Guidelines for Functional Use of the Rifton Activity Chair

Introduction

The Rifton Activity Chair accommodates most individuals with special needs, with its wide variety of chair features and accessory options. It is a positioning chair intended for classroom and home use enabling its users to learn functional sitting skills while actively participating in activities, tasks, and routines.

A functional sitting position (rather than restrictive seated positioning to retain symmetry and limit tone) means that a client can actively use and develop his or her own core muscles and improve their own postural motor skill, allowing the caregiver to further reduce accessory support over time.

Chair size

The Rifton Activity Chair is now available in Small, Medium and Large sizes, each with the option of either a Standard or Hi/Lo base.

The user’s overall height and weight is a general guide to decision making. Make sure that seat width, depth, and height adjustability are adequate for each user: Rifton Activity Chair dimensions

Frame base options (Standard, Hi/Lo) and seat height

Standard Base: The Standard base offers short or long legs, with adjustability of a 4 inch range. Leg options include with or without lock-in-place casters. The floor-to-seat height varies with the different leg choices. (See section on Footboard to compare to the footboard-to-seat height.)

Highest floor-to-seat settings (in inches):

• Short legs (16.5)
• Short legs with casters (20)
• Long legs (23)
• Long legs with casters (also 23)

Note: One of the legs with casters comes with a swivel lock — this leg should be placed on the right rear corner. The swivel lock keeps the chair from drifting sideways when it is being pushed forward. (Figure 1)

Hi/Lo Base: The Hi/Lo base offers a quick and easy seat height range from a 12–inch low to a 23–inch high. The foot pedal located at the rear of chair will raise and lower the chair seat. To raise seat, pump downward repeatedly on foot pedal until desired height is achieved. To lower seat, place foot under the foot pedal and lift to release the red safety lock, then continue to lift the foot pedal upwards with your foot. Stop when seat has descended to the desired height.

Chair options and features

Spring Option
Spring option allows user-initiated movement, allowing the chair to “bounce.” This can offer a self-calming effect for individuals with autism, as well as “give” in the backrest for those with extreme extensor tone. The chair can be ordered with spring or without spring.

The Standard base has a choice of spring with backrest and/or spring with seat tilt-in-space. (Figure 2) The Hi/Lo base only offers a backrest spring.

To determine whether spring is locked or unlocked, press firmly against backrest (or Standard seat). If it “gives,” the spring is unlocked. If it does not “give,” the spring is locked.

To activate the spring, turn white lock handle located on spring column (behind backrest or under Standard seat) to “unlock” position (Figure 3). To deactivate spring, turn lock handle back to “lock” position.

Note: The Spring option enables about 10° range of movement. Thus, angle adjustment of backrest or seat will be more limited when spring option has been ordered with your chair (Figure 4).

Locked Options on Backrest
There are two locked (non-dynamic) positions on the backrest gas spring. When locked, each position provides 15˚ of angle adjustment using the backrest angle lever.

Activity mode (-10˚ to +5˚): To lock the backrest in the upright or forward position for activities, turn the twist-lock collar to the right until it locks. With the angle lever, adjust the backrest angle forward or back 15˚. Note: When locking the backrest spring option, it may be necessary to move backrest forward or back to enable twist-lock collar to slip into position. (Figures 5 & 6)

Relax mode (-20˚ to -5˚): To position and lock the backrest for reclined resting, unlock the white twist-lock collar. Push down and back on the top of the backrest (not on the headrest) until the groove around the movable gas cylinder almost retracts into the outside cylinder. While still holding the backrest down, turn the white twist-lock collar to the right until it locks. This function is easier to perform with your client in the chair. Once locked, adjust the angle of the backrest forward or back 15˚ using the angle lever. (Figures 7 & 8)

Locked Option on Seat

The seat spring (on Standard base models only) also has two locked (non-dynamic) positions, each providing 15˚ of adjustment using the tilt-in-space lever.

