Page 25 - Mobility Management, September 2017

adaptation may present as a flexible posture/correctable posture within certain parameters.”
Hoffman noted, “Bower (2008) defined contracture as shortening of muscles and tendons. Long (2014) defines the effects of a ‘plastic response,’ when too much loading occurs and the ‘elastic limit is passed,’ causing deformation. Plastic adapta- tion takes place in both bone and soft tissue; commonly seen examples are kyphosis, scoliosis and contracture of joints, which in turn limit ranges and result in asymmetry.”
She pointed out, “Contracture is synonymous with fixed postures, and accommodation (making allowances in the seating system for the presenting asymmetry) of the postural presenta- tion is required. Contracture development is a gradual process. Remember that nerve tissue and blood vessels will also adapt
— therefore, awareness is essential when entering into any intervention which rapidly promotes increasing tissue length, as neurological and circulatory systems may be negatively affected.”
What If There Is No Intervention?
What happens if an asymmetry is not addressed by the seating team? As is often the case in complex rehab seating and posi- tioning...it depends.
Asked if a truly “fixed” asymmetry will worsen if it’s not corrected, Hannah said, “Typically no. Asymmetry cannot worsen or be corrected if the posture is fixed. The seating components around a fixed position are intended to give the consumer function and even pressure distribution or off-loading, if needed.”
Of course, everything changes if a supposedly fixed asymmetry isn’t entirely fixed.
“Yes,” Cousins said, “asymmetry can worsen without the appro- priate seating intervention if the underlying causes — for example, abnormal muscle tension or weakness — are still present.”
Hoffman said the simple answer to whether an unaddressed asymmetry will progress is yes.
“If some individual presents with what appears to be a scoliosis, which is fixed, and no appropriate, supportive seating is proved, then it is highly probable that the posture will continue to deterio- rate, and the scoliosis (Cobb angle) will increase,” she explained.
Davin used the example of a significant asymmetry that likely had a very modest beginning.
“Picture a client you may have seen in seating clinic, or imagine a client who presents with perhaps a left-sided pelvic obliquity (the left side of the pelvis is lower than the right), thus causing a left-sided scoliotic position (with the convex side of the
INTRODUCING
The Lateral Bracket That Grows With Your Client
WC20 Approved
16840-3 Compliant
Endless Configurations in a Single Bracket
Dual Swing-Away Swivel Mount Durable Serrated Links Patented Exclusive
Technology Lifetime Warranty
AELseating.com Innovation that Cares 866.656.1486
MobilityMgmt.com
MOBILITY MANAGEMENT | SEPTEMBER 2017 23