![Page 1: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/1.jpg)
PRESSURE & POSTURE IN WHEELCHAIR SEATING
![Page 2: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/2.jpg)
DEFINITION OF PRESSURE
Pressure = Force / Area
![Page 3: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/3.jpg)
ANATOMY OF THE SKIN
Epidermis
Dermis
Subcutaneous Layer
![Page 4: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/4.jpg)
EFFECTS OF PRESSURE
• Occludes capillaries
• Restricts flow of oxygen and vital nutrients
• Lymphatic drainage restricted
• Cell deformation under sustained pressure can also lead to cell death
![Page 5: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/5.jpg)
DEFINITION OF PRESSURE ULCERS
“A pressure ulcer is localised injury to the skin and/or underlying tissue usuallyover a bony prominence, as a result of pressure, or pressure in combination with shear”
International NPUAP-EPUAP Pressure Ulcer Definition
![Page 6: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/6.jpg)
SHEAR
• Forces parallel to the seating surface
• Often created by the effects of gravity
![Page 7: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/7.jpg)
SEVERITY OF PRESSURE ULCERS
GRADE I: Nonblanchable Erythema
“Intact skin with non-blanchableredness of localised area, usually over a bony prominence.”
NPUAP-EPUAP
![Page 8: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/8.jpg)
SEVERITY OF PRESSURE ULCERS
GRADE II: Partial Thickness Skin Loss
“Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough…”
NPUAP-EPUAP
![Page 9: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/9.jpg)
SEVERITY OF PRESSURE ULCERS
GRADE III: Full Thickness Skin Loss
“Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are notexposed.”
NPUAP-EPUAP
![Page 10: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/10.jpg)
SEVERITY OF PRESSURE ULCERS
GRADE IV: Full Thickness Tissue Loss
“Full thickness tissue loss with exposed bone, tendon or muscle.”
NPUAP-EPUAP
![Page 11: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/11.jpg)
PRESSURE ULCER DEVELOPMENT
PRESSURE
MOBILITY
ACTIVITY
SENSORY PERCEPTION
TISSUETOLERANCE
PRESSURE ULCER
DEVELOPMENT
EXTRINSIC FACTORS
INTRINSIC FACTORS
![Page 12: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/12.jpg)
EXTRINSIC FACTORS
• Localised Pressure
• Shear & Friction
• Poor Posture
• Time
• Temperature
• Moisture
INTRINSIC FACTORS
• Impaired Reaction to Pressure
• Restricted Movement
• Impaired Sensation
• Decreased Tissue Tolerance
• Heart Problems
• Vascular Disease
• Diabetes
• Serious Illness
• Old Age
• Incontinence
• Neurological Conditions
• Medication
![Page 13: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/13.jpg)
PREVENTATIVE MEASURES
• Maintain regular changes in position and avoid positioning over areas of erythema whenever possible.
• Keep the skin clean and dry. Manage any incontinence issues.
• Maintain good nutrition.
• Use appropriate equipment where applicable.
![Page 14: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/14.jpg)
P R I N C I P L E S O F
CUSHION DESIGN
![Page 15: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/15.jpg)
PRESSURE DISTRIBUTION IN NEUTRAL SITTING
Feet (19%)
Arms (2%)
Back (4%)
Thighs & Buttocks (75%)
![Page 16: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/16.jpg)
PRESCRIBING FOR PRESSURE
Goals
USER CHARACTERISTICS
TASKCHARACTERISTICS
CUSHIONCHARACTERISTICS
![Page 17: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/17.jpg)
DESIGNING FOR PRESSURE
CUSHIONCHARACTERISTICS
• Redistribution of Pressure
• Management of Shear Forces
• Postural Support
• Management of Vibration and Shock
• Thermal Properties
![Page 18: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/18.jpg)
DESIGNING FOR PRESSURE - MATERIALS
• Flexible, open-cell foam
• Quick recovery after compression
• Permeable
POLYURETHANE FOAM (PU)
![Page 19: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/19.jpg)
DESIGNING FOR PRESSURE - MATERIALS
• Rigid, light-weight, non-permeable, closed cell foam
• Shock absorbing properties
• Used in cushion bases to provide postural support in combination with a top conforming surface
POLYETHYLENEFOAM
![Page 20: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/20.jpg)
• Slow recovery after compression
• Can dampen vibration and shock
• Contours to shapes more closely than standard PU foams
• Hardness sensitive to temperature and humidity
DESIGNING FOR PRESSURE - MATERIALS
VISCO-ELASTIC FOAM
![Page 21: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/21.jpg)
DESIGNING FOR PRESSURE - MATERIALS
• ‘Liquid gels’ displace and conform to equalise pressure
• Baffles and compartments restrict flow
• The lower the viscosity the greater the shock absorbency
FLUIDS/GELS
![Page 22: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/22.jpg)
DESIGNING FOR PRESSURE - MATERIALS
• Air moves between cells equalising internal pressure
• Compartments restrict movement to improve stability
• Set up and maintenance required
AIR
![Page 23: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/23.jpg)
DESIGNING FOR PRESSURE - SHAPE
• Allows greater immersion and distributes pressure over a greater surface area
• Can improve dynamic stability
CONTOURING
![Page 24: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/24.jpg)
DESIGNING FOR PRESSURE - SHAPE
• Reduces surface tension and increases pressure redistribution
• Greater ability to move with the user –reduces shear forces
SEGMENTATION
![Page 25: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/25.jpg)
DESIGNING FOR PRESSURE - SHAPE
• Accommodates the Ischial Tuberosities
• Improves weight loading under the thighs
• Helps stabilise the pelvis
• Can prevent sliding forwards
ANTI-THRUST
![Page 26: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/26.jpg)
DESIGNING FOR PRESSURE - SHAPE
• Allows standard products to be customised for individual clients
• Can cater for a range of pressure requirements and scenarios
MODULARITY
![Page 27: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/27.jpg)
• Density
• Firmness
• Ability to return to original shape
Slab Molded
FOAM
![Page 28: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/28.jpg)
Pressure Management is
dependent on distribution of
weight and pressure off of the
ischials and onto the lateral
trochanter shelf & femurs
SHAPE
![Page 29: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/29.jpg)
.