For extra seat recline (Standard base only): If the seat has a gas spring (under the seat) it will also have the two locked positions allowing an extra 15˚ of recline from tilt-in-space. To unlock the seat spring, rotate the twist-lock collar under the seat counter-clockwise. Turn it clockwise to lock it and then use the tilt-in-space lever to make final adjustments.

Tilt–in–Space
Tilt-in-Space is built-in on both chair bases. It moves the entire seat and backrest from an active, forward, functional sitting position to a reclined, rest position and vice versa, maintaining the seat-to-back angle throughout. The Hi/Lo base offers backward tilt-in-space to 25° and forward to 15°. The Standard base offers backward to 15° and forward to 15°.

(Note: with the optional seat spring on the Standard base, the available tilt range is altered.)

To adjust the tilt-in-space angle, place one hand on a push handle or on top of backrest. With the other hand, simultaneously squeeze tilt lever and safety lock (Figure 9). There is an angle indicator on the side of the chair for consistent positioning and documentation purposes.

Backrest Adjust / Backrest Filler Pad
Backrest angle and height adjust easily with one-hand levers, while the client is in the chair.

Backrest angle is adjusted by squeezing the white backrest angle lever and moving backrest forward or backward. (Figure 10) On both chair styles, the backrest adjusts 5° forward and 20° back. There is an angle indicator for consistent positioning and documentation purposes.

(Note: with the optional backrest spring, the available backrest tilt range is altered.)

Backrest height is adjusted by depressing the backrest height lever and raising or lowering the backrest. (Figure 11) The height from the top of the backrest to the seat offers six positions, ranging from 15.5 inches up to 19 inches.

Backrest filler pad can be used for additional lower back support when the chair backrest is in the top 3 positions, which results in an open space between bottom edge of the backrest and the seat. The filler pad snaps easily into place on a snap stud centered at rear bottom edge of backrest.

Pads
Pads for backrest and for seat snap onto studs on the backrest and seat edges. Color options: red, tan, and blue.

Posture Support: Lumbar and Seat Support Kit
Lumbar and seat support kit provides extra postural support. The lumbar piece is placed behind the backrest pad for additional low-back support, and the seat support is placed under the seat pad toward the front to help prevent the user from sliding forward. (Figure 12)

To install custom lumbar and seat support, remove seat and backrest pads, then cut or trim support padding and affix to seat or backrest with hook-and-loop strips. Replace seat and backrest pads when finished.

Seat Depth
Seat Depth is adjusted by using two fingers to pull the white handle located below the seat. (Figure 13) Move seat forward or backward to desired position and release the handle. Make sure seat clicks into place. Seat depth range: 11–16 inches.

Push Handles
Push Handles provide an easy and ergonomic way for the caregiver to maneuver the chair and transport the user. (Figure 14) There is a left and right push handle, so each handle will only fit into the correct side of the chair. To install, depress the snap button at the bottom of the handle and insert it into one of the extrusions at the rear of the backrest. To adjust height, depress the snap button (you may have to temporarily move other prompts) and slide the handle up or down until the desired height is reached, then click into place.

Accessories

Accessories are used to optimize position for participation and function. By using only those accessories needed to support an active functional sitting position, the seated client can freely use head and upper extremities to accomplish a task.

For example, to achieve active, functional sitting, you may start with a well-stabilized pelvis in a slightly anterior seat tilt, and offer a surface such as forearm prompts or tray for the client’s arms to assist postural control. With this support, the accessories for the lower extremities and upper body can be minimized where possible. Since active, functional sitting requires co-activation of core postural muscles during tasks, this position will result in fatigue. Be ready to offer rest periods as needed with the tilt-in-space feature of the chair.

Head, Trunk, and Upper Extremity Accessories

Headrests

Flat headrest and Contoured headrest options are available.

To install and adjust height of headrest, depress the white button at the top back of the chair. Insert the metal headrest bar, then raise or lower it to the desired position, clicking it into place. Headrest height above seat level ranges from 17.5 to 24.5 inches.

