Christine Turner explains the benefits of good posture management post injury.

Taking the wheel

Why is the assessment for and provision of effective wheelchair seating solutions so critical?

Providing postural management for wheelchair users is always a challenge, and the issue of a client’s long term and ever changing needs is often left unaddressed. Posture is often seen as static, with the posture presented at assessment identified as being the clients permanent posture, likely to stay that way. But consider how our own posture changes with age, and our lifestyle changes. How much more so, then, will the postural requirements of clients with complex needs change, under the influence of rehabilitation input, variable and changeable muscle tone, spasticity and patterns, behavioural changes and so forth?

There is also a sense that ‘sitting’ is a static activity, but of course the human body is designed to move – and if not allowed to do so, then the effects are significant and can lead to reduced mobility and range of movement at the very least. Look at how much your body moves, even just from the effects of respiration. So sitting and posture is never static, but always changeable and evolutionary.

Unfortunately, it is not always possible to find equipment that gives a 100% solution, and so sometimes compromises need to be agreed by all the parties involved.

Assessment

So what does a posture management specialist look for when assessing a clinical need for wheelchair seating and postural management intervention?

The first step is to carefully evaluate the client’s physical presentation, taking into account of deformity, altered muscle tone, spasticity patterns, impaired sensation, effects of trauma and so forth. Once these areas have been evaluated and recorded, it is important to evaluate how much correction there is, from what is being seen.

For example, where there is a pelvic asymmetry that is correctable, then any seating solution should seek to correct it. If it is not correctable, then a posture management solution should seek to accommodate it, to reduce the risk of the deformity becoming worse.

A number of further factors should also be taken into account. For example, daily living activities such as toileting and dressing; leisure and activity needs; and environmental considerations – where the equipment will be used, and the amount of space available.

Vehicle access should also be considered. Often, the decision is made by professionals and family of a client to go ahead and purchase a vehicle early in the post traumatic process, so that the client can access the wider community and benefit from social opportunities. Unfortunately, this decision is often made without reference to the longterm wheelchair seating needs of the client, leading to costly modifications and adaptations later on.

As well as informing the appropriate selection of equipment, gathering data will also help to choose the best transfer techniques to maximise the benefit of a seating solution, and will help to take into account the needs of the care team members as well as the client. It is rare for a client to live in isolation, and the care team will have their own needs, for example due to stature, physical health, or age. Liaising with other professionals such as occupational therapists, physiotherapists, speech and language and vehicle supply specialists is also critical, to ensure that there is a true multi-disciplinary approach to enable the client to maximise their rehabilitation.

Trauma clients typically seen by Wheel of Health almost always need to be reviewed on an ongoing basis, due to evolving needs brought about by rehabilitation and the progression of their condition (both positive and negative). If the review process is not included in the plans, then the client risks developing a deformity, and/or pressure sores, as the equipment begins to become progressively less suitable for their needs.

Benefits

Good postural management should maximise function and comfort for the injured person, reducing the risk of deformity or pressure sores. In improving posture, it should also help self-esteem, and bring benefits in terms of improving respiratory and cardiovascular function; helping digestion; improving muscle tone; and also assisting the client to maximise visual and perceptual abilities by, for example, making it easier for them to turn their head.

It is worth noting that cognitive sensory problems do not necessarily mean that a powered wheelchair is not suitable, as it may be possible for specialist controls to be programmed according to individual need. Other more complex technologies such as touch screen or eye gaze technology may open up opportunities for clients to achieve independent function.

finally, remember that posture management should be considered on a 24-hr basis. If a client needs effective and structured posture management solutions in a seating position, then solutions will almost certainly need to be considered for when they are in bed as well.

Christine Turner | Consultant to Wheel of Health.

Accepted October 2014 | PI Focus | APIL