Page 9 - Seating & Positioning Handbook, 2022-2023

years ago, I knew [a therapist] who always put a backrest up 2" higher because it allowed the straps on the harness to be in the right place. But then inadvertently, if the person had upper-ex- tremity motion, their motion was blocked because the backrest was so high. But [the therapist thought] it was more important that the harness be in the right position.
“With things like [Bodypoint’s] Strap Guides, you could have an appropriately positioned, super-low back, but still have a harness in the right position, and their upper extremities would still be free to move throughout the range of motion.”
Roesler also explained the fine-tuning ability of today’s postural supports: “Most of our harnesses are called multi-direc- tional harnesses. So I can choose whether I want the pull to be forward or rearward. In some cases, if someone’s really asymmet- rical, maybe I want one rear so I can pull harder posteriorly and one forward just to do adjustments. So you have that versatility with a lot of our harnesses as well.
“And the same thing when you’re choosing the pull for a pelvic belt: Do I want it to be a rear pull, front pull, or a center pull? Center pull is obviously most standard. It’s one pull, one direc- tion. But if I have someone who’s really asymmetrical and I really want to control the pelvis, maybe I need something that I can
pull backwards. We actually call it a front pull, or pull forward to correct that pelvic obliquity.”
Secondary postural supports give seating teams another layer of positioning intervention. “You want the right kind of control with the secondary postural supports,” Roesler said. “And again, without [the supports] being restraints. You’re not trying to tie someone in the chair. You’re trying to still facilitate what func- tion they might have, and hopefully help reduce or slow down the progression of an asymmetrical posture. We know that it’s not usually possible to completely eliminate that asymmetrical posture or stop it without surgery or things like that, but we do want to try to control it or slow it down if we can.”
The Tasks Riders Perform in Their Wheelchairs
When creating the optimal seating system, Giles said her strategy is to list what the client needs to do in the wheelchair — “They push, transfer, rest, sleep, cath” — and then classify those activi- ties as rest, fine motor, or gross motor.
“Rest is always the number-one goal,” she noted. “We are looking for a position where they can release their muscles and still stay in alignment. Can I provide support systems and support surfaces to allow them to rest and not go into
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MobilityMgmt.com MOBILITY MANAGEMENT | SEATING & POSITIONING HANDBOOK 2022-23 9 Untitled-37 1 9/26/22 1:05 AM