Page 20 - Mobility Management, February 2018
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                                 ATP Series
Seating & Spasticity
“Spasticity can present in numerous ways depending on the individual,” he noted. “Spasticity is dependent on the severity and the location of damage to the nervous system. The individual can exhibit  exor tone, extensor tone or a combination of both in different parts of the body. The spasticity can also  uctuate and vary throughout the day. It often presents asymmetrically and
can cause a variety of postural changes or disturbances which can have a detrimental effect on the individual’s function.”
Spasticity can occur, Lucas said, “when there is damage or injury to the upper motor neurons of the central nervous system (brain, spinal cord). The damage in the nervous system causes imbalances or faulty signals from the brain and spinal cord to the
 Non-Invasive Treatment: 24-Hour Posture Management’s Potential Impact on Spasticity
The primary aim of 24-hour posture management is to prevent or reduce secondary complications resulting from poor posture, improve function, improve comfort and ultimately improve quality of life. We know that gravity combined with immobility will result in secondary complications, such as muscle and bony distortions caused by the adverse effects of spasticity, such as muscle spasms, fatigue, pain, decreased function, muscle and joint distortions. Body shape distortions result in asymmetrical postures, which increase the likelihood of peak pressure due to unequal loading of the body over the support surface.
The focus of intervention is to decrease spasticity, which can, in turn, improve mobility and function and help reduce the develop- ment of contractures. Bower (2009) stated that “despite the best physical therapy, orthotics and medications, spasticity combined with skeletal growth can result in the formation of joint contrac- tures and or dislocation.” The muscles of the hips are among the strongest and largest in a child and therefore the most commonly seen results of hip spasticity are hip dislocation and a shortening of tendons, which then lead to contractures and pain. Spasticity
is also often observed in the displacement of bones of the hands and feet. Distortion of the spine (scoliosis) is a commonly observed phenomenon in the population with cerebral palsy.
Therapy and orthoses are not administered to reduce spasticity, but rather to control the effects resulting from the neurological symptom with the aim of maintaining function and body alignment by working towards reducing the secondary consequences of spasticity.
A Holistic Management
It is essential that the focus is on the holistic management of spas- ticity to prevent musculoskeletal distortion. The 24-hour posture management approach provides a foundation for building a stable foundation for posture and takes into account the individual’s tone and how to facilitate movement to maximize activity and participation (Mendoza et al 2015) in line with the domains of the World Health Organization’s (WHO) International Classi cation of Function, Disability and Health (ICF) Framework (WHO 2001).
The individual’s positioning needs must be considered over the 24-hour period — i.e., sleep and resting positions, sitting and standing — in addition to any other movement opportu- nities the individual has available to them, such as leisure time. Body postures form an essential component of the individual with spasticity’s physical management. No amount of hands-on
therapy can compensate for this core element in preventing or relieving the secondary complications that can arise from spasticity and ineffective postural management.
By providing services to individuals with complex rehabilitation needs, which are geared towards early intervention and preven- tion, rather than surgical procedures to correct hip dislocations and scoliosis, in addition to the associated rehabilitation needs
— it is evident that cost savings can be achieved by implementing 24-hour posture management plans, equipment and protocol.
Treatment is planned on a case-by-case basis with the aims of reducing the physical challenges for caregivers, i.e., those of taking care of the individual’s personal hygiene, dressing and feeding.
Sitting and Standing Postural Orientations
There are many types of wheelchairs, seating systems, standing frames and other pieces of adaptive equipment, which are available to assist individuals with motor impairment to maintain symmetrical, stable postures during the daytime to promote function, and also to reduce or prevent secondary complications that often result from poor posture.
Lange (2009), noted that the concept of therapeutic positioning during the daytime is widely accepted. We just need to take a look around at most equipment providers’ Web sites, confer- ences and exhibition booths to note the plethora of equipment available to address both seating and standing postural needs. Everything is linked; for instance, Mendoza et al (2015) noted that the child with CP’s ability to “acquire postural control in sitting will in uence the development of gross motor functions, such as standing and walking.”

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