Functional movement & specialist seating: Supporting changing needs after brain injury

Independent movement is at the core of dignity and independence. As Action for Brain Injury (ABI) Week 2025 approaches with its theme "On a good day," healthcare professionals are reflecting on how the fluctuating nature and varying presentations of brain injury affects daily function. The theme recognises the unpredictable journey many individuals face - where capabilities can vary dramatically from one day to the next.
 
The challenges of fluctuating day to day function are particularly evident where there is significant impact on physical function and postural control of people with brain injury. Specialist seating solutions come into play for these individuals, playing a crucial role in maintaining comfort, function and dignity across the full spectrum of ability.
 
Managing postural support for individuals with brain injury requires a sophisticated understanding of how physical presentation can vary day to day, and by severity of injury. Clinicians and carers frequently observe that what works well during periods of function and engagement may not be practical during times of increased tone, fatigue, or sensory overload.

The reality of neurological presentation

For many individuals living with brain injury, the phrase "it depends on the day" becomes a familiar refrain when discussing functional abilities. Research highlights the unpredictable nature of motor function following severe traumatic brain injury (sTBI), with studies demonstrating that even years post-injury, individuals exhibit significant alterations in postural control and functional mobility (Arippa et al., 2024).
 
These fluctuations can include substantial shifts in:

• Muscle tone: From hypotonia to hypertonia, often varying within the same day, and within severity of injury

• Postural control: With trunk control and stability particularly affected during challenging periods

• Extensor patterns: Which may emerge suddenly during periods of fatigue or sensory overload

• Core stability: Often diminishing when cognitive demands increase or energy resources are depleted

Assessing these variations through an integrated approach that combines clinical scales with objective measures provides the most comprehensive picture of an individual's needs and informs appropriate seating interventions.
 
The role of dynamic seating systems

Specialist seating systems like the CAPS II represent a significant advancement in addressing these variable presentations. Unlike static seating, which may provide adequate support on "good days" but prove restrictive or uncomfortable during periods of increased muscle tone, dynamic components allow forces to be exerted and released where needed to prevent injury and help maintain posture.
 
1. Accommodating extensor patterns
Dynamic backrest options allow controlled movement when extensor patterns emerge - a common occurrence in many neurological conditions. Rather than fighting against these movements, which can increase discomfort, the system works with them, absorbing force and returning to position when tone normalises.
 
This approach aligns with contemporary understanding of tone management, where the goal is often accommodation rather than restriction, particularly when patterns vary in intensity throughout the day. This also assists with decreasing the risk of injury to the individual in the wheelchair – maintaining good position and posture in the wheelchair, rather than shuffling out of position.
 
2. Maintaining pelvic positioning
A stable pelvic base is fundamental to achieving effective upper body function and head control. Research consistently highlights that good pelvic positioning supports overall posture, balance, and function. This stability can be achieved through a combination of approaches, including appropriately contoured cushions, pelvic positioning belts, sacral support, and knee blockers. 
 
3. Enabling functional engagement
When seating adapts to changing needs, individuals can maintain functional engagement in daily activities regardless of fluctuations in their physical status. This consistency supports not only physical wellbeing but also psychological health by reducing the frustration associated with "bad days" limiting participation. It’s also vital for energy conservation, enabling the individual to engage in activities that are meaningful and important to them.
 
These essential features can be found in specialist seating systems such as the CAPS II, developed by AJM Choice partner, Active Design. The CAPS II system is specifically designed with versatility in mind, to support individuals whose presentation may vary significantly from one day to the next.
 
Clinical application: Supporting day-to-day variations
Dynamic seating systems enables clinicians and carers to implement a "spectrum approach" to support - one that recognises the continuum of needs that may present throughout a typical week:
 
On days with good postural control, dynamic components provide minimal intervention, allowing natural movement while maintaining safety
During periods of moderate fatigue, adjustable supports can be engaged to provide additional stability without restricting functional movement
When significant tone increases occur, dynamic elements absorb forces that might otherwise lead to discomfort or skin integrity issues
 
Importantly, the CAPS II dynamic seating elements can be engaged or disengaged as required. This flexibility is especially valuable for individuals who experience regular fluctuations but want to maintain consistency in their positioning equipment.
 
Functionality through adaptability
Beyond the biomechanical benefits, dynamic seating systems support patient and individual dignity by maintaining comfort and function regardless of day-to-day variations. This consistency is especially important for individuals who already face the challenges of unpredictable physical presentation. When specialist seating adapts to changing needs:

• Discomfort during high-tone episodes is minimised

• Function is preserved even during challenging period

• Independence is supported across the spectrum of "good" and "difficult" day

• Participation in meaningful activities remains possible despite physical fluctuations

For individuals living with the daily unpredictability of brain injury, dynamic and modular seating solutions offer a powerful tool for maintaining consistency through adaptability. By providing systems that respond to changing needs rather than imposing a fixed position, at AJM Choice we support not only physical wellbeing but also functional engagement and dignity. Movement needs might vary daily, but with appropriate specialist seating, comfort, function, and dignity can remain constant - providing certainty in an otherwise uncertain journey of recovery and adaptation.