Mobility Management - SEATING & POSITIONING HANDBOOK 2025

3D Printing’s Seating Possibilities Positioning Beyond the Wheelchair

HOW SEATING COULD IMPACT EARLYINTERVENTION PMDs

for Seating & Positioning

New technology, evolving perspectives, greater expectations

The Stars Aligning

As I was putting together this Seating & Positioning Handbook, I noticed the stories aligning thematically. How 3D printing and wheelchair seating are converging (starting on page 6). A new approach for early-intervention power mobility, with family-centric engineering (page 12). And our evolving understanding of the importance of providing optimal seating and positioning not just within the wheelchair, but outside of it as well (page 18).

All of the stories are forward looking and futuristic in different ways: in perspective, in design, in clinical comprehension.

And they all have so much to admire. I love that 3D printing in a massive field such as engineering has crossed over to take on custom seating needs (and I enjoyed learning so much from Emily Rose Williams). I love that Dave Savage has put his heart and soul into creating a power wheelchair for the littlest wheelchair riders while also considering the transportability and literal heavy lifting that their parents have traditionally had to take on.

I love that Lee Ann Hoffman, Caitlin Miller and Cathy Ripmaster are so passionately devoted to postural support outside the wheelchair, and their holistic perspective on how absolutely everything matters when we’re striving for best possible outcomes for clients.

And as I was pulling together this issue, some other factors began to align as well: policies. Yes, policies.

Read about the Centers for Medicare & Medicaid Services’ (CMS) decision to eliminate the ICD-10 requirement for seating (page 4). No longer will seating be inextricably tied to diagnosis codes. This decision followed an announcement a few weeks earlier that tweaked the provision process for replacing wheelchairs that had reached the end of their reasonable, useful lifetimes. That situation is still being untangled — streamlining the face-toface process when a system is within the same HCPCS code is one thing, but we don’t want to eliminate the seating evaluation entirely!

It feels amazing that all these good things are coming together at the same time in such a small, specialized portion of assistive technology and health care. So many other times, going back to Mobility Management’s founding in 2002, the forces in the universe have seemingly aligned against us, against you and your clients. But now, look at what you’ve achieved with your advocacy, creative thinking and persistence. Just look. m

Laurie Watanabe, Editor in Chief lwatanabe@wtwhmedia.com @CRTeditor

October 2025

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CMS: ICD-10 Codes No Longer Required for Wheelchair Seating Documentation

The Centers for Medicare & Medicaid Services’ (CMS) DME MAC contractors have removed ICD-10 codes from its wheelchair seating requirements.

The National Coalition for Assistive & Rehab Technology (NCART) reported the change in an Oct. 2 breaking news bulletin to stakeholders while linking to the updated article. The article’s revision date is Oct. 1, 2025.

ICD-10 — the International Classification of Diseases and Related Health Problems, 10th revision — is a World Health Organizationendorsed system used to code and classify medical diagnoses.

Johns Hopkins Medicine described the codes as “ a combination of diagnoses and symptoms, so fewer codes need to be reported to completely describe a condition.”

While the updated article still lists definitions for seating HCPCS codes and the need, for example for a specialty evaluation and subsequent written report to be available on request, diagnosis codes are no longer indicated.

The removal of ICD-10 requirement should give clinicians greater latitude to recommend seating based on a client’s needs, regardless of that client’s diagnosis. When ICD-10 codes were part of the documentation requirement, a client could be deemed ineligible for seating components or systems if that client lacked a qualifying diagnosis — even if the seating clinician were willing to document medical necessity.

Tamara Kittelson, MS, OTR/L, ATP/SMS, Intermediate Wheelchair Provider Certification/ISWP, is the executive director of the National Clinician Task Force (CTF).

In an interview with MobilityManagement, Kittelson said the previous ICD-10 requirement “used to eliminate some people” from receiving the seating and positioning technology that best matched their needs.

“You might have the presentation that you need tilt in space, you need a positioning cushion,” Kittelson said as examples. “But if your diagnosis didn’t fit into that framework, then you’re out of luck.”

The flip side of the elimination of the ICD-10 code requirement is that clinicians less familiar with seating and wheeled mobility — for example, clinicians who don’t perform seating assessments on a regular basis — no longer have that ICD-10 code list that tells them what seating interventions have been typically provided for clients with various diagnoses.

