Unit 3: Seating and Body Support Flashcards by Erin Brown

What are the main groups that require specialised seating/body support

The elderly
Cerebral palsy
RA (non-elderly)
Muscular dystrophy
MS
Motor neurone disease

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What are the problems associated with insufficient support

Poor/asymmetrical postures
Prevents function
May encourage development of deformities

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What are the problems associated with excessive support

Impedes function by obstructing movement

Encourages dependence on support (esp. in cerebral palsy children)

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What pattern of hypertonia is commonly seen in cerebral palsy children

Extensor spasm pattern: all four limbs forced into extension

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What stimuli can trigger extensor/flexor spasm pattern

Noise, movement, position, head orientation, heat, discomfort

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How can the extensor pattern in cerebral palsy children be diminished

Flex the hips beyond 90degrees

Alternative: extend hips and support the body via the knees and chest

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How should paresis be compensated for

Ensuring the centre of gravity is positioned as close to the mid-line as possible

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What are the 3 main stability pathologies

Hypertonia
Paresis
Dyskinesia

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What conditions is athetosis commonly seen in

Cerebral palsy and Friedrich’s ataxia

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Why do disabled people tend to have different proportional body size segments

Due to lack of/excessive loading/movement imposed by their condition which can stimulate or inhibit growth

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Why is obesity more common in disabled populations

Normal food intake is maintained despite reduced energy requirements
Hormonal and psychological problems

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What is the ‘windswept’ configuration

Combination of pelvic obliquity, rib deformities, hip contractures and dislocations
Creates a z-shaped body due to muscle imbalance

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Which conditions are characterised by pain during sitting

RA
MS
Back pain

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Why might sitting lead to back pain

Compression on spinal nerve roots

Often the cause is unknown

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Which condition is often associated with abdominal problems such as impaired swallowing ability and gastric reflux

Cerebral palsy

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Why does prolonged sitting lead to oedema

Venous pooling because muscle pump is not active

Lack of lymphatic flow

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What is the most common reason for seat rejection

Lack of comfort

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What factors can lead to discomfort

Over-restriction of movement: sustained loading

Inadequate support: requires more muscle action

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How are interface pressures kept to a minimum

Ensure a large surface area and contour to follow body shape

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What are the 2 main categories of seating support

Sagittal support

Lateral support

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Why is the ischial support so important

Area where the highest supporting pressures are encountered: may require extra consideration to avoid pressure sores

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What materials are used to minimise peak pressures at the ischial supports

Foam
Gel
Air filled material

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Why is the femoral support important

Governs hip angle and orientation of the femurs

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What is the ideal positioning of the horizontal femur

The femoral support should be angled higher distally than proximally
Usually around 15degrees to the horizontal

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What is the function of the posterior pelvic support

Maintain the upright pelvis in the sagittal plane

What are the 2 applications of use of pelvic straps

Prevent person from falling out of chair | To hold the pelvis in the desired position

What position should be pelvis straps be used at

At an angle that bisects the angle between the ischial and posterior pelvic supports

What is the most effective way of holding the pelvis in position

The ASIS bar: padded metal bar locked in position across the ASIS, curves over the abdomen

What can knee blocks be used for

Preventing forwards motion of the pelvis | Controlling windswept deformities (when combined with adduction blocks)

Potential problem with knee blocks

May exacerbate hip dislocation/subluxation

What position do foot supports normally create

Plantigrade foot position

When does the degree of thoracic support become important

When backrest recline increases

Should head support be maximised or minimised

Minimised

What is the most effective chest/shoulder harness design

A waistcoat: prevents forwards trunk flexion

How should lateral supports be applied

In combinations of 2 or 3 elements on opposite sides of the body

What is the most effective method of providing lateral trunk support

Lateral pelvic supports

What is the maximum height that lateral spinal support should reach

2cm below the axilla: nerves here are vulnerable to compression

What is the difference in lateral spinal support for symmetrical and asymmetrical trunks

Symmetrical: use in pairs Asymmetrical: use a 3-point loading system

Why is lateral instability of the head a frequent problem

Lateral head supports can be overcome by the person moving their head forwards (extending the supports forwards then limits visual fields)

What is another name for adduction blocks

Pommels

What benefits does using adduction blocks have

Reduces extensor tone/pattern

What postural position is commonly seen in hypotonic patients. How can this be overcome

Wide hip abduction and external hip rotation | Overcome by using abduction blocks

When are abduction and addiction knee blocks used together

To correct windswept deformities

What is the benefit and disadvantage of tilting back a seat

More comfortable but less functional ability

What is the difference between tilt and recline

Tilt: moving the seat and backrest angle back simultaneously Recline: moving only the backrest angle

When should lateral tilt be used

Only in some cases of asymmetrical postures in the frontal plane

What is a benefit of a higher seat height

Facilitates for easier standing

What are some basic features of 'easy chairs; or 'orthopaedic chairs' produced for the elderly

``` Minimal contouring = provide very upright posture High seat height = facilitates rising Small wheels = ease of movement +/- trays = for eating/leisure +/- restraints for confused patients ```

What are benefits and disadvantages of using sling-seats

Benefit: folding ability Disadvantage: sags, encourages flexed posture and pelvic obliquity

Describe modular seating

Assembling a seat from a standard kit of components to give the desired size and configuration Segments can be adapted to accommodate for changing needs

Benefits of modular seating

Versatile and adjustable | Avoids expensive fabrication costs of customised sating

Disadvantages of customised seating

Expensive Limited lifespan Tends to lock the person into one posture

Disadvantages of foam and wood customisable seating designs

Time consuming Requires high skill level to achieve acceptable quality of finish Errors in configuration are difficult to adapt

Describe Shapeable surface systems of seating

Relies on a series of small interlocking components which can be released to produce a flexible surface

Benefits of Shapeable surface system

Allows a wide variety of shapes to be formed Adjustable = can adapt to changing needs Good ventilation to the seating surface Can re-use the supporting framework

Disadvantages of Shapeable surface system

Heavy May be difficult to manipulate to the required shape Require patient cooperating when setting up

Describe the process of creating a moulded foam seat

Polyurethane foam obtained by mixing liquid components to release gas and foam. The foam sets into a honeycomb structure. When contained in an enclosed space, the foam will set into the shape of the container

Benefits of moulded foam seat

Very comfortable | Useful for patients who dislike being confined to one position (e.g. muscular dystrophy patients)

Disadvantages of moulded foam seat

Difficulty maintaining desired posture during foaming process Cannot be adjusted other than by cutting away areas of foam

Describe the bead bag vacuum consolidation technique

Uses plastic bags filled with small polystyrene beads that conform to shape of individual. Vacuum applied to the bag = consolidates into a rigid structure

Disadvantage of bead bag system and method of overcoming this

Needs frequent reshaping | Use adhesive in with the beads