Page 17 - Mobility Management, January/February 2020

MIDLINE MATTERS
HOW A DIFFERENT LOCATION
CAN IMPROVE FUNCTION
FOR SOME PWC USERS
BY LAURIE WATANABE
While much about complex rehab seating and positioning remains a mystery to those outside the industry, popular fitness movements such as CrossFit have made concepts of midline or core strength and stability part of mainstream conversation.
Take this excerpt from an Invictus Fitness post called “What Is Core to Extremity?” by Bryce Smith: “The core serves as a muscular corset that works as a unit to provide stability both with and without movement. All motions are generated from the core and translated to the extremities. Core to extremity means that the bridge that connects your upper body to your lower body is tight and secure with no loose ends and no broken beams. The midline is the bridge that allows efficient and safe force transfer.”
For complex rehab clients, core stability is crucial for function, such as the ability to sit in a position that enables them to propel a manual wheelchair. For power wheelchair users, core stability can make it possible to reach and effectively use a joystick or other type of driving control.
And for some power chair users, moving the driving control front and center — to midline, around the belly button — can make a huge differ- ence in function.
The Big Deal About Midline
Generally speaking, we have greater strength close to our bodies than farther away. Imagine lifting a gallon jug of water with one hand and extending your arm so the jug is at arm’s length from your body. Then imagine lifting that same jug, but keeping your arm and the jug close to your body, right around your midsection. Which position is easier to maintain and is less fatiguing?
The loss of distal strength — that is, strength farther away from the body — before the loss of proximal (closer to the core of the body) strength is common in some types of muscular dystrophy, for example. But Michael Flowers, CEO/President
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