enabled him to drink, feed and breathe safely.
- Pelvic obliquity and rotation were eliminated by providing a supportive seating surface that was adjusted to Ben’s physical measurements.
Caregiver & Family Feedback
After assessment, and in light of Ben’s difficulty weight bearing, it was recommended that the carers use a full hoist in order to effectively position Ben in the Phoenix chair each morning. After educating caregivers and staff on how to position Ben, they felt more involved with Ben’s care and postural management, and were motivated and enthused to take part in this every day.
Functional Changes
Ben’s chair could be easily moved throughout the home. This enabled him to spend time in different environments without having to compromise his posture or positioning by transferring to an unsupportive wheelchair. This was particularly evident at mealtimes when Ben could be transported to the dining room in his clinical therapeutic chair.
Impact on Skin
- Correct positioning and the use of tilt in space significantly reduced the risk of pressure injury development.
- The contact between Ben’s body and the supporting surface of the Phoenix chair was maximised. This helped to evenly distribute pressure and prevent high interface pressures under any bony prominences.
- Tilt in space redistributed weight and pressure from Ben’s sacrum and buttocks to his back.
- The same level of pressure management materials is included in the back and headrest of the Phoenix as standard to protect this area too.
Social Interaction
Caregivers reported that Ben’s improved position and the maneuverability of the Phoenix chair facilitated better communication and interaction with others. He was now able to move between different rooms within the home and spend time with more residents and staff.
Ben’s improved head position facilitated better voice projection and respiration, meaning his communication and speech were more audible and clear.
Ben’s kyphosis limited his visual field and interaction. This was significantly improved after swapping to a Phoenix chair. The curved position of his head and spine were also accommodated.
Ben’s story and other patient case studies are found in The Clinicians Seating Handbook. This practical guide by world-renowned OT, Martina Tierney will assist you in the prescription and use of therapeutic seating for patients with various conditions. It’s the best place to start.
*Note – the purpose of this blog is to give an overview of the product with some tips to consider on its use. This is not intended to be a substitute for professional or medical advice, diagnosis, prescription or treatment and does not constitute medical or other professional advice. For advice with your personal health or that of someone in your care, consult your doctor or appropriate medical professional.