Depth and angle of headrest can be adjusted as well. Loosen both black knobs, move headrest to desired position and re-tighten both knobs securely. (Figure 15)

Trunk Supports

Lateral supports provide comfortable side-to-side support for the user, and are fully adjustable in height, width, and angle. Each lateral adjusts independently of the other. To install and/or adjust the lateral support, loosen the black knob, insert the piece into the extrusion behind the backrest, and adjust height, angle, and width to fit the user. (Figure 16) When desired adjustment is reached, tighten the knob firmly. Lateral supports can be purchased either with or without chest strap.

Chest strap with lateral supports can provide anterior support. (Figure 17) To use the chest strap designed for use with lateral supports, thread the loop at either end of the strap over the knob and key assembly of the lateral supports with the chest strap buckle faced outwards. Loops can be threaded so that the chest strap encompasses the lateral supports, or so that it straps on the inside of the lateral supports.

Wide chest strap is a stand-alone chest strap. It is another option for chest strap that is not used with the lateral supports. (Figure 18) To install and adjust the wide chest strap, loosen black knobs at both ends of the strap and insert the keys into the extrusions behind the backrest. Slide knobs up or down until the desired height is achieved, then tighten firmly.

Butterfly harness provides anterior support while allowing freedom of movement. (Figure 19) To install, insert L-shaped metal clips at the ends of lower harness straps into clip slots at either side of the seat. To insert or remove, use a pen or key to depress the small white button and pull upwards to disengage the clip. Butterfly harness has four buckles to completely detach the harness pad. To use, transfer the client into the chair, place the harness pad on the user’s chest, secure all four buckles, and adjust straps as necessary.

The butterfly harness can be clipped into either set of small slots at the sides of the chair. Use the other set of clip slots for the seatbelt or pelvic harness. ALWAYS use a seatbelt or pelvic harness. Absence of a seatbelt or pelvic harness may result in falls and may pose a strangulation hazard when a chest strap, butterfly harness, or tray is in use.

Arm Supports, Tray and Handhold

Armrests come in left and right pairs and insert into large slots at either side of the seat. (Figure 20) Depress the white button just below the armrest slot, insert armrest, move it up or down to required height, and click into place. To remove (e.g., for transfer), depress the white button and pull upward.

Armrests can be set at a range of forward and backward angles, from horizontal up to 60° (up or down). To set angle, lift the white tab below the outer edge of the armrest and rotate to the desired angle.

When the tray is in use, the armrest adjustment will set the angle of the tray. (Note: Flat edge of armrests should be forward.)

Forearm prompts adjust fully to facilitate trunk and head control while sitting. (Figure 21) Forearm prompts come in left and right pairs. The support bar is inserted into the large slots at either side of the seat, using the same white button and slot as for the armrests.

Forearm prompts are very versatile and adjustable. They can be used for both arms or for one arm at a time. The prompts are attached to the support bar using a clamp and post system and can be mounted on the inside or outside of the bar, at the desired fore-aft distance from the client.

Insert the post into the clamp to the desired height. The forearm prompts can be mounted to the post in several positions to achieve the best position for the user. Forearm prompts are identical to arm prompts used on the Rifton Pacer. Adjust the forearm prompts to the best position for comfort and function.

Tray provides a firm surface for seated activities such as eating and art, and adjusts in height, angle, and depth. A softly-rounded rim contains spills. Tray only attaches to armrests, not forearm prompts. To install, set both armrests to the same height and angle. Pull the black handle on the bottom front of the tray and slide onto the armrests. To adjust depth, pull the handle to slide the tray forward or back and click into place. Adjust tray height and angle by adjusting armrest height and angle with the tray attached.

Handhold can be attached anywhere along the rim of the tray to provide additional support and security. To install and adjust, loosen the large oval knob on the handhold, slide it along the tray until the desired position is reached, then tighten securely.

