Page 28 - Mobility Management, September 2017

ATP Series
Asymmetry in Balance
product lines that will offer the therapist and/or seating team
the opportunity to not only accommodate, but intervene as
well. For example, let’s say you have a client who presents with pelvic rotation, which results in a windswept presentation of the bilateral lower extremities, in which one leg is abducted (angled away from the body) and one is adducted (angled towards midline of the body). Anytime you correct an asymmetry, you are successfully preventing the progression of that asymmetry, thus positively impacting the client’s future posture.”
Davin mentioned the extreme adjustability in such products
as Adaptive Engineering Lab’s Omnilink, capable of not just stabilizing a client’s trunk and torso, “but you can also ‘follow’ the patient back into a neutral position, should the client improve over time. The key to achieving both intervention and preven- tion of further asymmetry progression is to have supports which offer unparalleled adjustability, thus offering the seating team or therapist the opportunity to progress or ‘follow’ the client into improved positions as improvement is noted.”
Asymmetry can both be the result of instability or the cause of instability — Lee Ann Hoffman
Highly adjustable seating systems, capable of being quickly changed as a client’s needs evolve, are being offered by both Matrix Seating USA and Symmetric Designs.
And Hoffman said that incorporating other equipment beyond seating can also make inroads with asymmetrical postures.
“Again, to determine the role of the seating, a comprehensive assessment is required and an understanding of the ‘critical measures,’” she said. “Critical measures can best be described in the words of Long (2014), to determine the joint ranges of motion and to ‘identify critical limitations in the alignment of the pelvis and trunk.’ The limitations in the joint ranges of motion need
to be considered, as they have implications for lying, sitting and standing orientations. If the critical measures are not taken into account, and equipment is provided which is not respectful of the ranges, then the success of the posture management inter- vention plan will be severely limited, fail or even worse, result in further injury or damage to the individual’s posture, function and quality of life.
“Once the critical measures have been determined, the provi- sion of 24-hour posture management equipment can be imple- mented, alongside the appropriate training.”
Intervening and positively impacting a client’s asymmetrical posture can be a gradual, long-term process, Hoffman added. “The critical measures will be the guide to the intervention
when addressing asymmetry in sitting. There are a bevy of seating systems that can serve to meet the individual’s postural needs and seating requirements. Alongside, the intervention
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of positioning in the lying orientation with the support of an informal (pillows, blankets, towels) or formal (manufacturer-pro- duced system or modular component) sleep positioning system can promote symmetry and restore body shape and alignment. This gentle and caring approach in lying is lengthy: Remember, it took several months or even years to establish the postural asym- metry, and it simply won’t take one week of good positioning to restore or resolve the postural asymmetry.”
Seating teams need to be ready to adjust seating systems as postures positively change.
“Seating systems selected need to possess the ability to be changed, amended and adapted to meet the changing postural needs and gains made through 24-hour posture care manage- ment,” Hoffman said.
While working with an asymmetry might therefore be seen as a continuous process, Davin made clear that intervention is critical.
“Even a minimal amount of asymmetry can eventually lead to a moderate or severe asymmetrical presentation if no interven- tion is provided,” she said. “Therefore, in this clinician’s opinion, it is imperative to intervene when any asymmetry is noted.
“There are some exceptions to this rule: For example, often clients who present with a diagnosis of muscular dystrophy will intentionally position themselves in a position of anterior pelvic tilt, to create a ‘tripod’ effect to better stabilize a weak core/trunk. Barring any exceptions, it is important to attempt to neutralize the client, and aid in positioning him or her in as neutral and functional of a position as possible, in order to promote improved activities of daily living performance, function and self-propul- sion, if applicable — keeping in mind that a small asymmetry today turns in to a major asymmetry tomorrow with the poten- tial for physiological impact.” m
References
Bower, E. (2009) Finnie’s Handling the Young Child with Cerebral Palsy at Home (Fourth Edition), Butterworth- Heinemann, Edinburgh. ISBN 9780750688109.
Clayton S., Goldsmith L., Ellis T. (2017) 24-hour postural care: The journey so far in the UK. http://www.simplestuffworks. co.uk/wp-content/uploads/2016/10/An-Evidence-Based- Approach-to-Postural-Care.pdf [accessed May 25, 2017].
Pope P. (2007) Severe and Complex Neurological Disability: Management of the Physical Condition. Butterworth- Heinemann Publishers.
Taktak A., Ganney P., Long D., White P. (2014) Clinical Engineering A Handbook for Clinical & Biomedical Engineers: Long, D., Chapter 19, P 285-308. http://www.sciencedirect.com/ science/article/pii/B9780123969613000196
[accessed May 5, 2017].
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