Page 4 - Seating & Positioning Handbook, 2022-2023

ATP Series
Does asymmetry get a bad rap? If a person’s posture isn’t identical — left side vs. right — is that always detrimental? Or are asymmetrical postures sometimes
misunderstood?
Daniela Giles, PT, DPT, ATP/SMS, is Clinical Educator at Ride
Designs. “Asymmetry in itself is not pathological,” she said. “Asymmetry is required. Able-bodied people use asymmetry all the time. We use it for stability. We use it to relax and stay in a certain position. If we all sit in perfect symmetry, one — we usually can’t rest. And two, we usually can’t do anything effectively.”
Think about your last Zoom call and the number of times you crossed and uncrossed your legs as the minutes ticked by.
“We need [asymmetrical postures] for passive stability, and then we need it actively for power and control,” Giles said. “We use the example of a pitcher, or a soccer [player] getting ready to kick. They’re going to wind up into the most asymmetry possible to create power when they release through those ranges.”
In that same way, a wheelchair rider might find an asymmet- rical posture to be functional. “Sometimes, the asymmetry is very helpful,” Giles said. “They like it, and they don’t want to change.”
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Asymmetries & the Seating Assessment
Of course, just because an asymmetrical posture is helpful doesn’t necessarily mean it’s sustainable. Therefore, Giles said that carefully observing what the client does and says during the seating assessment is crucial.
“Any good assessment starts with listening,” she explained. “It’s a listening, listening, listening, patient-centered model. We’re not just looking at asymmetry and making a change arbitrarily. [Changes] are related to what they say, and what they need, and what their environment entails.
“We have to listen to the body as well. When I’m observing, I’m listening to their body and their movements. Listening would also include getting the detailed medical history. Whether you’re reading that history or it’s been given to you, you really have to try to gather that big picture, and that comes through listening. We always have to start with that.”
Tina Roesler, PT, MS, ABDA, Director of Clinical and Business Development at Bodypoint, agreed that getting a comprehensive medical history is important.
“I wouldn’t address an assessment with someone with asymmet- rical posture any differently at the beginning,” she said. “I might
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