Page 15 - Mobility Management, September 2019

force the person into more hip flexion than they have available, thus forcing the person’s pelvis posteriorly to accommodate for this. Backrest size and placement is also key. The backrest must be placed and adjusted to provide posterior support to the PSIS and lumbar spine. If there is inadequate support in this area, then a posterior pelvic tilt is very likely to occur.”
Seating & Positioning Interventions
Fortunately, the properly specified and fitted seating system can have a big impact on posterior pelvic tilt, Hannah said: “There are a number of factors that affect pelvic positioning within a wheelchair. It is important to choose a seat cushion that has an appropriate contour to support the posterior pelvis, including an appropriately positioned and shaped ischial well with proper depth. The seat dump angle will also affect posture and pelvic pressure and positioning. A pelvic positioning belt can also assist with holding the pelvis in a neutral position. A backrest with increased lumbar support can also assist with supporting a neutral position.”
“Another consideration,” Lucas said, “is the use of tilt (whether it is manual or power tilt) for decreasing posterior pelvic tilt. Allowing the person to tilt back 5° to 15° can decrease the negative effects of gravity on an individual’s posture. Gravity
will help keep the pelvis, trunk, and head back against the seating supports in a well-supported position. This tends to be a preferred position of stability and comfort while still allowing the person to complete safe, functional activities.
“This position can also decrease pain and increase sitting tolerance throughout the day. For an individual with a non-reducible thoracic kyphosis, this position can increase the person’s visual field and reduce the need to go into a posterior pelvic tilt to achieve a forward line of sight.”
Shear is always a concern during repositioning, so Lucas said, “When considering the use of a recline system, care should be taken in order to limit friction and shear on the buttocks and back of the client. Using recline by itself may rotate the pelvis posteriorly, and the buttocks/back can slide on the backrest and seat cushion. Tilt should be used prior to using recline, which will utilize gravity to keep the pelvis back and in a neutral position. When the person comes back up to an upright position, they should recline up
prior to tilting back up.
“These steps are vital in maintaining pelvic position and skin
integrity when using power positioning systems.”
And in helping to ensure posterior pelvic tilt is optimally
managed. m
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