Pelvis and Lower Extremity Accessories

Pelvic harness is an alternative to the more typical seatbelt. It gives a very stable base for developing sitting postural control. The pelvic harness firmly positions the user’s pelvis by securing hips and upper thighs, without placing pressure on the abdomen.

To install, place it on the seat with the wide ends toward the back. The short straps at the back corners have L-shaped metal clips — insert these into slots at either side of the seat. The buckles at the front narrow ends will be pulled around the user’s upper thighs and fastened at the rear; then adjust strap lengths for best fit. (Figures 22 & 23)

Pelvic harness is inserted and removed by using a pen or key to depress the small white button just below the clip slot. There are two clip-slot options at the side of the chair. Consider seat depth required and select the slot that allows best use of the pelvic harness.

Seatbelt comes with every chair. ALWAYS use a seatbelt or pelvic harness. Absence of either may result in falls and may pose a strangulation hazard when a chest strap, butterfly harness, or tray is in use. The seatbelt can be clipped into either set of small slots at the sides of the chair and is inserted/removed by depressing the small white button just below the clip slot.

Adduction: Hip Guides / Thigh Belt / Adductors

Hip guides provide additional lateral support to the user’s hips and can be adjusted for seat width. Seat width without hip guides is 14 inches. With hip guides, width ranges from 8.5 to 11.5 inches (both installed). Hip guides clip to arm supports and can be removed with the arm supports for transfers. They can be used with both armrests and forearm prompts.

To install, remove arm supports and thread the hip guides onto the arm support posts, then place arm supports back into the slots. To adjust width, depress the white button and move either hip guide in or out, clicking into place at the desired setting. (Figure 24)

Thigh belt provides additional support and security for the user’s thighs and helps adduct the knees. (Figure 25) To install, unsnap and lift up the front of the seat pad to access the H-slot under the seat pad. The metal slide will be on top and (by pinching the belt and pushing it through the H-slot) the belt looping will be under the H-slot to hold the position beneath the seat pad. Buckle across the client’s lap and adjust strap length via the adjusters on either side of the center buckle. The thigh belt will move forward with the seat if seat depth is adjusted.

Adductors can be used to limit lateral movement of the user’s knees and provide a comfortable lateral boundary. To install, depress the white buttons below the front corners of the seat and insert metal posts into the slots located on the seat sides at the front corners, with pads toward the seat. To remove, depress the buttons and pull the adductors out. (Figure 26)

Abduction: Abductor / Leg Prompts

Abductor keeps the user’s knees comfortably apart. Before installing, remove leg prompts (if present). To install, reach below the slot and depress the white abductor button. Insert the abductor post into the slot centered directly beneath the front of the seat. Adjust depth by depressing the white button and pulling the abductor forward or back; release to lock.

Leg prompts can be used in place of the abductor and provide both abduction and adduction. Before installing, remove the abductor (if present). Insert the leg prompt post into the slot centered directly beneath the front of the seat. Adjust depth by depressing the leg prompt button and pulling forward or back. To adjust width, depress the white width buttons on the housing behind the straps, move prompts closer or farther apart, then release to click into place. Secure the user’s legs with the straps.

Footboard and Foot Placement: Ankle Straps / Sandals & Wedges

Footboard is optional with the Standard base (Figure 27) and can be removed with a wrench. It is required on the Hi/Lo base and comes installed.

Footboard height may need to be adjusted for various users. The footboard-to-seat height ranges from 12–16.5 inches. The footboard can support weight during transfers and can be swung beneath the seat for transfers. It serves as a base for ankle straps, sandals, and wedges.

Ankle straps are used on the footboard to secure the user’s feet while providing a bounded range of movement (Figure 28). To install, place the black plastic clip at the end of the strap beneath the T-slot at the rear of the footrest and pull the strap firmly upward through the slot to secure the clip in the T-slot. Adjust straps as needed. Note: Sandals cannot be used together with ankle straps.

Sandals can be used with the footboard to provide more secure positioning of the user’s feet. Place the sandal base on the footboard and position it above one of the pairs of screw threads embedded in the footboard. Use the black knobs to secure the base, tighten halfway first, slide to position, then tighten firmly. Latch sandals onto bases using the white levers.

