Page 9 - Seating & Positioning Handbook, 2021-2022
P. 9

Removing the Stigma of Secondary Postural Supports
While rolling in their wheelchairs, consumers can be displaced from their optimal positions by even minor jostling.
Tina Roesler, PT, MS, ABDA, Director
of Clinical & Business Development for Bodypoint, recently moved back to the United States after years abroad. “Having lived in Europe the last five years, and watching people go over cobblestones, I’ve seen it, even with manual chair users — their feet slipping off the footplates,”
she said. Those changes in position can require wheelchair users to frequently stop to reposition themselves, which can be time consuming and tiring.
That’s where secondary postural supports, such as hip belts and chest harnesses, can be helpful, Roesler acknowledged.
“If they’re constantly having to be repositioned or repositioning themselves, that will definitely fatigue them a lot,” she said. “I see, especially with Bodypoint, users choosing to use a chest strap like our Monoflex, or something even more aggressive, like a chest harness when they’re on different surfaces. It depends on what level of control they have and how much, if any, trunk control they have.”
But as helpful as secondary postural supports can be, not all wheelchair users are fans.
“Sometimes I think [the supports] could be used better, but people are reluctant to put something on the front of their bodies that makes them seem more disabled, or that they need more help,” Roesler said.
Her response: “I’m a big proponent of ‘Even if you don’t think you need it all the time, this kind of postural support can really benefit you, maybe even during certain activities.’”
And Roesler encourages reluctant clients to think of secondary postural supports as a tool — possibly one that’s used only in certain circumstances.
“I also use the sports analogy, because when you look at people in sports, even if they’re high-level injuries, like power soccer, you have all these people with
secondary postural supports. And what are they using them for? They’re using them to maximize posture and maximize their personal performance or function in that sport. So I always think about How do you apply these things in sport, and could you apply these in everyday use in a way that the person would be accepting of it?”
So if a client is hesitant to use a secondary postural support because they’re sensitive to how they’ll be perceived, using the support “can be activity based; it doesn’t always have to be applied,” Roesler said. “The [Bodypoint] Evoflex belt has straps — you can take that off and push it down to the side so you can’t see it when you’re not using it. And then you can pull it back up — easily access and reattach it if you need to.”
Describing postural supports as tools to be used when needed — and pointing out that elite wheelchair athletes use postural supports, too — might help consumers to rethink their usage.
“A lot of people are resistant to it in everyday use, yet you see them in a sports chair, and they’re using three or four different postural supports and a backrest that are really benefiting them,” Roesler said. “But they don’t understand how to transfer that to their every day.” m
The priorities are much different, Roesler said, for clients using ultra- lightweight wheelchairs: “When you start thinking about someone who’s self propelling, it’s not necessarily posi- tioning per se of the upper extremities, but the position of the shoulder and
the upper extremity relative to the chair and the rest of the body. So basic biomechanics come into play. While we might not be positioning them stat- ically, we want to be sure the shoulders are in a more neutral position, and that there’s not too much external rotation or extension happening during propul- sion. All of that comes into play when you start talking about the trunk and the pelvis. You’re reducing repetitive stress and strain by having the best biomechanics at the upper extremity.”
The stability and positioning of
the trunk and pelvis directly impact upper-extremity function, Roesler said.
“I’m sure you’ve heard the old adage that proximal stability promotes distal function,” she explained. “So I think that’s why there’s so much focus on the pelvis and trunk: If I don’t have that stabilized, I can position the arms the best that I can, and [clients] still might not be able to function with their upper extremities properly.”
A stable pelvis and trunk, she added, allows the wheelchair user “to initiate control, to initiate movement at the upper extremity without falling over or being in an awkward position.”
And even when the arms aren’t being used to propel or operate the wheel- chair — for example, with dependent mobility, when a caregiver is pushing the wheelchair — those upper extrem- ities still need to be supported, Romero added. If arms are left unsupported, “Now we have to talk about shoulder pain management, because for the longest time, somebody’s arms might have been hanging, unpositioned. So now you have joint pain.”
Positioning Goals
The need for functional upper extrem- ities seems pretty obvious: Arms and hands perform many activities of daily living, and they often operate the

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