Module 3 - Hands-on Assessment
Conducting MAT
The pelvis is the ‘foundation stone’ in sitting as it supports the person’s body weight above it. Its positioning and stability affect the alignment of the head, trunk, upper and lower extremities. Asymmetrical pelvic alignment often results in a higher risk of pressure ulcer development. Thus, the pelvis is usually assessed first in the MAT.
The MAT is usually conducted in 3 stages.
1. Assessment in the existing seating system
- An initial postural assessment is recorded, including photos. The process should include assessment of:
- Pelvic tilt ( whether it is in neutral, posterior, or anterior tilt)
- Pelvic obliquity ( whether it is level, left side or right side lowered and by how much)
- Pelvic rotation ( whether one ASIS is more forward that another)
- Spinal curves (if there is exaggerated lordosis and kyphosis at the neck, thorax and lumbar areas)
- Symmetry in the trunk (the sternum or spinal process are perpendicular to ASIS or PSIS with no lateral deviation/scoliosis, and the shoulders are level)
- Trunk rotation: ( whether the shoulder and the pelvis are horizontally rotated against each other)
- Symmetry in head and neck position (this is often driven by visual field alignment)
- Upper and lower extremities are positioned and supported to facilitate neutral alignment of the spine and pelvis
- Note how this posture influences pressure distribution
- Note how the seating system impacts on current posture
2. Assessment in supine (See video "Supine MAT Assessment" )
- Provides gravity-eliminated information
- Assessment is conducted on a firm surface such as a plinth
- A PVC transfer board on a soft bed can be used for a short duration. Remove as soon as possible once assessment is completed to minimise risk of pressure ulcer development
- Clients who have open pressure ulcers in contact with supine support surface should not be placed on a hard support surface. Supine assessment only commences when wounds are healed
- Assess and monitor client’s risk for dysreflexia
- Urinary catheter should be emptied prior to assessment. Ensure the catheter tube is not pulled or blocked while performing lower limb flexibility assessment
3. Assessment in sitting (See video "Sitting MAT Assessment")
- Gravity may change active movement potential and joint flexibility
- Assessment should be conducted on a firm surface such as a plinth or firm chair. Feet should be supported on the floor or a foot block
- For clients who are ‘hand-dependent sitters’, manual assistance to support the pelvis and trunk may be needed in the assessment (assistance from another clinician may be helpful)
- Sitting assessment may not be feasible for some clients who are ‘propped sitters’ and may require two skilled clinicians or a firm sitting chair
- Clients who have sitting-acquired pressure ulcers should not sit on firm surface. Sitting assessment can commence only when the wounds are healed
- It is particularly important to note spasm patterns or reflexes in sitting
- By comparing joint flexibility and range of motion taken in supine assessment to sitting assessment, simulation tasks can be conducted in sitting to improve skeletal alignment. Generally, one should aim to:
- Correct a flexible posture towards neutral
- Accommodate a fixed deformity
- Partially flexible means partially able to be corrected and partially able to be accommodated.
(See postural intervention in Module 7 for more details)
- For example:
- In supine, the client has a neutral pelvic tilt with a flexible left pelvic obliquity and a flexible scoliosis apex on the left side at thoracic spine T8 level
- In sitting assessment, client uses his arms for support and sits with posterior pelvic tilt, exaggerated left obliquity and scoliosis to maintain balance
- Simulation tasks may include:
- placing a foam build-up under the left side of the pelvis to check if the pelvic obliquity is correctable and reduces scoliosis
- providing a posterior support with the clinician’s hands behind PSIS to reduce posterior pelvic tilt. Assess if there is an improvement in posture and balance with adjustment to posterior support
- providing a posterior and lateral support by using the clinician’s hands at the apex of the scoliosis if required
- Never simulate beyond the range of motion established in the supine assessment
- A mirror is useful for both clinician and client to view the sitting assessment and the impact of the simulation task