“That’s the rub,” Kittelson said. “It’s a double-edged sword. We know there are therapists out there who only do [seating assessments] once in a while, who don’t feel comfortable in their knowledge, who are overly dependent on the supplier ATP for what they should be [recommending] for that person.

“We know that’s happening all the time, and that’s one of the reasons the CTF continues to push for education and training and mentoring to try to help people become more confident.” m

International Seating Symposium Announces 2026 Virtual Professional Summit Dates

The International Seating Symposium (ISS), hosted by the University of Pittsburgh Rehabilitation Science and Technology Continuing Education, has announced the return of its Virtual Professional Summit (VPS) for 2026.

The ISS:VPS will be held on Wed., Jan. 28, and Wed., Feb. 25, next year.

“Each day will showcase four educational courses intercut with social discussions and supporter spotlights,” the ISS said in a supporter prospectus sent out Oct. 20. Supporter spotlight sessions will showcase new seating and wheeled technology products.

The University of Pittsburgh’s RSTCE hosts in-person ISS events in odd-numbered years. In 2024, the RSTCE debuted the ISS:VPS to offer online continuing education units for seating professionals via a two-day educational summit.

In a MobilityManagement interview last year, Rachel M. Hibbs, DPT, NCS, ATP/SMS, co-director of the ISS, said the split format of the ISS:VPS means clinicians, providers and students won’t need to miss consecutive days of clinic or school to attend the online sessions. m

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Carbon — whose partners include Adidas and Ford Motor Company — has been studying wheelchair seating

By Laurie Watanabe

Traditionally, cushions that provide the most help for wheelchair riders — such as custom-molded ones with robust support and positioning, or that accommodate asymmetrical postures — have tradeoffs. They can be bulky and heavy. They don’t breathe well; they trap and hold heat. They hold moisture, which can cause skin maceration and raise pressure injury risk. They can also be costly and time consuming to produce. Could 3D printing offer another option?

What is 3D printing?

Based in Redwood City, Calif., Carbon is a 3D-printing technology company working in the automotive, industrial, medtech, and consumer industries — the last of which includes bicycle seats, helmets, and midsoles for athletic shoes. Even if you don’t know Carbon’s name, you know its partners: Adidas, Rawlings, Riddell. In the automotive space, Carbon has worked with Ford Motor Company on HVAC parts and electric parking brake brackets, and with

Lamborghini on a fuel cap and clip components for an SUV air duct.

Now, Carbon is taking its talents to custom wheelchair seating, where precision can be the difference between success or failure.

Emily Rose Williams, Carbon’s business development director, has a degree in mechanical engineering from the University of Texas at Austin. She’s spent the last two years studying the wheelchair cushion industry.

“We make the printers,” she said in explaining Carbon’s business. “We make the software to design the lattice.”

A lattice is the 3D structure made of interlocking, repeating cells that get printed. Imagine LEGO blocks as cells, and a bunch of LEGO blocks snapped together as a LEGO lattice.

“I would say we are a materials company first and foremost that also makes printers to print the materials, and software to design the parts to make with our materials,” Williams said.

She explained the different ways to 3D print: “There’s FDM [fused deposition modeling] printing, which is an extruded melted plastic.

There’s SLA [stereolithography], which is a laser-based system: A laser cures the resin.”

Carbon, however, uses digital light synthesis: “A UV light cures an entire slice at a time to set the shape of a part. And then we take that part and put it through a thermal cure. So it’s a two-part system, which is different than a lot of the other 3D-printing methods out there.”

The process, Williams added, “allows for final end-use mechanical properties and more durable polyurethane chemistries. You can think about it as the part growing out of the vat of resin because the platform’s kind of lifting as the part is printing. The parts lift out of this liquid resin, and it is a layerbased process. Each layer cures to the layer beneath it, and you don’t have any issues with layer strength. Sometimes in an FDM system, for instance, there are pretty stark differences between layers. So if you were to have impact on the side of a part, you’d have some weakness at those layer points.”

3D printing and the demands of wheelchair seating

Carbon’s technology and processes are already producing “millions of custom parts every year,” Williams said.

