Q: Therapists have clients who range in weight and size (short to tall and slight to large), but many of them use a commode seat with a common aperture size. How can this work?
A: In terms of the aperture, the overall height and weight of a client doesn’t matter. The distance between Ischial Tuberosities (IT’s) determines the appropriate aperture because the client’s IT’s should be suspended in the aperture. Adult male IT’s are approximately 4”- 4.5” apart, while women’s are typically 5” – 6.5” apart. An aperture that is 6.5″ wide will work for most adults. While the IT’s are ideally suspended in the aperture, the inferior seated load is borne by the undersurface of the trochanters, a portion of the posterior thigh, the feet and the forearms. In adults this width between the undersurface of the trochanters usually falls in the range of 9-11”. The appropriate fore/aft position of the aperture also needs to be determined. This should be measured while the client’s trunk is in a stable position i.e. how they would sit in a wheelchair. The fore/aft position of the IT’s relative to the back support is affected by several factors, including; the client’s size, sitting posture, and posterior tissue. All of the above underscore the importance of adjustable aperture location, armrest height, back angle, footrest length, and the availability of different seat widths and depths.
Q: What type of client requires a custom seat? Heavy, skinny, tall, short…?
A: Custom seats are designed to meet the specific needs of clients when off-the-shelf offerings aren’t optimal. Wider and/or deeper seats are the most common kinds of customs. Tall clients typically need deeper seats while heavier clients typically require wider seats. Apart from meeting client size requirements, other reasons for custom may include:
- Pressure reduction in high-risk areas – foam height can be reduced, cut-outs made or softer foam can be selectively positioned
- Accommodation of a back frame that is narrower than the seat frame
- Provision of uniquely-shaped and/or -sized aperture
- Extra seat softness
- Higher seat-to-floor heights
- Non-standard openings (location, angle, width) and side cut-outs
- Leg-length discrepancies
- Pelvic obliquities
- Asymmetrical sitting – eg. when the aperture needs to be positioned off center
Q: How does positioning of the aperture impact the client?
A: The position of the aperture in relation to the client’s IT’s is extremely important. For Rehab Shower Commode Chairs (RSCCs) the one-size-fits-all seating approach does not work. For example, the IT’s of heavier individuals may be positioned further forward on the seat compared to a smaller person. Clients who slouch in order to gain better trunk support will be positioning their ITs further forward. In these cases, adjusting the seat so that the aperture is positioned further forward can provide a more optimal fit. In recognition of the importance of proper aperture positioning, we created the Ischial & Pelvic Alignment System (IPAS), which allows up to 2” of fore/aft adjustment or 1” of lateral adjustment of the seat. This means that the aperture can be more optimally positioned for the client’s ITs.
Q: Is it possible to put a Raz-CAT seat on a Raz-SP/Raz-AP or Raz-AT?
A: Yes. Putting a Raz-CAT seat on a standard-size frame would be considered to be custom, at an MSRP of $795.00. In the future, once molded CAT seats are available, we will be able supply them at a lower price.
