Module 3:
Hands-on assessment

Aim

This module aims to provide clinicians with instructions and practical tips for hands-on client examination as part of a seating and wheeled mobility assessment. It includes instructions on implementing the mechanical assessment tool (MAT), skin checks and a sitting balance assessment.

Rationale

A hands-on assessment is needed to explore, verify and quantify any issues reported by the client or which have become apparent in the course of a thorough initial interview. With an understanding of the relevant medical, psychosocial, functional and environmental needs of the client, a hands-on assessment can confirm the scope of potential interventions with regard to the presentation of the client’s body. Primary elements of the hands-on assessment include the MAT, a skin check, and an assessment of sitting balance.

The MAT is used to:

• Evaluate the flexibility of the client's body and assess flexible or fixed deformities in the supine position
• Assess potential and practical interventions for improving posture and pressure management through simulation in the sitting position
• Investigate the influence of tone and spasm on posture and positioning
• Assess functional and dynamic sitting balance to determine whether postural support is required (functional capability may be affected by postural supports and should also be considered)
• Provide clear records to set seating goals in the set-up of the trial and final seating systems
• Provide clinical reasoning for proposed seating intervention in documentation or reports.

If there is a history of skin breakdown, a skin check should be conducted to assess the client’s current skin integrity and to assist in developing strategies to reduce the risk of the occurrence of future pressure injuries. This will be covered in greater depth as a part of the investigation of pressure management in seating and wheeled mobility, refer to Module 8.

Outcomes

At the end of this module, you will be able to:

• Describe the basic anatomy and bony landmarks of the pelvis and spine
• Understand the rationale for and process of implementing the MAT
• Describe postural abnormalities
• Categorise sitting balance in relation to the level of spinal cord injury
• Know the purpose and process of a skin check
• Apply information obtained from hands-on assessment to establish postural goals
• The mechanical assessment tool (MAT)
• Clinical knowledge required to conduct a MAT
• Level of injury, sitting balance and seating
• Conducting the MAT
  • Assessment in existing seating system
  • Assessment in supine
  • Assessment in sitting
  • Case study
• Recording the MAT
• Interpreting the MAT
• Skin checks
• Common presentations and possible causes due to support surfaces
• Key concepts in this module
• Quiz for Module 3

In this module

• The mechanical assessment tool (MAT)
  • Clinical knowledge required to conduct a MAT
  • Level of injury, sitting balance and seating
• Conducting the MAT
  • Assessment in existing seating system
  • Assessment in supine
  • Assessment in sitting
  • Case study
• Recording the MAT
• Interpreting the MAT
• Skin checks
• Common presentations and possible causes due to support surfaces
• Key concepts in this module
• Quiz for Module 3