About Rehab Seating
Rehab Seating Systems (RSS) is a manufacturer of specialty medical seating serving five market segments; orthopedics, bariatrics, patient transportation, multi-purpose chairs, and home rehabilitation. The company office is located in Brookline, MA and the manufacturing facility is in Clinton, MA. The company is privately owned and was incorporated under RSS in 1995 but has been in business since the late 70s under a different name. RSS has chairs placed in over 1,000 hospitals, including many of the most prestigious orthopedic and bariatric programs in the USA.
The Ascender line contains five categories of products. They are,
1. Orthopedic chairs
2. Bariatric chairs
3. Transporter chairs
4. Multi-purpose (MP) chairs
5. Home Rehabilitation (@Home) chairs
All RSS products revolve around a simple core concept i.e. the combination of seat height, a retractable footrest and the E-Z Grip armrests. High seats are important during the post-operative phase of hip replacement surgery. The Ascender orthopedic line comes with a patented retractable footrest that facilitates entry and exit from the chairs (the important Sit-to-Stand Maneuver). Using seat cushions of different thickness and adjustments to the footrest mechanism, the chairs can accommodate a wide range of patient heights. Additionally, the chairs are available in three standard widths to allow patients of various girths and weights to comfortably fit into the chair. RSS is the only company with seating that offers this clinically significant combination of features to serve a wide array of orthopedic, bariatric and other mobility challenged patients.
The Sit to Stand Maneuver
Proper seating includes two distinct steps, each with biometric and ergonomic consequences. They are forward thrust and forward extension, termed 'Sit to Stand'. Each step can profoundly effect the critical joints at the hip, knee and ankle. Click here to view a short film that demonstrates the proper 'Sit to Stand' technique.
Critical measures of a chair's efficacy to facilitate sitting and standing include torque, maximal muscular activity, joint flexion (angles) and center of gravity. Other factors include the subject's age and medical condition.
Different types of chairs can significantly effect the sit to stand task. Seat height, back and arm support, seat slant and cushioning are important factors with seat height perhaps the most important. Standard seat heights are typically in the 15-inch range.
The Ascender line of medical specialty seating addresses each of these factors. Seat heights are adjustable to 23 or 25 inches by simply swapping the seat and back cushions (18 or 20 inches on the MP Chairs). Click here to view a short film demonstrating how to swap the seat cushions. The cushions themselves are firm but comfortable and effectively support the lumbar back. The back is typically shoulder high and has four adjustable positions ranging from 90 to 75 degrees. The lower positions allow post reconstruction hip patients to maintain hip flexion well below 90 degrees.
Seat orientation is horizontal with the floor, or can be optionally positioned at a 10-degree forward slope (standard on the MP Chair). This feature reduces torque and flexion on all critical joints during forward thrust and extension. Click here to view a short film showing the forward slope option. The slightly longer arm supports of the Ascender allow subjects to better manage the momentum transfer that follows the forward thrust during standing. This has the salutary effect of reducing both lower extremity joint torques and hip and knee range of motion needed to rise from the chair. And with the center of gravity firmly established following forward extension, caregivers will avoid the lifting injuries that too often accompany pulling patients into the standing position.
The Transporter model includes most of the features of the standard hip chair, but with a caster wheel system that allows the chair to be used in multiple applications including moving patients in a seat with many more features than a standard wheelchair. The Transporter also includes an IV pole attachment that can be placed on either arm of the chair and an O2 bottle holder. Click here to view a short film demonstrating the Transporter model.
Product Efficacy Example
An internal audit commissioned by Mass General Hospital's Patient Care Improvement Initiative showed that Neurology patients who experience difficulty getting into and out of traditional waiting room furniture due to low seat height were better able to enter and exit a higher seat with little assistance and with more comfort. The study found that approximately 40% of the patients visiting the Neurology practice fell into this category. Nearly all found the higher seat to be a significant benefit while waiting to see the physician.
The Neurology staff placed four Ascender Chairs at different places in the waiting area. The four higher seated chairs comprised one fifth of the total waiting room chairs. The Physical Therapy Dept. at Mass General oversaw the study in conjunction with the practice staff.
