Case Study: Katherine

Case study questions

1. Why would you be concerned about pressure management for Katherine?
2. What other questions and investigations would you consider to identify Katharine’s pressure issues in the current seating and wheeled mobility system?
   You are conducting a seating assessment on Katharine and have completed parts 1-4 from the basic MAT form. So far you have noted that:
   • Katherine sat with a 50mm right pelvic obliquity, left pelvis rotation, posterior pelvic tilt, left scoliosis apex at lower thoracic, lateral flexion of the neck toward left.
   • she had good flexibility for neutral alignment in the pelvic tilt, lower extremities and trunk in supine
   • she had significant weight lost last 2 years
   • her seat and cushion width was too wide for her in comparison to body measurement
   • she utilised a single valve low profile air filled cushion
3. What are the pressure management principles in selecting trial products for Katherine?
4. What should you consider as you conduct the trial?
5. Who would you consider consulting about Katherine’s goals and interventions?
6. Why would you be concerned about pressure management for Katherine?

Case study answers

1. Why would you be concerned about pressure management for Katherine?
   • Clients with SCI have neurologically impaired skin
   • Clients with SCI do not automatically weight-shift, due to the absence of sensation
   • Muscular atrophy and weight loss will increase localised pressure on bony prominence
   • Katherine had a stage 3 pressure injury 9 months ago; the prevention of a pressure injury is more difficult

2. What other questions and investigations would you consider to identify Katherine’s pressure issues in the current seating and wheeled mobility system?
   • Katherine’s perceptions on why the pressure injury occurred and management history
   • discuss Katherine’s pressure relief strategies, continence management, skincare and hygiene
   • discuss nutrition and weight issue with Katherine
   • assess Katherine’s ability or technique to weight-shift for pressure management
   • conduct MAT evaluation, skin checks, body measurement in supine, seating and wheelchair evaluation
   • summarise assessment outcomes to identity issues with postural asymmetry and postural instability, the appropriateness of equipment size and shape to the client’s, and the effectiveness of pressure and postural equipment
3. What are the pressure management principles in selecting trial products for Katherine?
   • provide appropriate sizing of the seating and wheel mobility system to reduce postural asymmetry and instability
   • promote a symmetrical posture for even weight distribution
   • assess cushion properties and set up: immersion to maximise pressure distribution and envelopment to reduce localise pressure
   • provide a safe and independent means of effective weight-shift
4. What should you consider as you conduct the trial?
   • correct equipment set up
   • provide education, operating instructions to Katherine, husband and carers
   • diligent skin checks
5. Who would you consider consulting about Katherine’s goals and interventions?
   • Katherine
   • Katherine’s husband
   • Homecare coordinators and key workers
   • Spinal Seating Services
   • Spinal Outpatient Clinics
   • Spinal Pressure or Plastic Clinics
   • Dietician
   • Physiotherapist
   • Occupational therapist, and
   • Suppliers