Parkinson’s and seating – What to consider when specifying a chair
Many occupational therapists will have worked with, or be currently working with, clients who are living with Parkinson’s disease and will, therefore, be all too aware that providing the correct seating for someone with this condition is vital.
In this article, Repose Furniture, one of the UK’s leading manufacturers of bespoke seating solutions, discusses what to take into consideration when specifying a chair for someone with Parkinson’s with its retained occupational therapist Kate Sheehan.
Parkinson’s disease is caused by the death of specific neurons in the brain area called the substantia nigra. These nerve cells produce a substance called dopamine, which is, therefore, lacking in people with Parkinson’s disease. Dopamine is a chemical that is responsible for the normal working of the part of the brain that controls movement.
Dopamine deficiency leads to the following symptoms of the disease:
- Tremors, which are generally more pronounced whilst resting
- Slowness of movement
- Stiffness of movement, making initiating movement difficult
- Impaired balance
The cause of Parkinson’s disease is not yet fully known, however, both genetic and environmental factors are considered to be involved. The disease is a degenerative condition which will present differently for everyone and as there is currently no cure, symptoms are treated as and when they appear.
Due to Parkinson’s disease causing a number of movement problems, including difficulty or delay of initiating movements, this can make getting comfortable in, or rising from, a chair difficult.
The movement from sitting to standing is more complex than we often appreciate. It requires us to gain sufficient propulsion from a resting position to move forwards and then upwards out of the chair. Then follows the change in centre of gravity as we lean forward to generate initiation of movement. This movement requires a certain amount of force and speed, and difficulty or slowness initiating movement can result in insufficient momentum to rise from the chair then mobilise safely.
“The movement from sitting to standing is more complex than we often appreciate.”
In the early stages of the condition, strategies to improve position and momentum can help, such as moving first to the front of the seat, tucking the feet in under the knees and having the arms positioned to push up can help prepare a client to coming forwards and upwards. Rocking back and forth a few times before trying to rise can increase the momentum and force to continue the movement. Cuing your client (“ready, steady, stand”) can also help to prepare and initiate the movement.
As the condition deteriorates, initiating movement can be so difficult or slow that standing even from a previously useable chair can be challenging. A chair, such as the Repose C-air, with a rise function may provide extra support and propulsion which is perfect for helping to initiate standing. Most riser chairs work by slowly tilting and elevating the seat to lift and angle your pelvis forward. Sometimes just a small angle on the riser function is enough to initiate a natural stand. Otherwise, the seat angle can be elevated until you are almost in an upright position, allowing you to finish with a small stand and walk off from the chair. Due to the support being provided, the rising function significantly reduces the risk of falls on initiating walking from the stand.
In the later stages of the condition, when the client finds it extremely difficult or impossible to move without carers support, considering comfort and the carer’s abilities to work with the client to achieve the optimal position, comfort and movement is essential.
It is at this stage that considering a chair that can adjust with the client’s changing ability is vital and the Repose Boston portering chair is a perfect example of such a chair as it offers a variety of features and benefits to make it the ideal seating solution for both the client and their carer by incorporating the following:
This allows the seat back angle to remain the same whilst the whole seating system is tilted backwards, allowing the angle of the hips, knees and ankles to remain unaffected which reduces shear and friction on the bottom and back during this movement. It also reduces the weight on the Ischial Tuberosities by redistributing the weight through the back.
“As the condition deteriorates, initiating movement can be so difficult or slow that standing even from a previously useable chair can be challenging.”
This feature can also help when transferring someone in a sling as it can support better pelvic positioning by using gravity to position the user in the back of the chair in the optimal position.
By incorporating this feature, the chair can be moved independently which maintains flexibility over the client’s body position, particularly the amount of hip flexion, allowing for the optimal position for comfort.
Independent leg rest
This offers the client additional flexibility over positioning, allowing them to use it in conjunction with the recline feature to create the optimal postural position for their body shape.
“In the later stages of the condition, when the client finds it extremely difficult or impossible to move without carers support, considering comfort and the carer’s abilities to work with the client to achieve the optimal position, comfort and movement is essential.”
This feature allows the footrest to be moved away to allow clear access for the user to be hoisted from the front or obliquely.
In the later stages of Parkinson’s, it is essential that a client’s skin integrity is monitored and reviewed due to the potential of pressure sores developing. A chair with pressure-relieving properties built into its design, which can be upgraded as the condition changes, is essential, for example, different and interchangeable pressure management seat and back cushion options.
The ability to move a client from one room/position to another in comfort and with ease to reduce the number of hoist moves is vital to enable the client to be transported from one room to another so they can be involved in different activities. As well as the Boston, the Repose Harlem Porter Chair is a great example of a chair which meets these demands and more.
All of these options allow the chair to be adapted to the client’s changing conditions, without impacting on their comfort and pressure issues. They also continue to encourage occupational performance.
Repose is a family business with over 100 years of combined experience in designing innovative seating solutions that deliver quality and comfort for the home, health and care markets. Working in partnership with healthcare professionals and through progressively more intensive research, Repose continues to refine its seating solutions to conform to the rigorous standards of the healthcare market.