2. Dedicated to seating and mobility solutions
Assist wheelchair users in achieving their goals
Respect lifestyle, function, posture, skin protection
Provide simple, effective and safe seating solutions
Invacare Matrx Seating objectives
Encourage postural stability and allow for functional movement
Promote activity and support healthy resting postures
Work for optimal support and pressure distribution
Use additional external components only as needed.

3. Invacare Matrx Guiding Principles
Consider breathing and swallowing
Secondary complications: tissue trauma, pain, deformities, and contractures
A full evaluation
The position of the pelvis directly impacts the spine (and head, extremities)
The pelvis is the foundation for seated function
Determine if a posture is fixed or flexible
Test seating solutions in motion

4. POSTERIOR PELVIC TILT WITH KYPHOSIS

5. POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS
CLINICAL
Presentation
Hyperextesion of neck to elevate head
Shoulder blades slide forward and apart, impeding shoulder elevation
Flattened lumbar spine and hyperkyphosis of the thoracic spine
IT’s slide forward
Pelvis tilts posteriorly resulting in increased load on the sacrum

6. POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS
Potential Causes Wheelchair fit Seat depth too long/short Foot rest too high/low Inadequate support for sacrum In manual wheelchair, hard to reach wheels Seat-to-floor height too high/low Clinical High or low tone in upper body Limited hip flexion (< 90 degrees ) Weak muscles: abdominals/back extensors Shortened/tight hamstrings Lack of balance/postural control

7. POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS
POTENTIAL
Solution
Flexible
posture
Possible use of harness
Possible use of table/tray
Stable back support that stabilizes the pelvis at the PSIS
Contoured cushion helps stabilize the pelvis in a neutral position
Place a positioning belt beneath the ASIS or across thighs

8. POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS
POTENTIAL
Solution
Fixed
posture
Use tilt to increase trunk extension and improve visual field
Provide a contoured back to match shape of spine
Utilize lateral support for increased immersion and pressure distribution
Contoured cushion to support the pelvis
If hip flexion is limited, open the back angle and/or adjust the cushion to achieve a level pelvis

9. ANTERIOR PELVIC TILT WITH HYPERLORDOSIS

10. ANTERIOR PELVIC TILT WITH HYPERLORDOSIS
CLINICAL
Presentation
Trunk overextended to prevent forward collapse
Possible that shoulder blades are pulled tightly together to maintain an upright position, limiting arm function
Increased lumbar curve and decreased contact with the back support
Pelvic to thigh angle less than 90 degrees
Pelvis tilted anteriorly (forward)

11. ANTERIOR PELVIC TILT WITH HYPERLORDOSIS
Potential Causes Wheelchair Fit Back support too upright Excessive lumbar contouring Clinical Tight quadriceps/hip flexors Weak abdominal musculature Obesity

12. ANTERIOR PELVIC TILT WITH HYPERLORDOSIS
POTENTIAL
Solution
Flexible
posture
Consider a chest-belt or harness
Make small, gradual changes to seat and/or back angle to reposition the pelvis and spine into a neutral position
Lower back support to tailbone to balance curvature of the lower spine

13. Extra foam insert can be added to increase contact and contour
ANTERIOR PELVIC TILT WITH HYPERLORDOSIS
POTENTIAL
Solution
Fixed
posture
Extra foam insert can be added to increase contact and contour
Angle back support forward to compensate limited hip extension
Lower rear seat height to help balance the trunk over the pelvis in an upright position

14. PELVIC OBLIQUITY AND SCOLIOSIS

15. PELVIC OBLIQUITY AND SCOLIOSIS
CLINICAL
Presentation
One shoulder often higher on the weightbearing side
The spine is influenced by pelvic asymmetry, resulting in a scoliosis.
The lumbar curve will be convex on the oblique (lower) side of the pelvis
Palpation of the Iliac crest reveals that one side of the pelvis is lower than the other
Increased risk for pressure sore on lower IT

16. PELVIC OBLIQUITY AND SCOLIOSIS
Potential Causes Wheelchair fit Sling or stretched seat upholstery Seat width too wide and/or arm supports too low Cushion does not offer adequate support/contouring Back angle does not accommodate for limited hip flexion Back support too wide Clinical Pain Issues with muscle tone/weakness Limitations of hip movement Scoliosis

17. PELVIC OBLIQUITY AND SCOLIOSIS
POTENTIAL
Solution
Flexible posture
Lateral trunk supports can be used to provide 3 or 4 points of support
Alternate approach – Deep contoured back with built-in support
Lateral support
Lateral support
Lateral support
Build up the cushion under the lower IT to balance obliquity

18. PELVIC OBLIQUITY AND SCOLIOSIS
POTENTIAL
Solution
Fixed
posture
Backrest must be deep enough to support the trunk and may have to be mounted in a rotated position
Build up under the higher IT to balance weightbearing

19. PELVIC ROTATION

20. PELVIC ROTATION
CLINICAL
Presentation
One ASIS and hip is further forward in the seat
One hip is usually abducted and externally rotated
One hip is usually adducted and internally rotated
Note that asymmetry in the forward position of the knees can also be due to leg length discrepancy or a dislocated hip

21. PELVIC ROTATION
Potential Causes Wheelchair fit Poor wheel placement on manual chair Seat-to-floor height too high for foot propulsion Clinical Limited hip flexion, abduction, adduction Leg length discrepancy and/or dislocated /subluxed hip Unable to reposition after foot propulsion

22. PELVIC ROTATION
POTENTIAL
Solution
Flexible posture
In order to maintain a functional head and shoulder position, you may need to allow for some asymmetry in the pelvis
Contoured cushion helps stabilize the pelvis in a neutral position
Align the pelvis and lower the backrest to stabilize at the PSIS level.
A pelvic positioning belt can help maintain hip alignment

23. PELVIC ROTATION
POTENTIAL
Solution
Fixed
posture
Positioning the backrest so that it follows the contours of the pelvis will increase the surface contact area, give more support, and help prevent further rotation.
Consider using a cushion that can be adapted to accommodate functional leg length discrepancy

24. HIP ABDUCTION

25. HIP ABDUCTION
CLINICAL
Presentation
Movement of the femur away from midline
Can be on one or both sides
Legs are wide apart –
Can cause pressure against legrests.

26. HIP ABDUCTION
Potential Causes Low or high tone Shortened abductor muscles Obesity Inadequate seat depth Seat width too wide Posterior tilt in pelvis

27. HIP ABDUCTION
POTENTIAL
Solution
Flexible: Use a contoured cushion to support the pelvis in a neutral position.
If needed, use additional lateral support to realign the femurs
Fixed: Adapt a contoured cushion so that it conforms to the user’s posture. Modify the wheelchair configuration to prevent secondary pressure issues.

28. HIP ADDUCTION

29. HIP ADDUCTION
CLINICAL
Presentation
Movement of the femur toward the midline

30. HIP ADDUCTION
Potential Causes Hammock effect from sling upholstery High tone Shortened/overactive hip adductors Anterior tilt in pelvis

31. HIP ADDUCTION
POTENTIAL
Solution
Flexible: Use a contoured cushion that enhances abduction
Fixed: Modify abductor height to prevent pressure build up between knees
Cushion ridgidizer contoured to eliminate “hammock effect” of sling upholstery