Page 10 - Seating & Positioning Handbook, 2022-2023

ATP Series
All About Asymmetries
asymmetry? Or as minimal an asymmetry as possible?”
Next, “We try to maintain that alignment for fine-motor tasks,” Giles said. “Fine-motor tasks are ‘close to home’ — hair, makeup,
two-handed activities that are close to your body. We want to see them supported to where they can use both hands, and not have to shift and find a spot to sit [to be able to] pick up their elbow.
“And then, number three is everything else: Gross motor. What is the proper alignment for gross motor?”
At that point in her educational presentation, Giles said she pauses and waits for someone to say, “Well, what is the task? What is the thing that they have to do?”
“Because the position, the proper alignment, the best alignment is the alignment that gets the job done, and it may be drastically different” according to the task, she explained. “The example I use is it’s different to push uphill than to push downhill. Your body will be in a different alignment. And so, what we try to do [with the seating] is just stay out of the way and not limit it. When I provide the supports needed for rest and fine-motor [activities], I don’t want that to be so much that it blocks gross-motor tasks.
“That’s how we prioritize the three goals. We’re always balancing those three, and they may fluctuate within the indi- vidual throughout their lifetime.” m
DISTINGUISHING POSTURAL SUPPORTS FROM RESTRAINTS
Secondary postural supports — such as harnesses for the pelvis, chest, or shoulders of wheelchair riders — can look a lot like the seatbelts or shoulder harnesses in a car or airplane. That can cause confusion for consumers and caregivers who therefore expect them all to work the same way.
But secondary postural supports, especially those designed for clients with complex seating needs, are entirely different.
Very Different Functions
Tina Roesler, PT, MS, ABDA, is Director of Clinical and Business Development at Bodypoint.
She noted that seatbelts are “a safety device. It’s a restraint. It’s meant to hold you in, no matter what.”
Aside from a similar appearance, there is no real comparison, she added, between a safety belt and a wheelchair postural support. “They are completely different. Different purpose, different design, different testing. Our postural support belts are not crash tested because that’s not their intention. It is a postural support device, not a safety device.
“When it becomes just a safety device, it’s a restraint. When it’s meant to keep someone from performing a function, it becomes a restraint. If you’re using it to keep Grandma from getting out of her wheelchair at the nursing home, it’s a restraint. But if it allows Grandma to push with her feet and be safe, it’s now a positioning device. Some of it comes down to documentation as well.”
Providing Stability & Support
Roesler did acknowledge that optimally positioned postural supports can improve a wheelchair rider’s safety as a supple- mental benefit. “Inadvertently, secondary posture supports might make the person more safe in their chair. For example, a high tetraplegic with no trunk control will maybe wear a chest strap when they’re in their power chair, just to make sure they’re not going sideways. It increases their safety, but it also lets them function when they’re going over bumpy roads because they’re not falling out of their chair. So inadvertently, it also becomes a safety [product], but that’s not the primary focus.”
While some clients or caregivers might balk at the optics of using secondary postural supports — because the supports can
look like restraints — Roesler noted the positioning strategies
of wheelchair athletes. “They’re using tons of postural supports. And why is that? Because they want to be more stable. They want to be at the optimal functional level. Postural supports help to stabilize them. So if I’m a T2 [paraplegic] and I want to shoot
a basketball, I’m going to have both pelvic supports and chest supports, so I can shoot the basketball.”
Everyday Positioning Benefits
Even off the court or field of play, postural supports can lend much-needed assistance during everyday tasks.
“I’ve seen some people as they get older, maybe they’re wearing a pelvic positioning belt,” Roesler said. “Maybe they’ve had kids, for example, and they’re picking kids up. Maybe they’re a high [paraplegic], and if they didn’t have that strap and they picked up their child, they might fall. Whereas that strap helps facilitate those tasks they need to do, and maybe it changes over time for some people.”
Roesler suggested that adding postural supports can be helpful in a range of situations: “I assessed a girl who had [cere- bral palsy]. She was using a power chair, but she was playing wheelchair tennis not in a power chair. So we were assessing her for an ultralight [manual wheelchair]. She had a manual chair, but it had a full seating system on it that she didn’t need. She was 16: She wanted to go hang out with her friends, but she couldn’t because of transportation issues.
“So now she’s in a 14"-wide rigid chair, and she had an Evoflex pelvic positioning belt and another strap on her lower extremities in her tennis chair. Her reason for not using the [previous] manual chair was, ‘Oh, my legs fall out, and I have had a lot of tone.’
“My question was why aren’t we using the same [positioning] devices on her everyday chair? And now she uses the Evoflex. She pushes her manual chair much more than she did before. She could go out with her friends, and she feels pretty confident in it, and her parents do also. So it was more of a stability issue than a safety issue. It wasn’t even extreme positioning. It was just a positioning belt and a leg strap. But sometimes that jump from activity to everyday... people don’t make that jump without someone pointing it out to them.” m
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