Page 26 - Mobility Management, September 2017

ATP Series
Asymmetry in Balance
scoliotic spine pointing toward the client’s left-hand side) with a right-sided lean (the client’s head leaning toward the right — right shoulder lower than the left, and right side of the pelvis higher than the left).
“This position could have very likely started with a very minor pelvic obliquity that was left unaddressed or not prop- erly neutralized. This once-small pelvic asymmetry could have started as just that: a minor discrepancy perhaps due to an ill-fitting wheelchair seating system or inappropriate wheelchair cushion, which has now, due to lack of intervention, turned
into not only a pelvic asymmetry, but whole trunk involvement. Furthermore, if this asymmetry is allowed to progress and remain unaddressed, it is likely that soft tissue contractures may develop as muscle tissue becomes affected by lack of movement and joint mobility potentially decreases. When an asymmetry is spotted, regardless of how insignificant it may seem at the time, it is imperative that the appropriate action be taken swiftly and effectively to neutralize the asymmetry and prevent the risk of further asymmetries from developing.”
“Seating intervention is only one part of the kaleidoscope approach, which encompasses 24-hour posture management,” Hoffman added (see sidebar). “By attempting to only address the
fixed/inflexible posture through seating provision, a keyhole approach is adopted. To only provide one intervention, namely seating, which may only comprise several hours of the day over the 24-hour period, is not sufficient in the fight against body shape distortion.”
Hoffman is an ardent believer in a holistic postural support approach.
“Time spent outside of the supportive seating/wheelchair needs to become a priority, and positioning in lying is quintes- sential to achieving not only better seating outcomes through gentle positioning, but also has a profound effect on the quality of sleep for the individual and their caregivers,” she explained. “Furthermore, the provision of a supportive lying position can conversely serve to improve posture and restore symmetry, which in turn will have improved outcomes for sitting and positioning in the seating system.”
When & How to Intervene
Hoffman is adamant about the need to intervene when a seating team is confronted by an asymmetrical posture.
“Intervention is essential in the fight against postural defor- mity,” she said. “Poor posture and positioning can lead to death.
Lee Ann Hoffman: The 24-Hour Postural Support Goal
Albeit a developing field in the North American marketplace, the provision and success of 24-hour postural support is evidenced widely in countries such as the United Kingdom, Europe, the Nordics and Australia, to name a few.
Exciting 24-hour posture care results
from a home-grown project, funded by
the Montana Council on Developmental
Disabilities, and undertaken by Posture 24/7,
is in its second year of working with children and teenagers across the state (https://posture24-7.org/mt-project/).
Many developing countries have received outreach work, with limited resources, and have found success in the 24-hour posture care management approach: http://www.eleanoresproject.org/
What 24-Hour Postural Support Does
Twenty-four-hour posture care management looks at all the positioning needs throughout the 24-hour period. Once the individual is out of the supportive seating system, consider all the available positioning options available to the individual, including but not limited to a standing frame, “relaxing” seating or an armchair, a bed, a shower chair/commode, a car seat and seating in leisure equipment.
Can 24-hour posture care management slow or prevent the
asymmetry from worsening or advancing? Yes. The focus of the approach is to promote comfort, promote function and prevent
or reduce the occurrences of secondary complications. Twenty-four-hour postural support has the ability to prevent, restore, preserve and protect body shape.
Asymmetry (tissue adaptation, contrac- ture and deformity) is a secondary compli- cation of poor posture/inappropriate posi-
tioning. The 24-hour posture care management strategy believes that body shape distortion is avoidable.
In our industry, we all have a duty of care, to provide the most appropriate intervention for the individual and their support network, within their given environment. We have the means to have a direct impact on the individual’s quality of life, and to ensure that individuals with complex rehabilitation needs are treated with care and dignity by addressing their positioning needs and not settling and accepting that postural distortion is inevitable.
Don’t you want better outcomes for the individual’s you work with? I do.
—­­Lee­Ann­Hoffman,­OT,­MSc.­Rehabilitation:­
Posture­Management,­Solutions­Specialist/Seating­&­ Positioning,­Invacare­Corp.
24 SEPTEMBER 2017 | MOBILITY MANAGEMENT MobilityMgmt.com