Seating for Complex Needs: A Conditions Guide for HCPs

Specialist seating for people with complex needs should always begin with the individual rather than the diagnosis.

Two people with the same condition may present very differently in terms of posture, muscle tone, mobility, cognition, pain, fatigue, pressure risk and ability to transfer. The role of seating is therefore not to “treat” the underlying condition, but to support function, positioning, comfort and day-to-day activity as part of a wider care or rehabilitation plan.

For healthcare professionals, a useful seating assessment should consider the interaction between:

• Diagnosis and disease progression
• Pelvic and trunk posture
• Head control
• Upper and lower limb function
• Ability to reposition independently
• Sit-to-stand transfers
• Pressure risk
• Cognition
• Fatigue
• Pain
• Spasticity, rigidity or involuntary movement
• Carer input
• The home environment
• Expected duration of sitting

At Chiltern Care Chairs, we work alongside Occupational Therapists, physiotherapists, rehabilitation teams and families to help identify seating that reflects the clinical and functional recommendations already made. Depending on the selected range, options can include different seat dimensions, motor actions, lumbar adjustment, head support, lateral cushioning, pressure-relieving seating and tilt positioning.

A diagnosis should guide assessment, not determine the chair

It can be tempting to think in terms of “a chair for Parkinson’s” or “a chair for MS”, but that risks oversimplifying the assessment.

The same diagnosis may produce very different functional presentations.

One person with Parkinson’s may remain independently mobile but struggle with bradykinesia and sit-to-stand initiation, while another may have more significant balance impairment, rigidity and postural instability. NHS guidance recognises slowness of movement, stiffness and balance problems among the key features of Parkinson’s disease.

The seating recommendation should therefore be driven by the person’s presentation at the time of assessment.

Stroke

Stroke can affect movement, sensation, cognition, vision, communication and fatigue in different combinations. Rehabilitation plans commonly include physiotherapy and equipment to support movement and function at home.

From a seating perspective, assessment may need to consider:

• Unilateral weakness
• Asymmetrical loading
• Reduced trunk control
• Altered sensation
• Neglect
• Shoulder positioning
• Ability to reposition
• Transfer technique
• Fatigue

A person who consistently loads one side may require more detailed attention to pelvic alignment, lateral support and arm positioning.

Seat width is particularly important. Excessive width may allow greater lateral collapse, while insufficient width can create pressure and restrict movement.

Where the person is working towards greater independence in transfers, the effect of seat height and armrest position on sit-to-stand should also be considered.

At Chiltern Care Chairs, where an OT or physiotherapist has identified specific dimensions or support requirements, these can be used to help narrow down appropriate chairs and configurations for trial.

Parkinson’s disease

Parkinson’s disease may involve bradykinesia, rigidity, tremor and impaired balance, all of which can influence the way someone approaches a chair and moves between sitting and standing.

Relevant seating considerations may include:

• Ease of initiating sit-to-stand
• Seat height
• Firmness of the seating surface
• Armrest access
• Trunk posture
• Stability when rising
• Ability to operate powered controls
• Changes in function at different points in the medication cycle

A deeply cushioned seat may make transfer initiation more difficult for someone who already experiences slow or effortful movement.

A powered rise function may be appropriate for some individuals where it supports functional goals, but it should not replace rehabilitation or active movement where these remain clinically appropriate.

Caution may also be required if the person experiences postural hypotension, as sudden changes from sitting to standing can produce dizziness or fainting in some people with Parkinson’s.

Multiple sclerosis

Multiple sclerosis can affect strength, balance, coordination, sensation, fatigue and mobility, with presentation varying considerably between individuals and over time.

For seating, fatigue is often particularly relevant.

A person may be able to maintain an effective upright posture earlier in the day but gradually lose trunk control or begin to slide as fatigue increases.

Assessment may therefore consider:

• Ability to sustain posture over time
• Pelvic stability
• Head and trunk support
• Lower limb positioning
• Ease of repositioning
• Independent use of controls
• Energy conservation
• Fluctuation in function

Powered adjustment can sometimes allow a person to alter their position without expending as much physical effort.

However, greater adjustability is only useful if the individual can understand and operate the controls effectively.