Footwear and bicycle saddles made using Carbon’s technology have similarities to wheelchair seating, Williams added. “Adidas has printed several million pairs of midsoles for their 4D line,” she said. “We’ve got 20-plus saddles on the market, some fully custom. A rider would come in, sit on the saddle pressure map, and then we can adjust the lattice for that user specifically.”

Bike saddles — which distribute weight as wheelchair seating does — “are custom lattices based on a pressure map,” Williams said. “Helmets will be custom shapes based on scans and shape captures of the players’ heads. So you can imagine in the cushion space, we could do a custom shape and a custom lattice based on a pressure map.”

The ability to create lattices per application gives 3D printing techs the ability to, for example, provide impact protection in a helmet exactly where it’s needed most. “You can vary the lattice based on where it is on the helmet, but also, the lattice can change throughout the width of that pad. With foam, you’re very limited to a single

density. Or you can have multiple foams stacked together — a comfort layer, and then an impact layer.” Carbon’s technology, in contrast, “can be seamless,” Williams said.

What could 3D printing do for molded seating applications?

Carbon’s first ventures into seating have focused on ultralightweight wheelchairs. But given the abilities of 3D printing, it’s easy to envision the general technology also producing custom-molded seating.

“We could print a custom cushion in roughly six to eight hours,” Williams said. “It depends on the size and the shape. But the other thing that’s nice about 3D printing is that it’s quite scalable. You could easily have multiple printers going at one time, and you’re only using what you need for that cushion. You don’t have any waste.”

Williams added that there could be “some flexibility on the lattice structure. So instead of just doing a single lattice throughout the entire cushion to mimic single-density foam, you could have the user pressure map on whatever they’re using to take the shape capture. You could have them pressure map and then add features into the lattice — like wells in the IT [ischial tuberosity] zones or in different areas where you might want a stiffer backrest. You can essentially have dual density or as many zones of density as you want in a single printed cushion.”

In seating clinic, a clinician could input a scan file and a file of the client’s pressure

map. 3D printing technology such as Carbon’s would create the seat cushion based on additional parameters from the clinician, such as seat width and depth.

How 3D printing could fit into seating provision

While Williams said she and the Carbon team are still learning about complex seating, she added, “A lot of the clinics I’ve talked to are limited in the number of patients they can see because of all the time they spend with the patient on the front end of the design, or on the back end, with the hand carving and things like that. We can cut down on that time because we have automated processes. And we provide different check stops. You can set it up however you want with different go/no-go stops — like, does this look OK, or do you want to adjust anything based on feedback from the patient? You can intercept it at any point.” A typical turnaround time for a Carbon-printed custom bike saddle, for example, is two to four weeks.

But clinicians and providers “wouldn’t necessarily need to bring in a printer to do the printing themselves,” Williams said. “They could outsource from a nearby [vendor] that has, for example, 10 printers available. So they wouldn’t be limited to just the time they have on their printer. We’ve got production partners that have the capacity of multiple printers. They buy resin in large quantities, so they get pricing at scale.”

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Carbon doesn’t do the manufacturing itself, but as it expands, “We like to work with new customers and help them find the right partner,” Williams said. “We’ve got partners that are fantastic at making bike saddles. We’ve got partners that are fantastic at making running shoes. We’ve got partners that are FDA ISO 13485 certified for medical device production. That’s where we would likely send customers or clinicians who are looking to make cushions.”

Eventually, Carbon hopes to have regional 3D printing partners who are the go-to specialists for wheelchair seating. “But right now, we’re taking the inbound requests,” Williams said, and matching those requests with printing providers.

So while a seating clinic could buy a 3D printer, hire or train someone to operate it, and renovate its facility to accommodate the equipment, the 3D printing industry has additional options.

“We found that it works better when we have manufacturers that know what they’re doing and do this every day,” Williams said. “They have better lead times, better material pricing, better margins.”

Otherwise, a seating clinic might need to print 500 cushions a year to justify buying its own 3D printer. “I would always recommend that customers go to a partner first and get started there,” Williams said. “It’s really easy to ramp up with someone that already has a printer. No learning curve.”

Is 3D printing right for complex seating?

Functionally, is a 3D-printed seat cushion going to perform as well as a cushion constructed of foam, gel or air cells?

