Wheelchair Seating and Positioning Sarah Crosbie, MS.Ed, OTR/L

Seating Intervention: Postural Control and Deformity Management Abnormal tone, muscle weakness, primitive reflexes Abnormal tone, muscle weakness, primitive reflexes Cerebral palsy, multiple sclerosis, traumatic brain injury Cerebral palsy, multiple sclerosis, traumatic brain injury

Seating Intervention: Pressure Management Decreased sensation, decreased ability to relieve pressure Decreased sensation, decreased ability to relieve pressure Spinal cord injury, muscular dystrophy, frail elderly Spinal cord injury, muscular dystrophy, frail elderly

Goals of Seating and Positioning Overall goal is to maximize function Overall goal is to maximize function

Goals Seating and Positioning Promote Posture Posture Normalize or decrease the influence of abnormal tone and reflexes on the body Normalize or decrease the influence of abnormal tone and reflexes on the body Maintain neutral skeletal alignment and range of motion to prevent deformity or muscle contracture Maintain neutral skeletal alignment and range of motion to prevent deformity or muscle contracture

Goals Seating and Positioning Promote Skin Integrity Skin Integrity Prevent tissue breakdown Prevent tissue breakdown

Goals Seating and Positioning Promote Comfort Comfort Increase comfort and tolerance of desired position Increase comfort and tolerance of desired position Decrease fatigue Decrease fatigue

Goals Seating and Positioning Promote Physiological Function Physiological Function Enhance respiratory Enhance respiratory Oral motor Oral motor Digestive function Digestive function

Goals Seating and Positioning Accommodate Deformity Deformity Incorporate a design that accommodates for the problem rather than trying to affect a change in the physical status of the users Incorporate a design that accommodates for the problem rather than trying to affect a change in the physical status of the users

Goals Seating and Positioning Enable Limb function Limb function Facilitate components of normal movement in a developmental sequence Facilitate components of normal movement in a developmental sequence Maximize stability to enable function Maximize stability to enable function Vision - positioning can aid in a providing a posture that brings eyes to midline Vision - positioning can aid in a providing a posture that brings eyes to midline Oral motor - correct posture to allow for increased ability to feed, swallow. Oral motor - correct posture to allow for increased ability to feed, swallow.

Goals Seating and Positioning Enhance Cosmetic appearance Cosmetic appearance Social acceptance Social acceptance Social interaction Social interaction Self esteem Self esteem

Optimal Seating Position Pelvis Pelvis Trunk Trunk Support natural curves Support natural curves Lower Extremities Lower Extremities Knees Knees Ankles 90 Ankles 90 Upper Extremities Upper Extremities Shoulder flex 30 Shoulder flex 30 Elbow flex 60 Elbow flex 60 Head Head

Supports Contacts against the body that Contacts against the body that Provide a stable surface Provide a stable surface Distribute weight Distribute weight Maintain desired position Maintain desired position Reduce extraneous movement Reduce extraneous movement Block reflex patterns Block reflex patterns Decrease tonal influences Decrease tonal influences

Evaluation of the System Does the system meet the user’s goals? Does the system meet the user’s goals? Does the system provide stability and allow for maximal performance in functional activities? Does the system provide stability and allow for maximal performance in functional activities? Is the system comfortable? Is the system comfortable? Is the system durable enough to meet the user’s needs? Is the system durable enough to meet the user’s needs? Can the system be financed by the user or third party payer? Can the system be financed by the user or third party payer?