AT to Enhance MobilityPositioning

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AT to Enhance Mobility/Positioning

• Adapted from Bryant Bryant (2003)

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Categories of Wheelchair users

• People who do not have function of their lower
  limbs
• People who have unstable posture
• People who have general physical problems

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Wheeled Mobility Units

• Manual Wheelchair
• Everyday wheelchairs
• Sports wheelchairs
• Junior wheelchairs
• Racing wheelchairs

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Powered Wheelchair

• A functional evaluation should be conducted when
  selecting a powered wheelchair. This includes
• Actual use of the wheelchair in everyday
  settings
• An evaluation of the persons ability to get in
  out of the wheelchair
• Ability to perform needed activities from the
  wheelchair

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Innovative Options!! The IBOT
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• Dont forget to consider the individuals
  preference for a particular style of wheelchair
  in terms of appearance.

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Components of Standard Wheelchairs

• Seats
• Seatback
• Armrests
• Front Riggings
• Wheels Rear Tires
• Casters
• Handrims

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Motorized Carts (scooters)
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Scooter Boards
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Gait Trainers
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Mobile Standers
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Positioning
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What is positioning?

• Positioning is the process of placing a student
  with physical disabilities in a position that
  allows the student to use their abilities and, at
  the same time, be comfortable in a lying,
  sitting, or standing position.

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Why is positioning important?

• Keeps the child from developing more severe motor
  problems
• Encourages the child to move around and learn
• Lets the child have the opportunity to interact
  better with others
• Makes it easier for staff to meet the needs of
  the child

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What is main goal of proper positioning?

• Try to take away or diminish the influence of the
  abnormal posture or reflex and replace it with
  putting the child in a position that is as near
  to normal as possible.

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• In other words, the more normal looking the
  positioning looks to you, the BETTER for the
  student!

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Anatomical Terms Positions

• 1. Cranial toward the head
• 2. Caudal - toward the feet
• 3. Medial - toward the middle
• 4. Lateral - toward/from the side
• 5. Proximal - toward the attachment of a limb
• 6. Distal - toward the fingers or /toes
• 7. Superior - above
• 8. Inferior - below
• 9. Anterior - toward/from the front (next slide)
• 10. Posterior - toward/from the back (next slide)
• 11. Peripheral - toward the surface (next slide)
• 12. Palmer - toward/on the palm of the hand
• 13. Plantar - toward/on the sole of the foot

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Anatomical Terms Positions cont.
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Anatomical Terms Movement

• Lateral Rotation (1)
• Medial Rotation(2)
• Supination (3)
• Pronation (4)
• Eversion (5)
• Inversion (6)
• Adduction (7)
• Abduction (8)
•  

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Anatomical Terms Movement

• Flexion Extension

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Ideal Pelvic Posture

• Neutral alignment head balanced over spine,
  spine balanced over pelvis
• Neutral pelvis
• Natural spinal curves
• Shoulders slightly posterior to pelvis
• Head in neutral position with eyes (gaze) forward
• Equal weight bearing through buttocks

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Asymmetrical Postures

• Posterior Pelvic Tilt
• Anterior Pelvic Tilt
• Pelvic Obliquity
• Pelvic Rotation

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Posterior Pelvic Tilt

• Most common pelvic tendency
• Flexed lumbar spine
• Thoracic kyphosis
• Shoulder protraction
• Increased cervical extension
• C-type posture

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Causes of Posterior Pelvic Tendency?

• Wheelchair considerations
• Seat depth too long
• Back support too short
• Sling back upholstery
• Elevating leg rests
• Lower extremities are not supported well
• Physical conditions
• Tight hamstrings
• Reposition themselves by sliding
• Can not maintain 90º of hip flexion

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Anterior Pelvic Tilt

• Increased lumbar lordosis
• Thoracic kyphosis is reversed or reduced
• Shoulder retraction

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What Causes Anterior Pelvic Tilt?

• Weak muscles/Low tone
• Weak hamstrings
• Weak abdominals
• Tight hip flexors

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Pelvic Obliquity

• One side is higher than the other
• Compensatory C-shaped curve in the lumbar and
  thoracic spine
• The shoulder on the side of obliquity tends to
  be elevated
• The obliquity is named for the side that is lower

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What Causes Pelvic Obliquity?

• Wheelchair considerations
• Sling back upholstery
• Wheelchair too wide
• Physical conditions
• Muscle Imbalance
• Irregular muscle tone
• (high or low tone on one side of the trunk)

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Pelvic Rotation

• One side of the pelvis is more forward than the
  other side
• Keep in mind that some level of pelvic rotation
  is usually found in an individual who has a
  pelvic obliquity

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What Causes a Pelvic Rotation?