With the aging of the baby boomer generation (and the attendant rise in orthopedic, bariatric and arthritis related problems), and the dramatic increase in obesity in the general population it is clear that the chairs that worked well for many years are no longer ergonomically suited for current patient needs. Something as simple as providing a comfortable chair in a common waiting area can significantly add to patient care and satisfaction.
The Seating Universe
At any given time, approximately one quarter to one third of the Earth's population is sitting down. With an estimated world population of 5 billion that's a lot of seats. Regrettably not all seats are chairs, and not all chairs are comfortable and designed for the task at hand. This is particularly true in the hospitals and other healthcare entities that comprise the United States healthcare system.
The US population is growing older and gaining weight. People will be sitting down more frequently. The need for ergonomically designed seating is on the rise, but the awareness of this need has not fully crystallized. How often does one see people in restaurants or public transportation struggling to find and fit into an appropriate seat? In the hospital setting even the most mobility challenged patients are stuffed into narrow, low wheelchairs for transport from their room to the laboratory or operating room. Often the large wheel snags the back tie strings of the patient's 'Johnnie' as entry and egress are attempted. This is the most undignified of circumstances, a category of care that the JCAHO has begun to scrutinize very closely.
Equally compelling are the direct injuries to patients and healthcare professionals who are forced to use chairs that are not ergonomically constructed. According to OSHA and professional nursing organizations, back injury related to improper techniques used to move patients is the most frequent cause of lost time. It is estimated that a nurse has a 50% probability of sustaining a back injury during her/his career and that back injury is the most frequent cause of early retirement from the profession. These facts are consistent with the current shortage of nurses in the US.
Similarly, patients are placed at risk if chairs are used that do not adequately facilitate the sit to stand maneuver. With the patient's center of gravity too high, most standard chairs place undo stress on the lower extremities to effectively complete the maneuver. Two outcomes are likely; the patient falls or the healthcare professional places his/her lower back at risk for a strain or worse. If the patient has recent hip or knee surgery a third possibility arises, dislocation.
Originally designed for post-operative management and rehabilitation of hip and knee joint replacements, The Ascender Seating System has been found to help any person with seating restriction problems. This clinically tested seating system has been scientifically proven in a biomechanical study that was published in the Journal of American Physical Therapy Association, August 1985 titled "Biomechanical Comparison of Rising From Two Types Of chairs" (comparison of Ascender to a standard height chair). Since this study was published, there have been several other studies and research that support the efficacy of the Ascender Seating System. The Ascender Seating System is now viewed as the easiest and most effective method for protecting corrective procedures and preventing patient falls during entry to and exit from a seated position.
The clinically tested design helps patients maintain correct skeletal alignment and proper hip and knee flexion that reduces stress on affected joints, nerve endings, muscles and blood vessels. The Ascender Seating System's patented exclusive features reduce the overall range of motion and ease the transfer from a seating position to ambulation. This in turn gives the patient more independence and less reliance on hospital staff and family members. RSS' product line offers some semblance of normalcy in the midst of a very difficult experience. Their use increases mobility, diminishes pain, and encourages a brighter outlook. They definitely improve the quality of life and advance the patient's psychological well being while speeding up his/her physical rehabilitation.
As mentioned, the largest cause of workman's compensation claims in hospitals is the result of injuries sustained by nurses and staff while lifting patients from a low seating position. This results in lost work time and added staffing costs. A recent study indicated that 12% of nurses were ready to leave the profession because of back pain. The seminar held by the National Association of Orthopedic Nurses entitled "Back Care for the Caregiver" concluded with the recommendation that hospital equipment be designed to protect the nurse when lifting patients. The Ascender Seating System accomplishes that goal.
RSS received two US patents and an FDA 510k clearance to sell its chairs as medical products. The patents cover the core conceptual design of the chairs i.e. adjustable seat heights and retractable footrest that facilitates standing and sitting.
RSS is on the cutting edge of a total paradigm shift in hospital based seating.