In true Complex Rehab Technology fashion, Williams said, “My answer is always going to be ‘It depends.’ Sometimes, data does not equal actual feedback from patients or users. It’s been such a learning experience for me to say, ‘Well, the pressure map looks good,’ but they don’t think it feels as good, or they like their old foam cushion that pressure maps way worse [than the 3D-printed one].’”

On a more objective level, though, Williams compared the resin in 3D printing to, for example, the durability of foam.

“What we found is that the more durable the foam, likely the heavier it is,” she said. “When you’re dealing with a high-density foam, you have the whole [cushion] made out of foam. We have a similar chemistry to a high-density polyurethane foam, but when you’re printing a lattice structure, you don’t have to fill it up 100% with this material. So, if we were to just print a slab of our material versus a slab of foam, obviously we’re going to be as heavy or heavier than that foam. Whereas, if you’ve seen our lattices, the structure of them makes them lighter than foam cushions.”

In addition to using less material and being lighter in weight, the lattice’s breathability, Williams said, is one of its greatest advantages.

“Having enhanced airflow and microclimate management is our true benefit,” Williams said. “You can feel it cooling, pulling heat away from the body much better. Moisture retention is much, much less because any moisture can just flow through the lattice structure.”

Even when completely wet, the lattice doesn’t soak up water — Williams said you can tap it to shed whatever water is clinging to it.

“I’ve heard from a lot of active users,” Williams said. “They want to go to the pool. Or they’re traveling and they want to take their cushion into the shower. You could take your [3D-printed] cushion off the chair and know it’ll be dry in a matter of minutes. You could never do that with foam. On the flip side, if you have some sort of incontinence cover so moisture isn’t soaking [into the foam], then you’re going to be sitting in a pool of liquid [on top of the cover].

“It’s the same with gel cushions and air cushions; they’re inherently not breathable because of what they’re made out of. I see our materials being able to solve for all of that.”

Cushions made using Carbon’s technology don’t need maintenance, and while they do get slightly warmer or cooler according to ambient temperatures, Carbon has tested the cushions in very high and low temperatures without seeing detrimental effects. “You can imagine using a running shoe in all climates,” Williams said. “Those are pretty similar climates you might imagine for a cushion.”

As for sizing, Williams said, “Small is easy. Where we are limited in build area is when we get large [sizes].” She declined to go into specific strategies beyond saying that Carbon is working on ways to build cushions with widths greater than 16x18".

Busting 3D printing myths

While 3D printing still might sound like science fiction to some, Carbon is proof of the technology’s real-world abilities.

“The biggest misconception about 3D printing is that it’s not ready for end-use products,” Williams said. “We’re fighting this battle every day — ‘Oh, my kid has a 3D printer in their garage.’ You could never print a durable cushion with that. But we are making end-use parts. They are durable. They last a long time. They are cost effective. Consumer companies wouldn’t be putting our products in their equipment if it didn’t make sense from a margin perspective.

“My day-to-day is just convincing people that 3D printing is effective and affordable. And we’re willing to try anything, if anyone has any ideas they want to test out.” m

Small Base, Big Possibilities

An early-intervention power chair reimagines family-friendly mobility

By Laurie Watanabe

So many early-intervention mobility needs have been met by enterprising creations such as Permobil’s Explorer Mini and the University of Delaware’s groundbreaking GoBabyGo adapted power toys.

But David Savage, ATP/SMS, RET, seating and mobility specialist at Children’s Specialized Hospital in New Brunswick, N.J., still saw a gap for very young children who lacked independent mobility and had complex positioning needs. And in May, his response — the early intervention Power Wheelchair (eiPWC) — won the Developers’ Showcase Audience Favorite Award at the 2025 Rehabilitation Engineering & Assistive Technology Society of North America’s (RESNA) conference in Chicago, Illinois.

The question of early intervention mobility

“One of the principles of engineering is you’re solving a problem, right?” Savage said, in explaining the genesis of the eiPWC. “My poster started with ‘What’s the problem?’

The problem is that the in-patient rehab children Savage works with “are way on the end of the spectrum in their positioning needs, if they’re going to be seeing me,” he said. “When I look at the Explorer Mini — I don’t work with the kind of kids who can use that. I think it’s great, but I don’t work with those kids.”

