Introduction to EPiC Seating

EPiC Seating - the latest product innovation by the Texas headquartered Stealth Products - has entered the UK market. EPiC Seating is a brand new seating system boasting a unique patented design that enables upper body postural variation throughout the day without subsequent loss of pelvic control and positioning. Compatible with a small but growing range of Tilt In Space (TiS) Wheelchairs the EPiC Seating product is retrofittable and works harmoniously with back supports from competitor companies including Jay Seating (Sunrise Medical), Matrx Seating (Invacare), SPEX Seating and Pride Quantum's Tru-Forming back supports to name a few. Read on to learn more about what the system is, how it works, why its needed, the clinical benefits and Cinque Ports Mobility's professional review. 

What is EPiC Seating?

EPiC Seating, seen in the image above, is the collective term for a number of components that, when retrofitted to a compatible TiS wheelchair, transform the standard backrest recline function into an Active and Passively Adjustable Dorsal Segmentation. To help you understand what you can see in the image let's break down each component. 

Firstly, a standard foam pressure cushion can be seen in the lower left. This can be any appropriate pressure cushion that meets the client's pressure risk requirements. At the rear and just above the height of the cushion is a flat sacral pelvic pad which is depth and angle adjustable and mounted to two tubular uprights. This section will be adjusted to the client's pelvic to thigh angle and will maintain pelvic alignment. 

Above the sacral pelvic pad is an ADI Aluminium Active Back Support which is mounted with an approximate 2" gap between the pad and the bottom of the back support. The ADI back is itself mounted to tubular backrest supports via FlipLock Hardware. Above the back support is a Stealth head support mounted directly onto the back support which is depth and angle adjustable. It is important to note that other back supports and head supports can be used other than Stealth Seating in place of the ADI back support and head support. 

Visible behind the back support are black release levers, one per push handle, which operate two gas struts mounted near vertically. These connect the top of the seating system to the bottom part, with a smart non-pivoting connection also in view. When the levers are squeezed simultaneously the entire thoracic part of the system (back support and head support, plus laterals if they were fitted) move in unison in a combined downward and rotational motion. This movement mimics the anatomic movement of the spine and will not create any shear and friction forces between the user and EPiC interface. Keeping the pelvis aligned while introducing dorsal segmentation will cause the centre of mass to shift backwards, accommodate for tone or postural fatigue and lumbar extension, allowing the spine to extend. The dorsal segmentation's maximum achievable angle is 14 degrees from vertical, but when combined with any additional tilt already applied to the base of the chair its possible (technically) to achieve 50 degrees or more relative to horizontal. 

At any point during the active dorsal segmentation adjustment the levers can be released and the back support pins will lock in place to set the range of motion of dorsal segmentation. Using free-hanging pins supplied with each EPiC setup its possible to lock the extent of the movement to any degrees between 2 and the maximum 14. To bring the back support back upright upwards force can be applied to the push handles in combination with squeezing the levels where the rams will assist in returning to a neutral setup. 

We've broken down the 'what' for you but the key question is probably 'why'. Let us dive into this next as we look at pelvic positioning, problems often seen when recline isn't properly utilised, and why this system changes everything. 

Why is EPiC seating different and what benefits does it bring?

Understanding the benefits of something new is best understood by looking at what problems it was designed to solve. Many wheelchairs such as the Invacare Rea Azalea or the Sunrise Medical Ibis (two of our most commonly prescribed TiS wheelchairs) come with a reclining back support function. With these the entire back support reclines, which leaves the pelvis unsupported when recline is introduced. The pelvis can then rotate backwards and so when the recline is moved back to vertical shear, friction and sliding will occur. While it is possible to disable this feature it is often left activated so that caregivers can recline the back (also referred to as 'opening the hip angle') either at the clients request or for activities such as personal care or to aid with hoisting. 

When a standard back support is reclined a chain of events can occur that ultimately leave the client sitting incorrectly and therefore at increased risk of ulceration and general discomfort, alongside losing function and needing to try to reposition themselves. This chain of events begins as soon as the back support begins to recline due to a non-anatomically accurate pivot location on the wheelchair. 

Wheelchair back supports pivot around the bolt that joints the backrest canes to the base chassis, typically many inches lower and aft of the client's own point of pivot which is at their hips (specifically the top of the greater trochanters). This causes the back support to shear against the clients back as the recline motion occurs which can cause a ruffling of clothing, damage to skin and pain if wounds are present in the contact areas. 

Once the reclining motion has stopped the client will likely lean forward to remove the shear force that may still be acting on their skin, and to allow their clothing to reposition to avoid uncomfortable folds or creases. Now that the hip angle has been opened the force of gravity acting on the body begins to encourage the client to slide on their cushion. This in itself creates a shear force and in a similar fashion to the back, the client can now experience discomfort, pain and a desire to reposition themselves often. Each time the client repositions themselves while in any level of recline it increases the chances that posterior pelvic tilt can occur.

Assuming the client has been reclined and returned to upright a couple of times while in the wheelchair it is now highly likely the original location the client started on the cushion will have changed, and that a sacral sitting position will be observable. Sacral sitting is referred to as 'a poor seated posture with a posterior pelvic tilt and thoracic kyphosis' by the National Institute of Health and it is generally accepted that this posture increases the risk of skin breakdown, pressure ulceration formation and loss of function. 

How does EPiC Seating solve this problem?

EPiC Seating is able to overcome this problem by relocating the pivot point that the back support moves about. This small change, in tandem with a non-moving sacral pad, ensures that even when the active and passively adjustable dorsal segmentation is moved to its maximum and returned to neutral repeatedly, the clients pelvis will not have entered into any level of tilt. No shearing. No discomfort. No repositioning needed. No wonder Stealth Products refer to this as Effortless Postural Control. Positioning now becomes very easy: a simple lever will bring postural variation and adjustments with lumbar extension, no tools needed!

This may sound too good to be true and you may be wanting to trial this system for yourself and/ or trial it with a client you are working with. If this sounds like you please give us a call on 01303 850760 or fill in our contact form and we can arrange a time to demonstrate it for you, completely free of charge. 

The Clinical Benefits of EPiC Seating

As we've explored above, the key benefit of the EPiC Seating system is that the dorsal segmentation action can be used throughout the day without increasing the risk to the client of pelvic misalignment. Dorsal segmentation, while keeping the pelvis correctly supported, can offer numerous benefits to clients with a broad spectrum of needs. These include aiding in respiration, digestion, peer engagement, fatigue management, personal comfort including the ability to stretch (lumbar extension) and many more. 

For us at Cinque Ports this is a bit of a game changer, especially for clients undergoing complex rehab or who already rely on specialist seating systems to manage their posture. We're really excited to be able to introduce this new product to various NHS and Private Occupational Therapists and Physiotherapists in Kent and East Sussex.