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Upper Body Positioning

Positioning the head correctly is vital, but weak trunk muscles could mean that an individual trying to reach. For example to fulfil normal daily activities, might not be able to return to a neutral balanced position.

Hence dynamic secondary supports such as harnesses are valuable aids, providing a certain degree of elasticity, thus assisting the torso to return to a neutral position. It is also important to provide posterior and lateral support to clients with poor trunk control. Back and lateral supports provide the essential posterior and lateral positioning control. 

For more information or a for a quote contact HIA at sales@hiaus.net.au

Upper Body

Trunk Kyphosis

Assessment

Trunk Kyphosis shows forward flexion of the upper trunk, usually thoracic area. Lumbar flexion, commonly with posterior pelvic tilt. Shoulders protracted. Little contact with the back support, and the individual may have to hyperextend neck to see straight ahead. 

Causes

Wheelchair issues: seat to back angle too close for available range of motion and inadequate support to prevent postural collapse.

Physical conditions: flexible or fixed kyphosis of the spine, posterior pelvic tilt, tight hamstrings, tight hip flexors, low tone in trunk, and muscle weakness.

Anterior Support

The goal of the anterior trunk support is to extend the trunk and retract the scapulae, reducing the kyphosis. This aligns the trunk over the pelvis, improves respiratory capacity, increases safe swallowing, improves head control, maintains a good visual field, and improves overall pressure distribution.

Solutions

Trunk Lordosis

Assessment
Hyper-extension of the spine, usually the lumbar area. Often seen in conjunction with anterior pelvic tilt. Shoulders retracted, and limited contact with the back support.


Causes
Wheelchair issues: Seat to back angle too closed so that the individual has to over-extend to remain upright, reversed biangular back, and inadequate support to prevent postural collapse.

Physical conditions: Flexible or fixed lordosis of the spine, tight hip flexors, increased muscle tone, low tone in trunk, muscle weakness, and “fixing” pattern to extend trunk against gravity.


Anterior Support
The goal of the anterior trunk support is to provide pressure to the sternum, reducing the lordosis and pelvic anterior tilt. This aligns the trunk over the pelvis and reduces shoulder retraction and fixing to facilitate function. If the individual is capable of active trunk flexion, dynamic support may allow more anterior movement for functional reach, while still providing stability and improved posture. For some users, reducing lordosis may require additional postural support at the lower ribs and abdomen.

Solutions

Trunk Scoliosis

Assessment

Lateral flexion of the spine, usually in the thoracic area., and can be C curve or S curve. Often seen in conjunction with pelvic obliquity, where shoulders are not level. Neck often flexed in the opposite direction to align visual field.

Causes

Wheelchair Issues - inadequate postural support to prevent postural collapse to the side, and inadequate lateral support. Uneven seating surfaces or a chair that is too wide for the user may cause the user to lean to one side to gain lateral or arm rest support.

Physical conditions: flexible or fixed lateral scoliosis of the spine, pelvic obliquity, increased and asymmetrical muscle tone shortening one side of the trunk, low tone in trunk, and muscle weakness.

Anterior Support

The goal of the anterior trunk support is to work in conjunction with appropriately placed lateral trunk and pelvic pads to align the trunk to midline. This allows the head to be level over the trunk for vision.

 

Solutions

Trunk Rotation

Assessment

Rotation of the spine, usually in the thoracic area. One can have double rotation, where a user with a rotated lower spine may rotate the upper spine in a compensatory posture, in order to face forward. This is often seen in conjunction with pelvic rotation, and can be seen in combination with scoliosis (rotational

scoliosis). One shoulder is usually forward or not in contact with the back support. 

Causes

Wheelchair Issues: inadequate postural support to prevent pelvic rotation and poorly fitted, contoured back support.

Physical conditions: pelvic rotation and increased and asymmetrical muscle tone shortening one side of the trunk.

Anterior Support

The goal of the anterior trunk support is to pull the forward shoulder back so that the trunk is aligned in the sagittal plane and the user can face forward without neck rotation for vision, swallowing, and breathing.

Solutions

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