A simpler chair with appropriate dimensions may be more functional than a highly adjustable system that the user cannot manage independently.

Motor neurone disease

Motor neurone disease is progressive and can cause increasing muscle weakness affecting mobility, movement, communication and other functions. NHS guidance notes that people with MND typically require ongoing support from a multidisciplinary team, including Occupational Therapists and physiotherapists.

Seating provision may therefore need to anticipate change rather than responding only to current function.

Considerations may include:

• Progressive loss of trunk control
• Head support
• Upper limb weakness
• Hand function and ability to use a handset
• Fatigue
• Transfer method
• Pressure risk
• Carer handling
• Future equipment compatibility

A chair that works well today may become unsuitable if the person’s function changes significantly.

Where progression is expected, clinicians may need to consider whether the seating can accommodate changing postural support or whether a more specialist system is likely to be required.

The timing of review is therefore particularly important.

Dementia

Dementia can affect memory, judgement, understanding, movement and the ability to carry out familiar tasks. In later stages, some people develop significant mobility limitations and may require increasing assistance.

For seating assessment, cognition can be just as important as physical function.

Consider:

• Can the person understand how the chair moves?
• Can they operate the handset safely?
• Will they repeatedly activate controls unintentionally?
• Does unfamiliar equipment increase anxiety?
• Can they communicate discomfort?
• Are they attempting to stand without assistance?
• Is the chair visually familiar and easy to identify?
• How will carers manage positioning?

A technically sophisticated chair is not automatically the best option.

Where control complexity creates confusion, a simpler mechanism may be safer and easier to use.

For people with more advanced cognitive impairment, seating may need to be considered alongside falls risk, supervision levels, mobility and behavioural presentation rather than as an isolated intervention.

Arthritis and complex musculoskeletal needs

Arthritis can cause pain, stiffness, reduced joint movement and weakness, particularly around the hips, knees, hands and spine.

Seating assessment may focus on:

• Seat height
• Seat depth
• Knee and hip range
• Ease of sit-to-stand
• Armrest design
• Hand function
• Lower limb support
• Back positioning
• Ability to change position

A seat that is too low may demand greater hip and knee flexion during transfers.

Similarly, a very deep chair can make it difficult to achieve effective back support while maintaining foot contact.

Where hand arthritis affects grip or dexterity, handset design and button complexity should also be considered.

At Chiltern Care Chairs, several ranges are available in different sizes and motor configurations, allowing seat dimensions and powered movement to be matched more closely to the user rather than relying on a standard chair size.

Frailty and deconditioning

Frailty, prolonged hospitalisation or general deconditioning can reduce strength, endurance and confidence, even where there is no single neurological diagnosis.

These patients may present with:

• Reduced lower limb strength
• Difficulty initiating transfers
• Fatigue
• Reduced sitting tolerance
• Fear of falling
• Reduced mobility
• Increasing dependence on carers

Appropriate seating may support safer transfers and improve confidence, while complementing wider rehabilitation goals.

A powered rise function can be particularly beneficial for individuals who struggle to stand from a seated position. By providing assistance with the initial effort of standing, a riser recliner can help reduce physical strain and make transfers more manageable. Where appropriate, clinicians can encourage patients to use only the level of assistance they need, allowing them to continue engaging their own muscles and maintaining strength and functional mobility.

As with falls prevention more broadly, seating should form part of a wider multifactorial approach rather than being treated as a standalone intervention.

Pressure risk and prolonged sitting

Pressure risk cuts across many diagnoses.

NICE identifies limited mobility, inability to reposition independently, loss of sensation, cognitive impairment and previous pressure damage among the factors associated with increased pressure-ulcer risk. It also specifically recommends considering seating needs for people who sit for prolonged periods.

Assessment should consider:

• Skin integrity
• Sitting duration
• Sensation
• Ability to weight-shift
• Pelvic position
• Shear
• Cushion specification
• Nutrition
• Continence and moisture
• Repositioning support

A pressure-relieving cushion does not remove the need for repositioning.

NICE recommends individualised repositioning based on assessed risk and the person’s needs, with assistance where the person cannot reposition independently.

Seating prescription should therefore form part of a wider pressure-care plan.