• Muscle imbalance causes an irregular pull on the
  pelvis
• Muscle contracture on one side causes an
  asymmetrical pelvis

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Pelvic Positioning Considerations

• 3 points for pelvic stabilization
• seat, back anterior support
• The pelvis is the keystone of positioning
• Optimize independence
• Enhance function
• Promote comfort/Relieve pain
• Distribute pressure

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Pelvic Positioning Considerations Cont.,

• Correct flexible deformities
• Accommodate fixed deformities
• Minimize postural supports
• Do not over position Sitting is a dynamic
  activity
• Understand the clients needs and then choose the
  product

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Seating Considerations Cont.,

• Consider the seating system and the chair
• Determine the objectives of the belt for the
  seating system and the client
• Consider the clients level of compliance.
• Consider the needs of the client or care giver
  operating the belt

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Seating Considerations Cont.,

• Consider the seating system and the chair
• Determine the objectives of the belt for the
  seating system and the client
• Consider the clients level of compliance.
• Consider the needs of the client or care giver
  operating the belt

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Lower Body Ideal Posture

• Feet flat on footplate in neutral position
• Ankles 90 º
• Knees 105 º neutral abduction
• Femurs parallel to seat
• Footplate position allows 2 clearance from floor
• 1 space from back of knee to front of seat

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Lower Extremity Conditions

• Extension/Flexion Patterns
• Leg Length Discrepancies
• Amputees
• Contractures/Deformities

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Extension Pattern/Reflex

• Hips extend adduct
• Knees extend
• Ankles plantar flex
• Anterior foot positioning required

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Flexion Pattern/Movement

• Hips flex
• Knees flex
• Ankles dorsiflex
• Posterior foot positioning required

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Lower Body Positioning Considerations

• Lower extremity positioning directly affects the
  position of the pelvis
• Lower extremity positioning helps sustain the
  position of the hips and knees
• Correct positioning assists in the prevention of
  deformities and distributes pressure
• Footplates positioned too low increase pressure
  under the thigh
• Footplates too high increase sacral area pressure
• Do not over position- Balance function support

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Lower Body Positioning Considerations Cont.,

• Always use a hip belt in conjunction with foot
  supports.

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Secondary Support OptionsAnkle Huggers

• Balances lower extremities in response to head
  upper body movements/patterns/ reflexes
• Reduces joint stress
• Stabilizes feet without blocking movement or
  circulation
• Dynamic kit available

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Secondary Support OptionsAdjustable-Angle
Footplates

• Accommodates contractures, deformities,
  amputations leg length discrepancies
• Individually adjustable in height, depth, width
  plantar/dorsiflexion

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Secondary Support OptionsFulcrum Series
Footplate

• Accommodate fixed deformities of the foot or
  ankle
• Capable of inversion/eversion, plantar/dorsiflexio
  n depth adjustments

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Upper Body Ideal Posture

• Same spinal curves as erect standing
• lumbar lordosis
• minimal thoracic kyphosis
• minimal cervical lordosis
• Trunk symmetry
• Neutral alignment head balanced over spine,
  spine balanced over pelvis
• Shoulders slightly posterior to pelvis
• Head in neutral position with eyes (gaze) forward

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Causes of an Asymmetrical Trunk

• Wheelchair considerations
• Back support too low
• Wheelchair too wide
• Physical conditions
• Postural weakness/Low Tone
• Hypertonicity of certain muscle groups
• Extensor pattern
• Fixed postural deformities- Kyphosis/Scoliosis

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Seating Considerations

• Spine posture depends on pelvic positioning
• the integrity of lumbar lordosis
• Manipulative skills of upper extremities
  dependent on trunk stability symmetry
• Do not over position- Balance function support
• Good trunk alignment is essential for head neck
  control
• Always use a pelvic support with an anterior
  trunk support

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Secondary Support OptionsStandard H Style
Harness

• Provides shoulder retraction
• Rear-Pull
• Caregiver operated
• Front pull
• User operated
• Dynamic kit available- 3 strengths, promotes
  respiration limited movement

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Secondary Support OptionsTrimline Harness

• Provides shoulder retraction
• Crossover backpack styles
• Comfortable choice for women
• Front-Pull
• User operated
• Dynamic kit available- 3 strengths, promotes
  respiration limited movement
• Rear-Pull
• Caregiver operated

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Dynamic Straps

• Allow the user to lean forward 3 to 4
• Allows for easier breathing
• Increased arm movement
• Acts as a shock absorber to enhance comfort
• Available in 3 strengths

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Secondary Support OptionsChest Strap

• Allows more upper torso movement and provides
  little shoulder support
• Velcro fastening D- ring design for limited
  hand functioning

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BP Proprietary Features

• Webbing
• Foam and Pad Shape
• Durability and Maintenance
• Comfort

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Need for Therapy

• Children with motor problems need therapy from a
  trained professional.
• Because each child has different positioning
  needs, ask the therapist for specific
  instructions on how to carry out the positioning.

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Who is involved in evaluating a childs
positioning needs?
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Basic Considerations in Positioning and Handling
Students with Atypical Motor Patterns

• Factors that influence muscle tone
• Methods to normalize tone
• Key points of control
• Protecting your back
• Body Mechanics of Lifting and Transferring