Page 6 - Seating & Positioning Handbook, 2022-2023

ATP Series
All About Asymmetries
dive more into the anatomical reasons why there’s an asymmetrical posture, how long it’s been there, if it’s reducible or not reducible, all of those kinds of things. But that would be something that almost any wheelchair evaluation should follow and go into.
“I think it ties back into their goals, and it’s going to be different for each person. How reducible is it, and how much do they tolerate a new change in position, for example? And then what I look at, especially when you start talking about applying secondary postural supports, is — when I support them in what maybe is the ideal position, what happens to their function? Because sometimes they’re used to a position and they’re func- tioning in that position. If I change it too much, maybe now they lose function, which is the last thing we want to see.”
As for when asymmetrical postures become problematic, Giles said, “Where it becomes pathological for our wheelchair users
is when it’s always one way. Able-bodied people will lean one way, and then lean the other way. We get uncomfortable in one position], so we go to another position. We might lean forward or we might lean back.
“But in the wheelchair user population a lot of times, why they [demonstrate] a certain level of asymmetry is disability related. They had surgery, they had a hemipelvectomy, they had a [surgical] fusion. That creates the propensity towards an
asymmetry in one specific direction.”
And since that asymmetry takes place in the same specific
direction, Giles added, that asymmetrical position becomes the new norm. “When it’s consistent and persistent in a single direc- tion, the tissues will accommodate to that,” she said. “The joint capsule gets tight. Range of motion, muscles, ligaments — every- thing changes, and they lose the ability to go through midline to the other side. This is pathological. This is asymmetry that is not okay and that we need to look at.”
Understanding Fixed vs. Flexible
When discussion turns to whether an asymmetrical posture should be accommodated or corrected, Giles said it’s important to understand what a “fixed” posture truly is.
Ride Designs’ philosophy, she explained, is that joints or body segments shouldn’t be considered fixed “unless they do not move at all. In the description that we were talking about — consistent and persistent one way versus the other way — oftentimes, we will look at a joint, and we will say, ‘Does it correct?’ If someone’s got a left pelvic obliquity, can we correct it towards neutral or through neutral?
“If it doesn’t correct or it’s really stiff, we might say, ‘That’s a fixed pelvic obliquity.’ But that’s erroneous, because most of the
SAM HANNAH: WHY PRECISE POSITIONING MATTERS
If life is a game of inches, then Complex Rehab Technology is an industry of fractions of inches (or mere millimeters).
Mobility Management asked Sam Hannah — now the CEO of Symmetric Designs, and formerly an ATP with Motion (Specialties) — about the importance of precise positioning, especially for wheel- chair riders with asymmetrical postures.
Why is it important to be able to position supports such as headrests and shoulder straps exactly where the clinician wants them to be? And what are the potential advantages or benefits of being able to fine-tune positioning components in that way?
Support Where the Client Needs It
“The upper straps of a trunk positioning harness should be positioned for even pressure distribution and to reduce the risk of the harness shifting up or left/right,” Hannah said. “A shifting shoulder harness can result in an increased client risk of stran- gulation, interference with tracheotomies, trunk instability and general discomfort.”
He added that the position of the harness should not be dictated by backrest or hardware capabilities: “Shoulder harness positioning should not be limited to the ability of the backrest
to accommodate the mounting of buckles or clips. Proper trunk positioning and support is crucial to the client’s overall stability and upper-body function. Having the ability to independently position the left- and right-side shoulder harness straps can improve the ability to accommodate asymmetries. With a range
of adjustment, trunk positioning accessories are critical factors in improving functions such as breathing, digestion, speech and swallowing.”
And Hannah said the same principle applies to head positioning. “The position of a headrest or head positioning device should not be dependent on where the headrest receiver is mounted on the backrest. For example, in a client with a scoliotic posture, it is common for the headrest to be offset in relation to the backrest to provide accurate support. Asymmetrical positioning of headrests is often needed to improve vision, breathing and swallowing. Having a range of adjustment allows the clinician
to more accurately fit the entire
seating system to each client’s
unique needs, initially and for the
future as needs evolve.” m
Editor’s note: Check out Symmetric Designs’ new Strapparatus, which “provides versatile mounting options for shoulder harness buckles” and also functions as a strap guide so seating teams can place shoulder harness straps “exactly where they need to” — symmetric-designs.com.
Strapparatus
6 SEATING & POSITIONING HANDBOOK 2022-23 | MOBILITY MANAGEMENT MobilityMgmt.com