Postural Supports and

Custom Wheelchair Seating

What are Postural Supports?

• The World Health Organization defines postural support as:

Any part of the body that comes in contact with a surface, such as a wheelchair.

• Examples: Wheelchair (postural Supports)

Seat

Backrest

Foot rests

Arm rests

Lateral support

Lumbar supports

Wheelchair seating Specialist

OT or PT?

• Often depends on the clinic setting and wheelchair seating specialists available.

OT Domain of Practice

• Biomechanical Frame of Reference

• Rehabilitation Frame of Reference

• Model of Human Occupation Frame of Reference

Wheelchair seating: A Client Centered Process

• Client (preferences, understanding of day to day needs in a wheelchair and postural supports)

• Spouse/ partner

• Family

• Care givers

• Therapist (Knowledge base)

Canadian Journal of Occupational Therapy looked at the

Wheelchair Procurement Process through the perspectives of

the clients, their family members, care givers and the

Prescribers. This client centered study examined barriers to

appropriate seating systems for individuals with physical

disabilities and their families and caregivers. Clearly the

involvement of the consumer client and the practitioners’

knowledge must be collaborative to provide a wheelchair that

offers the postural support to meet the needs of the client on a

functional, social and environmental level.

Factors in choosing a wheelchair

Functionality: What is the environment the client will be using the wheelchair in?

Seating, Wheelchair Support and postural:

Durability and safety:

What are Postural Supports?The World Health Organization defines postural support as: Any part of the body that comes in contact with a surface, such as a wheelchair.

Examples: Wheelchair (postural Supports) SeatBackrestFoot restsArm restsLateral supportLumbar supports

Appropriate wheelchair seating and postural supports can reduce many future complications:

Pressure sores

Secondary disabling conditions

In efficient respiration

Armstrong (2008) pp. 57

Prevention of Pressure sores through good postural support.

Evaluate and Monitor the following areas:

- Ischial tuberosity/ sacrum

- Back of the head - Spine of the scapula

- Calcaneus

- Elbows, knees, wrists, back of knees and hips

Proper postural supports such as armrests assist in allowing for more efficient breathing. If a client rests their arms on their arm rests (close chained activity), the respiratory muscles will be more effective while preforming reversal of muscle action.

Inefficient Respiration

Poor posture while seated for a long period of time can inhibit the normal up and out motion of the ribcage. This is particularly important for clients with poor trunk control, such as a person with cerebral palsy (CP) or Muscular Dystrophy (MD).

If a person who is lacking trunk control is placed in a wheelchair that does not provide adequate trunk support and other supports, the rib cage may not expand enough to allow the lungs to fully inflate, resulting in inefficient respiration, and less oxygen getting to the body.

• A study conducted by Bakes and Devenport titled “Wheelchair Components and Pulmonary Function in Children with Cerebral Palsy found the following:

• A person with Cerebral Palsy, who experiences no obstruction in airways, may experience less efficiency during respiration, without correct postural supports.

• If this same individual experiences further compromise by the development of secondary physical deformities, such as scoliosis, caused by poor postural seating, the effects on respiration would be further compromised.

• In this study, it was found that lateral trunk stability through the use of an anterior pelvic belt, upper extremity supports as well as posterior seat tilt of 30 degrees, may align the trunk and lessen weight or compression on the abdomen, thus allowing the diaphragm to move more freely, leading to more efficient respiration (Bakes, Davenport, 2012 pp. 84-85).

References

Armstrong, W., Borg, J., Krizack, M., Lindsay, A. Mines, K., .. and Sheldon, S.,(2008) Guidelines on the provisions of Manual Wheelchairs in less resourced settings. World Health Organization (WHO) pp. 57Barks, L., Davenport,P.,(2012). Wheelchair Components and Pulmonary Function in Children with Cerebral Palsy: Assistive Technology® 24.2.pp.78–86. Clark, J., Michael, S., Morrow, M., (2004). Wheelchair postural support for young people with progressive neuromuscular disorders: International Journal of Therapy and Rehabilitation, Volume 11, No. 8. , P. 358- 371. Retrieved from: http://web.b.escohost.com.ezproxy.greenriver.edu/ehost/pdfviewer/pdfviewer?sid=453bf50- b449-4512-8547-cbea9792cb0c%40sessionmgr110&vid=7&hid=107Mortenson, W. B., & Miller, W. C. (2008). The Wheelchair Procurement Process: Perspectives of Clients and Prescribers. Canadian Journal of Occupational Therapy. Revue Canadienne D’ergotherapie, 75(3), 167–175. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4113492/Parent, F., Dansereau, J., Lacoste, M., Aissaoui, R. (2000). Evaluation of the new flexible contour backrest for wheelchairs: Journal of Rehabilitation Research and Development Vol. 37 No . 3, Pages 325—333.Sladyk, K. & Ryan, S. (Eds.).(2015).(5th Ed). Ryan’s Occupational Therapy Assistant: Principles, Practice Issues, and Techniques. Thorofare, NJ: SLACK Incorporated. ( 478, 31, 54, 76, 272-282, 476, 478, 480, 522-523,391 -391).