Wedges can be added beneath sandals for custom tilt and/or height. To install, pull back the white lever at the side of the sandal to free it from the base. Wedges may be used either way around and can be stacked. Secure the user’s feet using the sandal straps.

Progression of Functional Sitting: Accessory Support Reduction

Lack of head and trunk control is a primary reason that individuals with physical challenges are unable to sit independently. Leaning back even slightly, as in the typical wheelchair or a passively positioned seated posture, actually prevents the possibility of improving and developing head and trunk control.

Functional sitting requires learning how to maintain the shoulder girdle over the stabilized pelvic girdle, and to bring the upper body back to this balanced position after moving out of midline to complete a task. Use of forearm prompts can provide upper-extremity weight-bearing assist and support, with which a client can then learn head and trunk control.

The active/functional sitting posture can be viewed as similar to the preparatory posture in the sit-to-stand transfer. The pelvis tilts anteriorly, the shoulder girdle is placed in front of the pelvis, and this position transfers body weight forward over the legs. Stabilized in this position, the core muscles are challenged and the shoulder girdle can be mobile to accomplish tasks.

Functional sitting for clients with physical disabilities requires co-activation of core muscles that may be quite weak and that fatigue with use. Early learners need many opportunities to sit actively for short periods of time, for dynamic sitting practice incorporated into meaningful activities. The tilt-in-space feature allows rest periods between activity-based learning opportunities.

Each person is unique in terms of fluctuations of tone, presence of spasticity, and the strength and motor control of their trunk and extremities. However, the following example shows consideration of supports and removal of supports in one sample instance.

Initially, the client needs a well-stabilized pelvis (pelvic harness or seatbelt). Consider slight anterior tilt of the seat, plus support at the trunk (e.g., laterals with chest strap and forearm prompts) and a headrest. The client needs lower-extremity support as well (e.g., leg prompts and sandals).

As leg control improves, leg prompts can be removed. Next, the headrest can be removed. The chest support can be loosened, lowered, and finally removed as well, leaving the pelvic harness and use of forearm prompts in place. Note: As peripheral trunk support is lessened, the individual may still require some foot placement or control (such as ankle straps) to help prevent sliding into posterior tilt or sacral sitting, until improved control allows foot support to be fully removed.

Depending on the client’s progression of pelvic stability and/or trunk stabilizing abilities, either the pelvic stabilizer or the forearm prompts will be the next supports removed. By using just one or the other of the forearm prompts at different times (and/or alternating use with the stand-alone chest strap, for example), core stabilization of the trunk can further improve. (Positioning the chair near a table and using a Rifton Anchor is another way to offer this later-stage trunk-stabilization opportunity.)

As trunk control and independent sitting improves, the final support to be removed may be the seatbelt. Transitioning to a regular classroom chair or bench is another way to both challenge practice and ultimately generalize the client’s active sitting skill.

Incorporating sit-to-stand practice into classroom transitions is another way to progress head and trunk control. By slightly elevating the seat and giving it a forward tilt, the sit-to-stand transfer practice can be made easier for the early learner. Close attention to the seat-to-floor height—perhaps removing the footrest or swinging it back under the seat—can assure ongoing practice opportunity of sit-to-stand transfers, with the client’s feet having direct access to the floor. The chair’s forearm prompt or armrest can easily be removed during transfers as needed.

Please note: This article does not replace the direct personal advice of a medical professional. Correct use of the Rifton Activity Chair requires the ongoing guidance of a qualified therapist.

Source material:

Bidabe L. (2003) Mobility Opportunities Via Education. A curriculum written to serve children and adults with severe disabilities. 7th printing. Bakersfield: Kern County Superintendent of Schools. Available: www.move-international.org

Kangas, Karen M. Seating for Task Performance. Instructional Session. 18th International Seating Symposium 2002. Accessed March 2010.