Wow, how satisfying my personal experience was to listen to so many engaging speakers, reunite with colleagues from all over the world and feel energized by the common passion we all share!
That passion is 24-hour postural care, pressure care and function for all ages and diagnostic demographics.
Our Posture & Mobility table was hopping to say the least, and that wasn’t just Scott! So many clinicians stopped by to share their thoughts on their own experiences with our training and mentorship programs, whilst others had a curiosity and desire to participate at some point once funding is secured. We were delighted to see many clinicians scan our QR discount codes that were special for the duration of ESS. We left there exhilarated and exhausted!
Although Jenn wasn’t there, she was present very much around us. Between clinicians and manufacturers asking for her and the amazing information pieces she created for us, she was with us every step of the way despite her being in Columbia, South America!
What were the highlights for me?
A palpable overarching message throughout the entire conference and highlighted in varying levels of depth by several top clinicians from around the globe was the theme of “On-time Mobility”, the “F-words in childhood development”, the clear message related to the fact that “Every Child has the right to move” and “Understanding the relationship of developmental-milestones and how self-initiated mobility contributes to development”
There were many excellent presentations related to these listed topics. Some of the speakers I had the privilege of listening to as well as to speaking with, whose passion in combination with credible research and clinical expertise, were Dr. Ginny Paleg, Dr. Teresa Plummer, Dr. Lisa Kenyon, and Dr. Heather Feldner. There may have been others and I apologize if I have omitted anyone.
The takeaway message for me was very clear: “If we are not providing total mobility for young children with disabilities early enough, we are not optimising their potential for participation”
“Waiting until preschool and school age is not serving our children or their families appropriately”
I was so impressed by Rachael Wallach’s (United Kingdom) presentation. Her humorous, yet powerful style of communication really resonated. The title of her presentation was “Disrupt Devices, Disrupt Disability”
I mean, who in this the world of Assistive Technology would not want to listen to a presentation with this title?
One of her statements “Like glasses: wheelchairs should be sexy - changeable for the individual choices and style”. Powerful - right?
We have a way to go in this respect in many parts of the world where getting a suitable wheelchair in the correct configuration can be a challenge, never mind getting it paid for. But I believe 100% that Rachael’s aspirations and messaging is critical food for thought for us all whether we are prescribing or designing wheeled mobility technology.
Another key statement by Rachael was that “The Symbol for disability needs to change, it should not be a device!” And I agree 100%. What are your thoughts?
Her message around Disrupting assumptions ,disrupting manufacturers, & disrupting perceptions Is available in YouTube and well worth watching/listening: Rachael Wallach: Disrupting Disability - YouTubehttps://www.youtube.com › watch
A conversation we seldom hear in clinical practice when conducting seating assessments is that about toilet mechanics, how many continence products the individual is going through in a day and about pelvic surgeries.
I really paid attention during the presentation from Dr. Carina Siracusa, Casey Clarke which was titled, “Custom molded seating and the pelvis: Orthopaedic and Visceral Considerations”
Did you know that the Coccyx has a 30-degree range of motion? I had certainly not remembered this from my University Anatomy!
Carina discussed visceral considerations and the effect of immersion and envelopment on pelvic floor / visceral issues. We were reminded that the pelvic floor is the floor of our core!
She suggested Kegel exercises and deeper breaths as requested tasks to be tried by the individual during their shape capturing process.
We were reminded of the value of the diaphragm as a core muscle and suggested that it is best to have the diaphragm as symmetrical as possible. Alongside this was the reminder that the Pelvis ideally needs stability and symmetry for visceral stability and mobility.
It was great for me to hear her validation of the impact of pelvic- thigh angle on bowel excretion.
It reminded me of the presentations I have done in the past all about “The Other Seat”, aka the commode and/or rehab shower chair and critical clinical considerations related to posture, skin integrity and function. In Carinas words “the Pudendal nerve: S2-4 keeps pee and poop off the floor” and asymmetry of the pelvis can put pressure on the pudendal nerve. This nerve supplies innervation to Puborectalis which stays contracted unless when pooping. It goes from one side of symphysis pubis - wraps around the rectum and back up to the other side of symphysis pubis. For this important function, 110 degrees hip flexion is optimal to allow bowel movement.
