Part 1 of this blog highlighted the common questions I’ve received from service users related to custom molded seating. Part 2 will dive into the service provider’s perspective. Below are questions I have commonly received from service providers over the years, as well as my response based on experience.
Isn’t it scary to create something so uniquely custom without being able to see, feel, touch or try the final solution we are making for the individual under our care? What if I just want the supplier to do it?
Many things feel scary when we try them for the first time (or first few times!). It’s perfectly reasonable to feel fear, uncertainty, or apprehension when beginning to work with custom molded seating. The responsibility that comes with how your work impacts the quality and longevity of life for the service users you work with can add to the sense of fear, but over time and with practice this can be one of the most beautiful, rewarding, and impactful aspects of your career.
Like almost all aspects of clinical work, custom molded seating (and the comprehensive hands-on assessment that happens prior) is a skill. It is something that needs to be learned and practiced. It’s something that can improve with intent. The more confident we are with hands-on skills and clinical problem-solving, the less stress and fear we will experience.
During the molding process, it may be helpful to see the molding bags as simulation, since this is the perfect opportunity to see if the overall postural alignment plan is both achievable and tolerated. The wonderful part of this is that due to the nature of the molding bags, it’s not the end of the world to have to start over if there is any doubt. It is better to spend more time ensuring that the alignment and any related function is correct or as desired up front than to realise after the seating is manufactured and finished that it doesn’t work. Pictures from the front, back and sides should be taken with permission following all client protection rules so there is something to compare with at time of delivery.
Remember that the clinician is the knowledge holder - the expert on the anatomical, physiological, and functional details obtained from their thorough hands-on assessment. With confidence in your assessment findings, and clear communication with the seating specialist/molder, we can feel confident in our seating solutions.
I highly recommend that if you are working with individuals with body shape distortion +/- pressure care needs that you follow a standardised process for your hands on evaluations; document using correct language and use measuring best practices. You can see our assessment form here.
Become familiar with your available molded systems. Ask your supplier if they would be willing to do a mold on you so as you can experience how it feels yourself.
Ensure that the seating specialist/supplier/molder understands your clinical findings and client goals and be clear on your role during the molding process. The Team approach will yield better results in my experience.
How do I know who is responsible for what during the molding process?
The skillset and communication of everyone on the team is very important.
During the molding/shape capturing process, the clinician is the holder. In this role, we provide feedback about the alignment of the pelvis, trunk, head, and lower extremities at every step. We are responsible for ensuring that the desired posture is being maintained and not lost from beginning to end.
The seating specialist/molder needs to be skilled with translating clinical findings to seating angles, shape, and orientation, handling the molding/shape capturing bags and transmitting the captured data to the manufacturing team all while observing and listening to how the individual being molded as well as the carer is reacting.
The individual and/or their carer is the most important member of the team, and will have extremely important insights to the process and need to be involved at each step.
What if it’s not done right?
Once the mold is captured and everyone is satisfied, the shape should not change in manufacturing. When the mold is delivered, it is the responsibility of the clinician to check that the postural alignment is as it was during the shape capturing / molding session. This is where the pictures taken during the molding process can be valuable. Particular attention should be paid during the entire process to how this mold will interface with the mobility base, feet support, arm support and head support alignment as well as to how the whole system will work within the individuals environment from a functional and practical perspective
Mid-fits were quite popular at one time where the seating was sent for trial before it was sealed/covered and finalised, therefore offering an opportunity to change anything that was not ideal. As technology has improved and scanned files can be edited by the seating specialist upfront, there are less companies promoting the concept of mid fit as it was realised that it was adding time and cost to final delivery and was often unnecessary. There are however some situations where a mid-fit may still be recommended by the supplier/specialist/molder.
As mentioned above, it is important to spend time ensuring proper alignment and tolerance during the molding process to ensure the mold is done right the first time. If the final product is not the same shape as was captured during the molding process, or if the shape that was captured simply wasn’t in line with assessment findings, it is up to the service providers to make modifications and ensure the individuals needs are being met appropriately.
The associated cost seems very high
Yes, the costs can be high, however we are not talking about purchasing a new bicycle or a new couch. We are talking about investing in an essential postural support/ seating system that will serve as an extension of a person’s human body and allow them to function physically and physiologically while potentially improving or maintaining their quality and longevity of life.
I believe that if off the shelf seating solutions cannot meet the needs of the individuals we are working with based upon a thorough hands-on evaluation, this leaves very little choice other than a bespoke/custom solution. In the absence of this, body shape distortion with consequential possibility for pressure injuries and physiological dysfunction (respiratory and gastrointestinal for example) can by far outweigh the cost of the provision of custom molded seating.
What happens if there is change in body size or shape?
Change is often inevitable whether working with children or with adults. I always ask myself if the changes that will occur as a consequence of NOT getting this custom solution will be less or greater than the changes we can plan for while molding (such as growth, weight gain, etc.).
We should ask each manufacturer of custom molded seating how they plan for change within their seating solutions. Some may suggest a system with liners which can be removed as the child grows. In this case, we must consider where the growth will occur when a liner is removed and if global growth is what we are looking for. Others may offer different solutions for varying amounts of growth and shape change.
It is definitely one of the challenges when making a system unique to the individual body. I would still choose for my loved one to grow while well-supported as opposed to growing without the body structure support needed. We also have to think carefully about how much we really want a system to be changeable and by whom!
Are we not taking away function by giving so much support?
On the contrary - by giving support where needed, we are potentially increasing function. Think about functional reach or respiratory and GI function. We know that sitting can be hard work, and that proximal stability is necessary for distal mobility/function. By giving optimal support based on our hands-on assessment findings, ensuring the individual is immersed and enveloped in both the seat and back support, we are likely to witness facial relaxation, increased O2 saturation levels, deeper inhalation and expiration, reduction in tone in the upper and lower extremities and overall gain in function.
When a full hands-on assessment has not been completed with a postural alignment plan agreed upon beforehand, there is more likelihood of dissatisfaction related to function upon receipt of the seating.
What are the risks for the individuals skin integrity?
The more common risks are related to peak pressure points and/or range of motion limitations that have not been appropriately captured during the shape capturing process as well as heat/moisture build-up.
The sling used for hoisting can create a problem in this regard. As I’m sure you can imagine, immersion and envelopment into the molding bags are negatively impacted when the sling is left in situ on the molding bag. Sometimes it is the lesser of two evils however, as getting the individual out of the captured shape can be difficult and require the use of the sling for safety. The molder who is tuned into this can ensure the sling is accounted for, but this can be challenging and merits a discussion with the molder beforehand. It is important to examine the captured shape for tracks of the sling once the individual has been removed and discuss with the supplier if there is any doubt about the shape that has been captured. The use of all day slings in general with molded seating is a hot topic for discussion and one that I plan on returning to in the near future!
Regarding heat build-up most molded seating systems use foam as a main ingredient, which as we know is an insulator of heat. Manufacturers offer varying cover materials to help mitigate this problem. There is also an excellent solution from WheelAir which is designed to provide airflow through the custom back support to reduce moisture and heat. The clothing and layers of incontinent protection used will also have an influence.
What other questions do service providers have regarding custom molded seating? What would you add to my answers above? We would love to hear from you! Comment below.