positioning in w/c Flashcards
Scoliosis
Lateral bending of the spinal column
Rotation of the spinal column
Can be flexible or fixed
Lordosis
Excessive inward curvature of the spine
Usually at the lumbar area (lower back)
Kyphosis (hunchback)
Excessive rounding of the spine
Usually at the thoracic area (neck)
Orthopedic conditions
Often occur in children with neuromuscular disorders such as cerebral palsy, muscular dystrophy and spina bifida
Due to an imbalance in muscle tone surrounding the vertebral column
Can cause problems with posture, digestion, breathing and motor control
Pelvic and Hip Deformities
Dislocated hips Pelvic obliquity Pelvic rotation Pelvic tilt Windswept deformity
Hip dislocation
Head of the femur does not articulate with the acetabulum (hip socket)
In those with neuromuscular disorders, caused by excessive tone or lax ligaments
Pelvic obliquity
One side of the pelvis is higher than the other side
Pelvic rotation
One side of the pelvis is rotated forward of the other side
Pelvic tilt
Posterior: Top of pelvis is tipped backward
Anterior: Top of Pelvis is tipped forward
Windswept deformity
One hip is adducted and one hip is abducted
3 categories of seating intervention
Management of deformities and postural control Pressure management (prevention of skin breakdown) Comfort
outcomes of proper seating
Normalization of tone and reflexes
Control or prevention of deformity or contractures
Enhanced function through maximized stability
Enhanced organ function
Increased comfort and decreased fatigue
Evaluation: physical skills
Range of motion
Skeletal condition
Evaluation: neuromotor skills
Muscle tone
Reflexes
Postural control
Movement
seating and positioning rules
Alignment and stabilization of pelvis is first area to be addressed
Neutral position is ideal: hips flexed at 90 degrees, pelvic is level side to side and front to back
Modifications to the seating surface may be necessary to accommodate deformities to allow for a level pelvis
modifications for LE positioning
Shorten the seat depth or undercut front of seat to allow legs to come under the seat
Support legs in position they are fixed in
For leg length discrepancies provide foot rests of different heights
Angle footrests to accommodate ankle contractures
Straps across the top of the feet, behind the heels or across the ankles can help
modifications for trunk positioning
Lateral supports – greater control when placed high on trunk and close to the body
Tilt – placing a person with poor trunk control at a slight backward tilt eliminates gravity slightly and helps the person maintain a more symmetrical posture
Anterior Supports – help person maintain upright position (straps, panels, rigid shoulder supports)
trunk positioning rule
it is important to attempt to support the individual in their natural position instead of forcing them into a more “normal” position
head and neck positioning
Position of head is important in inhibiting reflexes and promoting visual skills
important to support person in a functional position to foster use of vision and engagement in environment
head and neck modifications
Head rests
Headbands that provide anterior support
Lateral supports applied at temporal area, neck or side of face (May be useful in inhibiting the ATNR)
May need support for fatigue, travel or for changes in position only
UE positioning
Lack of support can affect head and neck positioning
Injury to arms that are left to hang can occur
Desired position allows elbows to bend at 90° angle
Use trays or individual arm troughs to provide support for the arms
skin integrity positioning
Important to note areas of increased pressure
Many types of materials are available
Important that positioning provides ways for pressure relief (tilt, recline, etc.)
