Page 19 - Mobility Management, July/August 2021

digestion, respiration and elimination being affected. So just by allowing these asymmetries to become habitual and eventually obligatory, we start to see that affects so many areas.”
24-Hour Support
for Consistency
One major goal of managing posture around the clock is to maintain the optimal positioning that clients expe- rience while in their wheelchairs. Maintaining postural support in bed or during a hygiene regimen works to carry over the positioning achieved in the wheelchair.
“We’re trying to avoid fixed-deformity postures, especially in the pediatric population,” Rhodes said. “They may present with very low tone, and if not supported appropriately, that could result in shortening of the muscles also known as contracture onset, or they may fluctuate in tone that will move them out of midline if not provided with appropriate support, also resulting in permanent deformities
if not supported correctly. For those with low tone, we can provide appropriate support and get them into a neutral and safe position where they aren’t getting pressure sores or contractures that result in asymmetrical postures.
“For those with fluctuating tone, espe- cially those commonly presenting with extensor tone patterns, we can provide dynamic seating options that allow the seating system to ‘give’ enough to allow the individual to return back to a safe position during those fluctuations.”
Bollinger pointed out the need to also make sure the positioning supports what- ever activities the client is performing. “The goal for me is always to capture and create good alignment early on,” she said. “So what’s the optimal position lying down, what’s the optimal positioning in sitting, what’s the optimal position in standing? We need to look at the orienta- tion and try to create the body ‘neutral’ in those positions.
“Notoriously, we have had seating systems for toileting where we have an
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