Savage’s clients have more complex positioning needs, and thus more complex seating equipment. What they do not yet have: Independent mobility.

In his Developers’ Showcase poster, Savage said, “Volitional movement in early development promotes cognitive perceptual development. Children with profound mental and physical disabilities are missing milestones due to their inability to move themselves through space. These same children often require supportive seating to maintain any position against gravity and have limited fine motor ability.”

Or in engineering terms: Children need to be able to move independently. “We learn how to perceive vision by moving through space,” Savage said, as one example.

Complex seating, compact base

The eiPWC combines a child’s existing seating with a compact base, such as those from Group 2 power chairs.

The system shown at RESNA’s conference (pictured) combined Sunrise Medical’s Kid-Kart seating with a compact Quantum Rehab power base, though there are many other possible seating-mobility pairings.

“The interfaces are fairly simple,” Savage said.

To demonstrate what’s achievable, the sample system was built to accommodate a

power chair], until that’s what you need.”

Instead, Savage praised the University of Delaware program’s approach.

“They had an ad: ‘If you have a child between 6 months old and 3 years old who’s not yet walking, please contact us, and they can come to our lab at the University of Delaware and play with our robot,’” Savage explained. “I think that’s a beautiful way to approach people. I’m one to one with parents who already trust me, because I set up their kid in supportive seating. So when I ask, ‘Would you like them to be able to move?’, it’s always yes.”

Bringing the Kid Appeal

The eiPWC is unlikely to be a child’s primary mobility device because children under 3 years spend a lot of time in strollers. But “that doesn’t mean you don’t still need to be able to move yourself,” Savage noted.

And the socialization opportunities for a toddler moving around in such an intriguing system can’t be beaten.

At the RESNA conference, Savage drove the eiPWC in the exhibit area … that is, when visiting kids weren’t at the controls.

That’s gigantic, if power mobility can help a kid be more approachable to his peers — David Savage

child with complex conditions. It carries a ventilator and oxygen equipment, plus both switch and proportional driving controls. The baby doll model at RESNA even had a feeding tube. Because the power base is small and the seating can be easily removed, the system is also transportable without the need for a wheelchair ramp van.

In addition to being able to carry equipment that a child with complex medical conditions might need, the eiPWC is also family friendly, since the seating is already familiar to caregivers … and because the smaller base can maneuver more easily in tight spaces and is less intimidating due to its more compact size.

That lack of intimidation is crucial, as pediatric seating specialists well know.

Savage said that when talking with parents, “It’s not ‘Do you want your kid to use a power wheelchair?’ That’s not the question. No one wants their kid [to use a

He recalled a Japanese girl who, despite being unable to talk with Savage in English, saw him driving the eiPWC via remote control and took over, without needing instructions, once Savage handed her the remote.

That scenario was replayed when a group of kids came into the hospital where Savage works and also did some driving.

“The socialization factor of that, when somebody’s moving, versus a kid sitting in a supportive stroller,” he said. “It’s huge. That’s gigantic, if power mobility can help a kid be more approachable to his peers.”

What’s next for the eiPWC?

Savage said he’s talked with industry leaders, including some working for manufacturers, and gotten positive feedback, though he acknowledged, “They’re part of the choir.”

“I’d like to do some hard research,” he added, explaining that the focus of such

a study would be less on the device than what its movement can accomplish. The usual Complex Rehab Technology research hurdles would be present, no doubt, “Because there’s really no one that I want to not use it. Where is it contraindicated?

“There’s a small enough pool of candidates to try it with our therapists. We have pediatric long-term care, and they want to use it with some of their kids, which would be a wonderful group to try it with,” he said, since those children stay at the hospital for longer periods. “And yet, working on it in your home environment is better.”

The eiPWC has already been vetted, Savage noted: “When we were confident that yes, we’re going to use this with kids, I brought over an electronic engineering professor from Rutgers University, who happens to be the father of one of our seating clinicians.”

The eiPWC passed muster, “so we started using it with kids,” Savage said. “I approach parents and say, ‘Would you like your child to be able to move themselves?’”

You can guess what their responses are.

