Module 7 - Postural Interventions
Setting postural goals
A thorough assessment leads to accurate goals; accurate goals lead to successful interventions
There are usually multiple possible reasons and hypotheses to a postural presentation or problems identified in the current seating and wheeled mobility system. The systematic investigations in Modules 2-5 assist clinicians and clients to set clear clinical goals using deductive reasoning.
Keys to goal setting
The client's 'shape' and optimal sitting posture for balance skill and skeletal alignment was identified in Module 3 through flexibility testing and simulation. A review of the MAT outcomes will also assist in setting postural goals.
The client's 'size' was established through body measurement in Module 4 and compared with the existing seating system in Module 5. Review the dimensions recorded on the body measurement form and the seating and wheeled mobility form to identify possible goals related to size.
Review postural goals to see if there are any positive or negative implications to the client's function. Discuss pros and cons with the client and compromises that may be needed.
As an example, a client with T5 SCI presents with posterior pelvic tilt and thoracic kyphosis in his current manual wheelchair. Common causes for posterior pelvic tilt are:
- Fixed posterior pelvic tilt
- Fixed thoracic kyphosis against a planar back support, forcing the pelvis forward
- Shortened hamstrings
- Seat depth too long
- Foot plates too low
- Inadequate postural support leading to compensatory posture to maintain stability and function.
The possible causes are reduced after the systematic seating assessment in Modules 2-5
- Supine MAT: The client has sufficient joint motion in the pelvis, thoracic spine, hip flexion and knee extension for the current wheelchair configuration when compared to the seating and wheelchair evaluation. Possible causes 1-3 are eliminated
- Body measurement, seating and wheelchair dimensions: the client's thigh depth is longer by 1½ inches/40mm than seat depth when the pelvis is well positioned into the wheelchair. The client's lower leg length is well supported by footplates. Possible causes 4 and 5 are eliminated
- Sitting MAT: The client is a hands-dependant sitter. When arms are raised during the sitting MAT, the client falls into a posterior pelvic tilt and thoracic kyphosis. During simulation, the client is able to erect trunk upright when the posterior superior iliac crests are supported. Support around the mid-thoracic area enables the client to maintain lateral trunk stability while extending both his upper limbs for reach. The current wheelchair has a worn-out fabric upholstery.
In this example, the postural goals established are to provide adequate posterior pelvic support to stabilise pelvis and to provide lateral support at mid-thoracic area to maintain trunk alignment for optimal function