positioning in w/c

Question 1

Scoliosis

Answer 1

Lateral bending of the spinal column
Rotation of the spinal column
Can be flexible or fixed

Question 2

Lordosis

Answer 2

Excessive inward curvature of the spine

Usually at the lumbar area (lower back)

Question 3

Kyphosis (hunchback)

Answer 3

Excessive rounding of the spine

Usually at the thoracic area (neck)

Question 4

Orthopedic conditions

Answer 4

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

Question 5

Pelvic and Hip Deformities

Answer 5

Dislocated hips
Pelvic obliquity
Pelvic rotation
Pelvic tilt
Windswept deformity

Question 6

Hip dislocation

Answer 6

Head of the femur does not articulate with the acetabulum (hip socket)
In those with neuromuscular disorders, caused by excessive tone or lax ligaments

Question 7

Pelvic obliquity

Answer 7

One side of the pelvis is higher than the other side

Question 8

Pelvic rotation

Answer 8

One side of the pelvis is rotated forward of the other side

Question 9

Pelvic tilt

Answer 9

Posterior: Top of pelvis is tipped backward
Anterior: Top of Pelvis is tipped forward

Question 10

Windswept deformity

Answer 10

One hip is adducted and one hip is abducted

Question 11

3 categories of seating intervention

Answer 11

Management of deformities and postural control
Pressure management (prevention of skin breakdown)
Comfort

Question 12

outcomes of proper seating

Answer 12

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

Question 13

Evaluation: physical skills

Answer 13

Range of motion

Skeletal condition

Question 14

Evaluation: neuromotor skills

Answer 14

Muscle tone
Reflexes
Postural control
Movement

Question 15

seating and positioning rules

Answer 15

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

Question 16

modifications for LE positioning

Answer 16

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

Question 17

modifications for trunk positioning

Answer 17

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)

Question 18

trunk positioning rule

Answer 18

it is important to attempt to support the individual in their natural position instead of forcing them into a more “normal” position

Question 19

head and neck positioning

Answer 19

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

Question 20

head and neck modifications

Answer 20

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

Question 21

UE positioning

Answer 21

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

Question 22

skin integrity positioning

Answer 22

Important to note areas of increased pressure
Many types of materials are available
Important that positioning provides ways for pressure relief (tilt, recline, etc.)