“It’s a work of passion,” Savage said. “Everyone’s doing great work, but something’s missing. That’s not OK. I’m trying to fill a gap. That’s engineering. Let’s fix the problem.” m

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Why everyone wins when kids are consistently positioned

By Laurie Watanabe

While so much of seating focuses on wheeled mobility, much of life happens out of the wheelchair. That’s especially true for children, whose daily environments can include home, school, cars and caregivers’ homes, where activities such as sleeping, eating, bathing, learning and playing still require functional, safe support.

This summer, Mobility Management hosted three clinical experts for our Pediatric Positioning: Beyond the Wheelchair webinar. Lee Ann Hoffman, Caitlin Miller, and Cathy Ripmaster discussed, respectively, lying posture care management, standing and gait training, and sitting outside the wheelchair.

Understanding all that 24-hour positioning support can achieve is a work in progress. But our clinical experts supplied plenty of motivation to continue educating all stakeholders.

Use the QR code (lower left) to register for free to access the full webinar on demand.

Lee Ann Hoffman on Lying Posture Care Management

“Lying posture care management (LPCM) is a therapeutic process that helps those with limited movement lie in supported symmetrical positions,” said Lee Ann Hoffman, OTD, EdD, MSc, OTR, ATP/ SMS, CAPS, the assistant program director and assistant professor of occupational therapy programs at the University of St. Augustine for Health Sciences in Dallas. Hoffman has also served as co-vice chair for the RESNA 24/7 posture care management special interest group.

“This is part of something that we call 24-hour posture care management,” she explained. “This includes standing and sitting over the 24-hour period. The idea itself is actually very simple. However, it’s powerful.”

Hoffman pointed out that people with mobility impairments might spend eight or 12 hours a day lying down. “If those hours are spent in an unsupported posture, the results can be damaging,” she said. “So

think about the presentations we often see: scoliosis, hip dislocation or contractures. But if we intervene early and consistently — that’s key — then we can address those postures and provide support of lying positions. We can actually aim to and have the outcomes of protecting body shape, improving comfort and even supporting functions such as respi ration, sleep and pain management.”

Hoffman emphasized that LPCM is about more than just nighttime sleep. “It applies to napping that some of us do during the day, at times at rest, and then also any other time spent lying down. So think about rest and therapeutic positioning when you think about lying posture care management.”

High-quality sleep is so foundational that when it’s disrupted, “the impact the next day can be so powerful,” Hoffman added. Consider how you feel after a poor night’s sleep: “Maybe you have found that you’re quicker to snap at somebody and you think, ‘Oh, this is not really typical for me.’

“Now let’s think: How is my person who’s nonverbal going to communicate this discomfort they’re in, this pain, this fatigue they’re experiencing because of that poorquality sleep? I want us to really think back to not just the individual themselves who is requiring sleep positioning, but what impact does that also have on the family and the care support who are around this individual? They are most likely also having sleep disruption.”

Being upright and moving not only helps them to make choices with their body; they’re also in a less dependent position

— Cathy Ripmaster

Cathy Ripmaster on standing and gait training

Cathy Ripmaster, MSPT, has worked as a physical therapist at Lincoln Developmental Center in Kent County, Michigan, for the past 25 years. Her school has approximately 100 students, ages 5 to 26, who qualify for the school with the label of severe multiple impairments.

Ripmaster has worked with the MOVE program — Movement Opportunities Via Education/Experiences — since 2002 and is a MOVE international trainer.

“When I think of kids that need 24-hour postural care, these are individuals who are not able to move unless other people help reposition them,” she said. “Think about what happens to our bodies if we are on prolonged bed rest. Now imagine that this is these kids’ lives, and what can happen to

them if they’re not up and moving.”

Therefore, Ripmaster said, getting children upright to stand or use a gait trainer is “not only supporting bone and joint health, but we’re able to help them participate in their lives.”

That participation brings with it increased autonomy. “They’re able to become an active participant in the things going on around them,” Ripmaster said. “Being able to be upright and moving not also helps them make choices with their body — they’re also in a less dependent position. They have options to move towards things that are preferred. It’s easier for them to be at eye level with their peers, and people are more likely to interact with them and encourage communication.”

The Lincoln Developmental Center uses the MOVE program, whose principles “are

very much how we direct our day and interact with our students,” Ripmaster added. “It’s more than just getting kids up in equipment. It’s a six-step program, so we’re looking at the highest level of skills that a person needs to be independent in sitting, standing and walking, and transitioning, and they’re all linked to very functional activities — for example, walking 10 feet to get from the hallway to their bed because their wheelchair doesn’t fit through the doorway.”

