1. 15/2/101 Posture and Seating Physiotherapy Occupational Therapy

2. 15/2/102 Aims and Objectives To have understanding of what posture is and relate theory to positioning of neurologically impaired patient in sitting. To have an awareness into correct position in sitting and be confident in identifying potential problems. To understand and identify how poor posture & seating affects function.

3. 15/2/103 To enhance understanding of correct seating to prevent further complications. Raise awareness of specialist/dynamic seating on ward and support features available and how to utilise. Pressure care precautions and relation to seating of patients on ward. Aims and Objectives

4. 15/2/104 What is good posture?

5. 15/2/105 Correct posture!!! a)pelvis b)thighs c)feet d)knees e)trunk f)weight of arms g)head

6. 15/2/106 Why is Posture Important? A dynamic posture must be able to: Accept and move around base of support Align the body to prevent deformity or pain Maintain joints in appropriate positions Adjust to changes in the body or support

7. 15/2/107 Why is positioning and seating important To facilitate correct alignment of trunk and head To allow strengthening of trunk muscles To enhance and reinforce recovery of function To restore /maintain a functional posture To decrease tone –Reduce excessive activity in unaffected side –Reduced risk of developing shortening of affected side To aid lung function To protect vulnerable soft tissues from pressure

8. 15/2/108 Problems following a stroke Significant motor and sensory loss Changes in tone leading to high or low tone Cognitive and perceptual deficits Visual and/or spatial neglect or inattention Speech and communication difficulties

9. 15/2/109 Different postures and positions have a direct influence on tone and movement. What have you seen? Positioning of neurologically impaired patients

10. 15/2/1010 Positioning of neurologically impaired patients Incorrect positioning may lead to malalignment: –rotation of the pelvis relative to the trunk –lateral flexion of trunk –windswept lower limbs –unilateral hip adduction –abduction of opposite hip –bilateral knee flexion –shoulder retraction, internal rotation and adduction –extremes of elbow wrist and finger flexion

11. 15/2/1011 How bad posture affects function Give it a go!! Slump down in your chair Independence within daily tasks -Feeding -Washing and dressing -Transfers Social interaction Increased fatigue

12. 15/2/1012 Principles for appropriate chair provision Back rest Seat width Seat depth Arm rest height Seat height

13. 15/2/1013 Specialist seating This type of seating is required for those who have limited ability to make small changes in movement.

14. 15/2/1014 Specialist/Support Features Tilt in Space Back angle recline Elevating foot/leg rest Raise facility Lateral support Head support Hip straps Calf straps Tray Arm rest Pressure relief Upholstery

15. 15/2/1015 Pressure Care Posture in both lying and sitting can effect development In sitting the predominant sites for pressure sores are - Ischial tuberosities - sacro-coccygeals - trochanters - Lateral malleolus

16. 15/2/1016 Pressure and Seating Important factors to consider: level of sensation ability to relieve pressure shear forces continence period of time in chair

17. 15/2/1017 Standard Chair –Apply principles of good seating –consider effects of pressure relief on posture Chairs Locally

18. 15/2/1018 Specialist Chairs Stroke Rehabilitation Very adjustable

19. 15/2/1019 Wheelchair/Electric wheelchair Mobile Adjustable Assessment required

20. 15/2/1020 Practical session Groups of 6 What’s wrong with the person’s posture in the photo - discuss Feedback to the whole group

21. 15/2/1021 Posture 1 Discuss:- What is wrong with this person’s posture – relating to what you know about problems following a stroke? What would you need to consider when providing a chair for this person? What chair would you provide, what features would you use, would you provide a cushion? What would be your plan for the person sitting out?

22. 15/2/1022 Posture 2 Discuss:- What is wrong with this person’s posture – relating to what you know about problems following a stroke? What would you need to consider when providing a chair for this person? What chair would you provide, what features would you use, would you provide a cushion? What would be your plan for the person sitting out?

23. 15/2/1023 Posture 3 Discuss:- What is wrong with this person’s posture – relating to what you know about problems following a stroke? What would you need to consider when providing a chair for this person? What chair would you provide, what features would you use, would you provide a cushion? What would be your plan for the person sitting out?

24. 15/2/1024 Any Questions?