The Clinical Foundations Therapists Shouldn’t Skip!
If you are new to prescribing seating and find the process overwhelming or are not sure how to connect your MAT Assessment findings to the intervention, I want to share some thoughts and propose some questions to you. I have observed a trend recently where modular backrests and cushions are being prescribed, to “future proof” as much as possible. I know that as a young therapist, I did this on an occasion. However, when we do this, we are adding weight, potentially reducing function, and ultimately missing the key foundations of seating. One thing I know to be true is that good outcomes come from getting the foundations right. If you get the foundations right, everything else will follow.
Whilst I initially wanted to keep this as a single blog, make sure you read both Part 1 and Part 2. Even simple seating has several key points and questions to clinically reason and work through. I hope that the below questions and perspectives are useful and practical when you are next reviewing or prescribing seating. As always, if you are not sure, please do not hesitate to reach out.It is essential to look at the entire picture during a MAT Assessment and not have tunnel vision on one element. Ultimately, the person needs to be comfortable and functional, or they will return to their old seating.
Posture Is a Symptom, Not the Problem
What you see in front of you - obliquity, rotation, leaning, sliding - is the body’s solution to a deeper issue[BG1] . These compensations emerge because the user is trying to solve a problem we haven’t addressed yet, such as:
When we treat the posture alone, we chase problems. When we treat the cause, posture often improves with minimal force. Before you adjust a lateral or a headrest, look closely at what is causing the actual problem. You might be surprised.
Clinical takeaway: Before you correct anything, ask: “What and why is the body working so hard to stabilise?”
Pelvic Stability Is the Non‑Negotiable Starting Point
Every therapist knows the pelvis matters, but in practice, it’s often overshadowed by more visible postural challenges. If you are not sure of what you are seeing or feeling, come back to the pelvis and re-evaluate. I personally find that locating the ASIS and asking myself “what am I seeing, what am I feeling and what is the cause” helps to minimise the extra noise and questions you may have. It keeps you focused on the foundation.
A well‑supported pelvis gives the user:
If pelvic stability is missing, nothing above it will stay consistent.
Clinical takeaway
If you’re adjusting headrests, thoracic pads, or knees before the pelvis, you’re working in reverse. The pelvis is the foundation.
You now have the first steps in your wheelchair seating foundations. To continue with your intervention and the key clinical foundations of wheelchair seating, keep reading in Part 2.
Tilly Brook, MOccThy (Hons) (OT)
Director Clinical Services
Tilly Brook graduated from the University of Adelaide in 2008 with a Bachelor of Health Science followed by a Masters of Occupational Therapy (Hons) in 2010 from the University of Sydney. Tilly worked within rehabilitation, working primarily with adults with a brain injury until 2015 when she moved to Singapore. In Singapore, she worked with children and adults at the Cerebral Palsy Alliance School (CPAS). In 2017 Tilly’s clinical knowledge continued as she worked with Mobility Solutions in Auckland, New Zealand. On her return to Australia, Tilly assisted in the development of the Clinical Hub Team at Sunrise Medical where her passion and experience for mentoring and educating therapists grew. Tilly Joined Permobil in January 2022 and is driven to grow therapists, enabling them to be the best therapist they can be.