Ripmaster added that MOVE focuses “on what is needed for that child to be participating in their home, what is physically challenging for that student, and what breaks the backs of their families. Then we’re looking at what kinds of activities the families would like them to do based on their level of function.”

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If a child needs positioning support in one of those areas of occupation, typically they’re going to need positioning support in the other ones

—

Caitlin Miller

Caitlin Miller on non-wheelchair seating

Caitlin Miller, OTD, OTR/L, received her doctorate in occupational therapy from Belmont University in Nashville, Tenn., and went on to work at Vanderbilt Children’s Hospital in its outpatient setting and within its specialized seating and positioning clinic. At Numotion, Miller now serves as director of sales.

“It is very all encompassing,” Miller said in considering seated positioning outside the wheelchair. “There are so many other alternative positioning places that a child could be, so I like to provide framework around that, as a clinician and now as someone who works on the vendor side. The framework allows us to look very holistically at the child.”

Miller said she considers “areas of occupation” that include sleep, playing, social participation, activities of daily living. She also referenced what Hoffman and Ripmaster said earlier about lying posture and standing.

“If a child needs positioning support in one of those areas of occupation, typically they’re going to need positioning support in the other ones,” Miller noted. “And so in looking at that holistic approach, I like to organize it in my brain that way. Not only does this give us framework, but it actually leads us to our goals of the piece of equipment.”

This approach, Miller added, can provide a starting point.

“I locally guest lecture at some universities and new clinics, where clinicians don’t have experience with equipment,” she said. “You walk in and they’re looking at you wide eyed and terrified, because they have no idea where to start. So I like to bring them back to baseline and say, ‘This evaluation for equipment is going to be no different than any other evaluation, right? We’re going to leave with a goal.”

For example, an activity chair: “It has a tray, it has positioning components like laterals and a chest harness, because we know as clinicians that posture promotes function. If we don’t give them that proximal stability, we are not getting that distal mobility to be able to self feed. We can accomplish that through a piece of equipment.

“Same thing with grooming: If we have a child that wants to complete grooming at the sink, activity chairs can have an anterior tilt feature, which allows them to really have good weight bearing through their lower extremities. That can help promote that reach that Cathy was talking about.”

Advocating for consistent posture management

How do these clinicians promote the need for 24/7 posture care management to parents, school aides, clinical peers?

“Caitlin’s using my favorite OT term: It depends,” Hoffman said. “It depends on who I’m speaking with. If I’m speaking with a medical professional, I can maybe cut to the chase. If I’m dealing with folks who are not in the medical realm — families, friends, caregivers, teachers — I like to use an individualized approach. ‘Have you ever slept in a hotel for the first night of your vacation, and it’s not your pillow, the room temperature is not right, all the things just don’t align?’ And then bringing that back to the client in front of us: ‘These could be things that are impacting their function.’”

The discussions, Hoffman added, “are not a monologue or a soliloquy. It is about having that real interaction about ‘What have you noticed?’”

“I was in an evaluation with a parent who had just had a baby welcomed home out of the NICU,” Miller said. “And I love equipment because I know what a gift it can be to families. But I had no knowledge of where mom was in her phase of acceptance of all of this; it can be very overwhelming. So I think gaging where your families are in their journey, meeting them where they are with lots of empathy and lots of explanation.”

Ripmaster added, “I also feel like it’s everyone’s role, right? I think it is not only educating that family and talking with them, but it’s also looking at all the people who are on the team and making sure that everyone understands the importance of these items, starting now.”

Another important message: Optimal positioning beyond the wheelchair can make a positive difference even if it that support doesn’t start in early childhood. “I work with students up to age 26, and I can still see a difference when we’re really intentional with our programming and positioning when we start in their 20s,” Ripmaster said. “So we can all start now and not feel bad that we haven’t started before. Because we didn’t know. But move forward. We can make a difference every day in what we do.” m

How is my person who’s nonverbal going to communicate this discomfort they’re in, this pain, this fatigue, because of poor-quality sleep?

— Lee Ann Hoffman

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