Page 8 - Seating & Positioning Handbook, 2021-2022

ATP Series
Positioning the Extremities
HOW SUPPORTING ARMS & LEGS CAN YIELD GREAT FUNCTIONAL BENEFITS By Laurie Watanabe
IF THE PELVIS IS THE FOUNDATION OF FUNCTIONAL height or length or width wasn’t considered. A tray platform
wasn’t considered. It’s a ripple effect.”
Upper-Extremity Positioning Goals
So what are the priorities when positioning a wheelchair user’s upper extremities?
Tina Roesler, PT, MS, ABDA, is Director of Clinical & Business Development at Bodypoint.
“It depends on the client,” she said. “If I’m looking at someone to drive power controls, for example, I’m going to look at what maxi- mizes their stability so they can still use what function they have to reach the joystick or manipulate the joystick, and what position helps them maintain that. Say they have tilt in space or recline: You don’t want them to lose that position when they tilt the chair back so they can’t reach the joystick to untilt, for example.
“I think we’ve done better at looking at that and discussing that. I think with some of the higher levels of [spinal cord] injury that need total arm support, I think we’re doing much better.”
positioning in a wheelchair, then how do the upper and
lower extremities impact optimal positioning?
“The arms are so important,” said Gabriel Romero, VP of Sales
& Marketing for Stealth Products. “People always go straight
to the pelvis, but a lot of other things dictate what the pelvis is going to do. The arms are like wide pillars — they [can be] folded in front for good frontal support, or pushed to the side so they can give good lateral support. You really have to figure out what’s the best solution for them.”
Failure to optimally position the upper extremities, Romero added, can lead to other positioning problems. “I’ll see a non-funded or a more basic chair, and I’ll see the person’s kyphotic positioning just due to armrests not able to be adjusted, or arm pads not being wide enough. When adults start losing strength, or children don’t have strength, they’re going to go wherever their arms take them. You’ll start to see shoulder dipping, you’ll start to see head tilting because an armrest’s
8 SEATING & POSITIONING HANDBOOK 2021-22 | MOBILITY MANAGEMENT MobilityMgmt.com
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