Page 23 - Mobility Management, September 2017

ATP Series
Asymmetry in
Balance
DO YOU INTERVENE? ACCOMMODATE? OR DO BOTH?
TPs and clinicians who are recommending, determining and building the seating systems for wheelchair users are not starting on a symbolically level playing field.
That’s just the nature of the seating and mobility calling. Instead, seating teams must contend with a range of clinical
challenges, including client histories, diagnoses and prognoses, and balance all of that with the client’s daily goals and environments.
The Asymmetrical Posture
One such wheelchair seating challenge is the asymmetrical posture — common due to the number of conditions that can cause its presentation.
“Asymmetry can be defined by the presentation of the body either not appearing to be identical on the left and right side, or an imbalance between the body halves,” said Lee Ann Hoffman, OT, MSc. Rehabilitation: Posture Management, Solutions Specialist/Seating & Positioning, Invacare Corp. “It’s a deviation from the symmetrical presentation — even-sided or equal presentation of the left and right side.”
“Clinical reasons for an asymmetry could include a pelvic obliquity, scoliosis or a leg-length discrepancy,” said Sam Hannah, ATP, Symmetric Designs. “Some of the causes can stem from a consumer trying to offload pressure, [or having]
By Laurie Watanabe
low muscle tone and/or poor seating.”
Steve Cousins, Ph.D., R&D director for Matrix Seating
Ltd., said asymmetrical postures could be caused by “cerebral palsy, brain injury, multiple sclerosis, spinal muscular atrophy, muscular dystrophy, spina bifida and other disorders. [Or by] simple biomechanical issues, like using a canvas sling seat in a wheelchair so the pelvis can slip and sideways tilt, inducing a spinal curve, or slipping forward (too open a seat/back angle, no shaping to the seat/cushion) in a wheelchair seat so that
the pelvis tilts posteriorly, affecting the natural spinal lordosis (which helps to protect the back from developing scoliosis). Causes related to the underlying clinical issues are abnormal muscle tension (pulling asymmetrically) and collapse under gravity due to muscle weakness.”
Kirsten Davin, OTDR/L, ATP/SMS, added that an asymmet- rical posture can develop over time.
“In some cases, what was a minor asymmetry or a non- emergent diagnosis at one time may progress into a significant postural issue, and could eventually present with vital organ structure compromise,” she explained. “For example, a child who presents with minimally invasive scoliosis at age 3 may experience spinal stenosis, continued progression of scoliosis, and perhaps as a result of poor positioning or clinical progression,
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