Postural asymmetry

Postural asymmetry is not a diagnosis in itself but is common across a range of neurological and musculoskeletal conditions.

Patterns may include:

• Pelvic obliquity
• Posterior pelvic tilt
• Lateral trunk lean
• Rotation
• Head deviation
• Windswept lower limbs
• Forward sliding

The first question is whether the posture is flexible or fixed.

If an asymmetry can be corrected safely, the seating may be configured to encourage more neutral alignment.

If the posture is fixed, forcing symmetrical positioning may increase discomfort or pressure.

This is where specialist clinical assessment becomes particularly important.

Seating features such as lateral support, alternative backrests or tilt may assist positioning, but their use should follow the clinical objective rather than simply correcting the appearance of the posture.

When tilt-in-space may be relevant

Tilt-in-space changes the orientation of the seat and back together while maintaining the seat-to-back relationship.

It may be considered where the person:

• Cannot reposition independently
• Has reduced trunk control
• Requires greater postural stability
• Tends to slide forwards
• Experiences significant fatigue in upright sitting
• Spends prolonged periods seated

Tilt can also form part of pressure-management strategies, but it should not be treated as a substitute for appropriate repositioning, cushion selection or tissue-viability assessment.

Chiltern’s specialist seating ranges can include additional tilt positioning depending on the model and configuration.

When a riser recliner may be sufficient

Not every person with a complex diagnosis requires highly specialist seating.

A riser recliner may be appropriate where the individual:

• Maintains relatively stable sitting posture
• Can reposition independently
• Primarily needs assistance with transfers
• Benefits from leg elevation
• Can use the controls safely
• Does not require significant lateral or pelvic support

The aim should be to prescribe the least complex seating system that safely meets the identified needs.

Adding more motors, controls and accessories does not automatically improve the clinical outcome.

Measurement remains fundamental

Whatever the diagnosis, the basic dimensions of the chair remain critical.

Assessment should include:

• Seat height
• Seat width
• Seat depth
• Lower leg length
• Armrest height
• Back height
• Foot support
• Head support where required

A chair that is incorrectly sized can undermine otherwise useful specialist features.

An excessively deep seat, for example, may prevent the user from sitting fully against the backrest. An overly wide chair may reduce lateral support and make the armrests less useful during transfers.

Chiltern Care Chairs offers seating with a range of dimensions and configurable support options, which can help translate an HCP’s clinical measurements into an appropriate product specification.

Consider the environment and carers

Complex seating should always be assessed in context.

The home environment may affect:

• Recline clearance
• Transfer space
• Hoist access
• Walking routes
• Position relative to other furniture
• Electrical supply
• Carer access
• Flooring
• Ability to position the chair safely

Carers may also need to understand how and when to use powered functions, particularly where the person cannot operate them independently.

A technically appropriate chair that cannot be used safely within the home is not an effective seating solution.

When to involve other professionals

Seating needs may sit across several disciplines.

Depending on presentation, input may be required from:

• Occupational Therapy
• Physiotherapy
• Tissue viability
• Rehabilitation medicine
• Neurology
• Nursing
• Speech and language therapy
• Dietetics
• Moving and handling specialists

Pressure damage, significant postural deformity, progressive neurological disease, complex transfer requirements or rapidly changing function are all reasons to consider wider multidisciplinary input.

Working with Chiltern Care Chairs

At Chiltern Care Chairs, our role is to support the seating recommendation rather than replace clinical assessment.

We can work from measurements, postural requirements and functional recommendations already identified by the HCP, then help the individual trial seating that reflects those requirements.

Depending on the chair selected, options may include:

• Different seat heights, depths and widths
• Alternative backrest styles
• Single, dual or tri-motor movement
• Powered lumbar adjustment
• Head support
• Lateral cushioning
• Pressure-management seating
• Tilt positioning

Customers can trial chairs at the Chesham showroom or arrange a free home visit where seeing the chair within the person’s usual environment is more useful.

For complex cases, the most effective outcome usually comes from combining the HCP’s clinical assessment with careful product selection and trial.

To discuss a seating requirement or professional referral, contact Chiltern Care Chairs on 01494 793129.