Also, the Anococcygeal Raphe attaches the coccyx to external anal sphincter which means the coccyx needs to be free to move in and out of its range for optimal function. A very different conversation than we usually hear at seating/postural care conferences, yet I think there was a lot shared that we should perhaps consider when working with our service users/clients with seating/postural care needs who also may be experiencing bowel and bladder complications.
My takeaway messages were:
1. “When individuals we work with don’t feel stable in their pelvis, they ‘grip’ with their abdominal muscles. The better we do with the pelvis - the better the breathing can be” and...
2. Do we ask enough about toilet mechanics? Do we enquire about how many continence products the individual is going through in a day and do we ask about pelvic surgeries with view to the impact this may have on bowel, bladder, and respiratory functions?
I also listened with interest to Dr Laura Finney speak about the “Application of the Segmental Assessment of Trunk Control (SATCo) to maximise participation in the seated posture”
Laura discussed how we might use the “SATCo” which is a validated and reliable tool to assess a Childs trunk as a multi segmental unit. The Trunk is divided into 7 segments starting at the head. The conclusion I took away was that “Postural support should be tailored to the level of trunk control for each child” and the concept of 360 degree support was advocated based upon objective assessment results.
More can be learned about this Trunk Control Assessment here.
How wonderful it was also for me to catch up with and listen to Jackie Casey share some of her PHD research, “A cross-sectional study identifying risk factors hindering independent wheelchair mobility for children with cerebral palsy”. A true highlight was her sharing that she had just completed her studies and is now Dr. Jackie Casey! Huge Congratulations Jackie!
Another delightful highlight for me was listening to Loes Mulder and Carolien Martens (Netherlands) who have become wonderful colleagues and dare I say friends of mine over the years! The title of their presentation was “Intrathecal Baclofen Pump (ITB) and Seating. What changes after implanting ITB”. This is another topic we don’t hear being talked about frequently when considering 24-hour postural care. Not only did they explain very clearly the impact and related clinical considerations for Intrathecal Baclofen Pumps (ITB) and seating; they presented it in English which in my opinion is no easy accomplishment!!
When their presentation was complete, they also participated in our Posture & Mobility Passport challenge …… and won one of our top daily prizes!
Finally, a presentation by Dr. Sharon Sonenblum titled, “Using technology to explore seated anatomy and its impact on pressure ulcer risk”, was mind opening. For example, the MRI images so beautifully and clearly described demonstrated what really happens under the ischial tuberosities in many of the individuals we may find ourselves working with. The Gluteus Maximus is often not protecting the ischia despite it being quite a logical clinical assumption that it does. I always enjoy listening to Sharon speak. An engineer by background and a principal research scientist at Georgia Tech, USA. Sharon has a fantastic ability to help clinicians understand what’s really going on!
My head was exploding with thoughts and renewed information at the end of each day filled with presentations! Thank goodness I took notes and had a plan for each day! I didn’t make it around the full exhibit hall which was disappointing to myself - Even with a plan!
I did however get to see some newly available as well as some improved seating solutions.
For example, the addition of the Cryo fluid technology from Jay Medical touted as a fluid option available for some of the JAY wheelchair cushions that excels at reducing the risk of pressure injuries. The patented Cryo Fluid provides more options for skin protection according to JAY/Sunrise Medical. It actively cools the seated skin surface for up to 8 hours while evenly distributing pressure, reducing shear, and lowering the risk of moisture.
You can read more about this technology here.
I appreciated a great clinically oriented introduction to a new Adjustable fluid cushion from Ki Mobility which you can read all about here.
One of the cushions I often reference with clinicians is the Medifab, ‘Spex Flex ‘cushion. As one can imagine, I was delighted that this cushion was recognized with an innovation award during ESS: You can read all about the innovation awards here, and the Medifab Spex Flex cushion here.
As you can tell; there was SO MUCH, and overall was a great conference experience for me.
From having our own Posture & Mobility exhibit table where we got to share our continuing professional development, coaching and mentoring opportunities for the first time ever. And to choosing to not be a speaker myself for the first time in over 25 years alongside having my whole family contributing in some way to the planning and execution of this conference participation it was truly beyond my expectations.