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.

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

POSTERIOR PELVIC TILT WITH KYPHOSIS

Hyperextesion of neck to elevate head

Shoulder blades slide forward and apart, impeding shoulder elevation

IT’s slide forward

Flattened lumbar spine and hyperkyphosis of the thoracic spine

Pelvis tilts posteriorly resulting in increased load on the sacrum

POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS

CLINICAL Presentation

Potential Causes

Wheelchair fitSeat depth too long/shortFoot rest too high/lowInadequate support for sacrumIn manual wheelchair, hard to reach wheelsSeat-to-floor height too high/low

Clinical High or low tone in upper bodyLimited hip flexion (< 90 degrees )Weak muscles: abdominals/back extensorsShortened/tight hamstringsLack of balance/postural control

POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS

Possible use of harness

Possible use of table/tray

Contoured cushion helps stabilize the pelvis in a neutral position

Stable back support that stabilizes the pelvis at the PSIS

Place a positioning belt beneath the ASIS or across thighs

POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS

POTENTIAL Solution

Flexibleposture

POTENTIAL Solution

Flexibleposture

Use tilt to increase trunk extension and improve

visual field

Contoured cushion to support the pelvis

Provide a contoured back to match shape of spine

Utilize lateral support for increased immersion and pressure distribution

If hip flexion is limited, open the back angle and/or adjust the cushion to achieve a level pelvis

POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS

POTENTIAL Solution

Fixedposture

POTENTIAL Solution

Fixedposture

ANTERIOR PELVIC TILT WITH HYPERLORDOSIS

Trunk overextended to prevent forward collapse

Pelvic to thigh angle less than 90 degrees

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

Pelvis tilted anteriorly (forward)

ANTERIOR PELVIC TILT WITH HYPERLORDOSIS

CLINICAL Presentation

Potential Causes

Wheelchair FitBack support too uprightExcessive lumbar contouring

Clinical Tight quadriceps/hip flexorsWeak abdominal musculatureObesity

ANTERIOR PELVIC TILT WITH HYPERLORDOSIS

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

Consider a chest-belt or harness

ANTERIOR PELVIC TILT WITH HYPERLORDOSIS

POTENTIAL Solution

Flexibleposture

POTENTIAL Solution

Flexibleposture

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

Extra foam insert can be added to increase contact and contour

ANTERIOR PELVIC TILT WITH HYPERLORDOSIS

POTENTIAL Solution

Fixedposture

POTENTIAL Solution

Fixedposture

PELVIC OBLIQUITY AND SCOLIOSIS

One shoulder often higher on the weightbearing side

Increased risk for pressure sore on lower IT

Palpation of the Iliac crest reveals that one side of the pelvis is lower than the other

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

PELVIC OBLIQUITY AND SCOLIOSIS

CLINICAL Presentation

Potential CausesWheelchair fitSling or stretched seat upholsterySeat width too wide and/or arm supports too lowCushion does not offer adequate support/contouringBack angle does not accommodate for limited hip flexionBack support too wide

Clinical PainIssues with muscle tone/weaknessLimitations of hip movementScoliosis

PELVIC OBLIQUITY AND SCOLIOSIS

Lateral trunk supports can be used to provide 3 or 4 points of support

Alternate approach – Deep contoured back with built-in support

Build up the cushion under the lower IT to balance obliquity

Lateral support

Lateral support

POTENTIAL Solution

Flexible posture

POTENTIAL Solution

Flexible posture

Lateral support

PELVIC OBLIQUITY AND SCOLIOSIS

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

POTENTIAL Solution

Fixedposture

POTENTIAL Solution

Fixedposture

PELVIC OBLIQUITY AND SCOLIOSIS

PELVIC ROTATION

One hip is usually abducted and externally rotated

Note that asymmetry in the forward position of the knees can also be due to leg length discrepancy or a dislocated hip

One ASIS and hip is further forward in the seat

PELVIC ROTATION

One hip is usually adducted and internally rotated

CLINICAL Presentation

Potential Causes

Wheelchair fitPoor wheel placement on manual chairSeat-to-floor height too high for foot propulsion

Clinical Limited hip flexion, abduction, adductionLeg length discrepancy and/or dislocated /subluxed hipUnable to reposition after foot propulsion

PELVIC ROTATION

A pelvic positioning belt can help maintain hip alignment

In order to maintain a functional head and shoulder position, you may need to allow for some asymmetry in the pelvis

Align the pelvis and lower the backrest to stabilize at the PSIS level.

POTENTIAL Solution

Flexible posture

POTENTIAL Solution

Flexible posture

PELVIC ROTATION

Contoured cushion helps stabilize the pelvis in a neutral position

Consider using a cushion that can be adapted to accommodate functional leg length discrepancy

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.

POTENTIAL Solution

Fixedposture

POTENTIAL Solution

Fixedposture

PELVIC ROTATION

HIP ABDUCTION

Movement of the femur away from midline

Legs are wide apart – Can cause pressure against legrests.

Can be on one or both sides

HIP ABDUCTION

CLINICAL Presentation

Potential Causes

Low or high tone

Shortened abductor muscles

Obesity

Inadequate seat depth

Seat width too wide

Posterior tilt in pelvis

HIP ABDUCTION

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.

HIP ABDUCTION

POTENTIAL Solution

POTENTIAL Solution

HIP ADDUCTION

Movement of the femur toward the midline

HIP ADDUCTION

CLINICAL Presentation

Potential Causes

Hammock effect from sling upholstery

High tone

Shortened/overactive hip adductors

Anterior tilt in pelvis

HIP ADDUCTION

POTENTIAL Solution

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

HIP ADDUCTION