Building a Better Seating System With Bodypoint Designs

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Building a Better Seating System With Bodypoint
Designs

• Basic Wheelchair Positioning
• - Trudie Read OTR/L

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Overview

• The positioning team
• Anatomical terms
• Pelvic positioning
• Lower body positioning
• Upper body positioning
• Questions

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The Builders

• Manufacturer Bodypoint Designs
• Architect Therapist
• Supplier Distributor
• Builder Dealer
• Materials Products
• Tools Educational Materials

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Anatomical Terms Planes

• Transverse Coronal
  Sagittal Median
• or horizontal or frontal
  or paramedian

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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 finger/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 TermsMovement

• 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 ASIS and PSIS are level
• Natural spinal curves
• Shoulders slightly posterior to pelvis
• Head in neutral position with eyes (gaze) forward
• Equal weight bearing through ischial tuberosities

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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
• ASIS in higher than the PSIS
• Flexed lumbar spine
• Thoracic kyphosis
• Shoulder protraction
• Increased cervical extension
• C-type posture

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What Causes a 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

• ASIS in lower than the PSIS
• Increased lumbar lordosis
• Thoracic kyphosis is reversed or reduced
• Shoulder retraction

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What Causes an Anterior Pelvic Tilt?

• Weak muscles/Low tone
• Weak hamstrings
• Weak abdominals
• Tight hip flexors
• (ilipsoas and rectus femorus)

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Pelvic Obliquity

• One ASIS 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 a 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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Correction of Common Asymmetrical Postures

• Posterior Pelvic Tilt C-type Posture
• Anterior Pelvic Tilt Spinal Extension
• Pelvic Obliquity Lateral Tendency
• Pelvic Rotation Asymmetrical Pelvis

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Options For Posterior Pelvic Tendency

• Center-pull or Dual-pull
• Position belt anywhere between 45 and 90
• Belt is inferior and anterior to ASIS
• The higher the belt is from the ASIS,
• the more the posterior tendency is
  encouraged
• Belts design and angle prevents the individual
  from sliding

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Options for Anterior Pelvic Tendency

• Four-point hip belt
• Position the primary padded belt over the ASIS,
• and attach to the back of the chair
• Position secondary straps between 45 and 90 to
  the seat
• Secondary straps prevent the belt riding up
• into the abdomen and from twisting

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Options for a Pelvic Obliquity

• Rear-pull hip belt
• Pull from the rear of the pad
• Position one side of the pelvis, lock it in place
  
• and then position the other side
• Four-point hip belt is recommended for
• an individual with excessive movement

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Options for a Pelvic Rotation

• Rear-pull hip belt
• Two-point or Four-point hip belt
• depending on the individual

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Options for Thrusting

• Leg harness- Prevents hip extension by holding
  the femurs into the seat
• Top strap attaches to back post at 90º, slightly
  below ASIS
• Bottom strap passes under the thigh and attaches
  to seat rail
• Contra-indications Pelvic fractures, open wounds
  in the groin area/upper thigh, unstable hip joint

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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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Summary

• The positioning team
• Anatomical terms
• Pelvic positioning
• Lower body positioning
• Upper body positioning
• Questions

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References

• Albert M. Cook, Susan M. Hussey. Assistive
  Technologies Principles and Practice.
  Mosby-Year Book, Inc., 1995.
• Diane E. Ward. Prescriptive Seating for Wheeled
  Mobility. Health Wealth International, 1994.
• Thomas Hetzel. Helping Gravity Help You.
  Bodypoint Designs, Inc., 1998.
• Jean Anne Zollars and Patty Ruppelt. Beyond the
  Obvious Developing the Inner and Outer Eye.
  Thirteenth International Seating Symposium
• Sheila Buck. Back to Basics and Beyond 3.
  Therapy Now, 2001.
• Seventeenth International Seating Symposium.
  Seating Mobility for People with Disabilities,
  2001.