Module 7 - Postural Interventions
Key principles to postural interventions (cont.)
2. Provide adequate postural support and positioning for the shape and the size of the client
Body shape
- Correct a flexible posture towards neutral, accommodate a fixed deformity to slow progression of the deformity, partially correct and partially accommodate for partially flexible deformity. Never correct posture beyond the range of motion established in the supine assessment
- Match the sitting 'angles' in MAT evaluation to the seating system configuration to maximise postural alignment, stability and balance
- note the point of support for balance during the sitting simulation
- consider the angles within the spinal curves, as the degree of supports for lordosis and kyphosis influence the sitting angles
- thigh to trunk angle translating to seat support to back support angle
- Configure or contour the seating system to compensate for body mass distribution/body build. For example:
- Some males have significantly broader trunk and shoulders than hips, in which case a wheelchair frame to accommodate a wider trunk may be required. Hips guide or contour cushion can assist to centre the pelvis
- A bariatric client has more tissue bulk behind the pelvis which forces the pelvis forward against a planar back support. Seating system aims to support pelvis at the posterior superior iliac crest and yet allow room for excess tissue to recess behind the support. Consider a bi-angular back support or a customised back cane with PSIS support.
- Positioning equipment has varying degrees of customisation for postural management:
- Primary support:
- Seat support/cushion: design features may include ischial well, modular or compartmental segments for corrections or accommodations for pelvic tilt, obliquity or rotation. Pelvis and thigh stabilising accessories may be optional
- Back support/backrest designs can be described as planar, bi-angular, segmented and custom contour. Many back supports have additional features to allow customisations: seat depth adjustment, seat to back angle adjustment, PSIS support, built-in or additional thoracic lateral supports. When selecting a back support to meet the client's needs, consider the effectiveness of the PSIS support and adjustment for lumbar and kyphotic curves, the height of posterior support required, the mounting position and depth of thoracic lateral supports. A minimum of three-point control is required for correcting or accommodating scoliosis. Segmented back allows for pelvic or shoulder rotations.
- Secondary supports: when installing a hip belt or upper body harness, assess for the angles or "line of pull" to optimise or correct body positioning. Other positioning accessories include anterior knee block and ankle huggers
- Primary support:
- Wheelchair options and set up:
- Consider all aspects of the mobility system when addressing postural issues (refer to Modules 9 and 10). For example, seat dump in MWC, and power seating is in PWC
- Refer to seating services for assistance for clients with severe postural deformity
Download Seating and Posture Issues - Possible Solutions, produced by Muscular Dystrophy Campaign, UK
Download Postural intervention for posterior pelvic tilt and kyphosis
Body size
- Incorrect size may lead to poor skeletal alignment, inadequate support and development of pressure areas and/or compensatory posture in order to function. Imagine wearing a pair of shoes sized too big or too small for 16 hours a day, every day.
Download Translating evaluation measurement to wheelchair dimensions, by Michael Babinec, OTR/L, ABDA, ATP
Other resource: Seating system for people with spinal cord injury: cushion, backrest and other considerations