Page 18 - Mobility Management, July/August 2021

ATP Series
By Laurie Watanabe
FOLLOW-THROUGH
Why Managing Posture in the Wheelchair Is Just Part of the Positioning Equation
It’s simple math: Even clients who spend many hours a day in their wheelchairs also spend many hours a day out of their wheelchairs.
Julie Harkness, a Sales Representative for Motion (formerly Motion Specialties), noted, “If [a wheelchair user] spends 12 hours in the wheelchair, then there’s an equal amount of time where that posture has the potential to be adversely affected by being in a position where it’s not supported.”
Ryan Rhodes, MS, OTR/L, ATP/SMS, Pediatric Sales Specialist for Leckey at Sunrise Medical, concurred: “I like to look at [the day] as a clock, as a big pie graph. How much of the time in a day are we really in our wheelchairs? It is quite a bit of time, but even 12 hours is only half of the day. Twenty-four-hour positioning
is really important for the carry-over of what we’re trying to address during our seating evaluation.”
When It’s Not the Wheelchair’s Fault
Harkness said when something goes wrong with a client using a wheelchair — a pressure injury, for example — wheelchair seating is immediately scrutinized. “My experience is that the minute anyone gets any skin breakdown, [people think] it’s the chair’s fault,” she said. “And at least 50 percent of the time, it’s not the chair’s fault. It’s the commode, it’s the sling, it’s how they’re lying in bed, it’s how they’re sliding down the bed.”
16 JULY-AUGUST2021|MOBILITYMANAGEMENT
Those unsupported hours can cause all kinds of problems. “I would say the bed is the biggest [problem] area, because most
of our clients spend at least 10 hours in bed,” Harkness noted. “People will put the head of the bed up and not put the feet of the bed up, and basically that creates a big slide. The tendency when you’re on a slide is to push with your heels, and that’s where you get heel breakdown.”
Unsupported hours in bed can eventually impact wheelchair seating needs.
“We see a lot of postural deformities that result from lying
in bed,” Rhodes said. “Oftentimes, we see somebody with a windswept deformity that’s a result of them always being on their backs with their knees bent and those knees always falling to
one side for an extended period of time. Once we sit them up, we can’t get those knees back to midline, so during the seating eval- uation, we have to accommodate that cushion and seating system for a windswept deformity.”
“What we know is that the body for some reason, whether
it be muscle tone or reflexes, creates asymmetries,” Bollinger said. “And then the body accommodates to those postures, and eventually that accommodation becomes a habit, and then it eventually becomes obligatory. And that is where we begin to see skeletal changes. We see contractures, and that’s where we start to see function being affected. We see bodily functions like
MobilityMgmt.com