ImmersionMaximizes surface contact area to reduce peak pressures.Pressure = Force/Area
Off-LoadingTransfers forcesaway from the ischialtuberosities with greaterweight bearing on thetrochanters, hips andthighs.
EnvelopmentFluid sac completelysurrounds the bonyprominences, evenduring position changes.
CUSHION DESIGN
![Page 30: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/30.jpg)
Static • Support surface contour that prevents sliding and downward migration of the pelvis.
Dynamic • Flow of materials reduces tension between bony prominences and tissues during functional activities, wheelchair propulsion, accommodates movement within a specific range.
Optimal shear reduction addresses both static and dynamic shear without compromising posture.
SHEAR MANAGEMENT
![Page 31: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/31.jpg)
ASSESSMENT TOOLS
![Page 32: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/32.jpg)
MAT = Mechanical assessment tool
3 stages:
1. Assessment in existing seating system
2. Assessment in supine
3. Assessment in sitting
MAT EVALUATION
![Page 33: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/33.jpg)
PRESSURE MAPPING AS AN ASSESSMENT TOOL
• Aim: to minimise peak pressures and maximise surface area
• Pressure gradients indicate the potential presence of shear forces
Pressure = Force / Area
![Page 34: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/34.jpg)
PRESSURE MAPPING
How will your cushion map?
![Page 35: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/35.jpg)
P R I N C I P L E S F O R
SEATING & POSITIONING
![Page 36: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/36.jpg)
SEATING & POSITIONING
Assist individuals in achieving their goals and aspirations, while respecting lifestyle,
function, posture and skin protection by providing simple, effective, and safe seating
solutions
![Page 37: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/37.jpg)
SEATING & POSITIONING
• Facilitate postural stability while allowing purposeful movement .
• Accommodate 3-dimensional anatomical shapes, working to match contours for optimal support and pressure redistribution.
• Wherever possible, support postures from within the contours of the seating system. If needed, complement with additional external components.
SEATING OBJECTIVES
![Page 38: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/38.jpg)
SEATING & POSITIONING
• A comprehensive evaluation, including a physical assessment in both supine and sitting, is the foundation of all effective seating solutions. Where possible, trial seating in static and dynamic situations.
• The position of the pelvis directly impacts the spine, which in turn influences the position of the head and extremities.
GUIDING PRINCIPLES
![Page 39: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/39.jpg)
SEATING & POSITIONING
• Determining if a posture is fixed or flexible is important for selecting appropriate seating solutions.
• The effect that seated posture has on breathing and swallowing should be a primary concern.
GUIDING PRINCIPLES
![Page 40: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/40.jpg)
M A N A G E M E N T O F
COMMON SEATING AND POSTURAL PROBLEMS
![Page 41: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/41.jpg)
Pelvic Stability
Contouring of the pelvic well provides lateral trochanteric support and anterior/posterior pelvic stability, promoting spinal extension for improved upper extremity function, head control and physiological function.
Note: Back support must be addressed for complete postural and skin protection solution.
STABILITY
![Page 42: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/42.jpg)
POSTERIOR PELVIC TILT WITH KYPHOSIS
Cervical spine may hyper-extend to maintain a functional visual field
Scapula may protrude posteriorly
Flattened lumbar spine and increased thoracic kyphosis
Pelvis tilted posteriorly with the Anterior Superior Iliac Spine (ASIS) higher than the Posterior Superior Iliac Spine (PSIS)
Tendency for pelvis to slide forwards
CLINICAL PRESENTATION
![Page 43: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/43.jpg)
POSTERIOR PELVIC TILT WITH KYPHOSIS
Consider anterior chest support
Consider support for upper limbs Firm back support that stabilises from the PSIS up to slightly above the apex of the kyphotic curve
Pelvic positioning belt beneath the ASIS
Contoured cushion to help stabilise the pelvis in a neutral position
FLEXIBLEPOSTURE
![Page 44: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/44.jpg)
POSTERIOR PELVIC TILT WITH KYPHOSIS
Consider utilising tilt to achieve a more upright position and improve functional visual field and head position
If spinal process or ribs are prominent increase backrest depth for greater immersion
For a unilateral limitation in hip flexion, modify the cushion to split the sagittal seat angle to accommodate and try to achieve a level pelvis
Contoured cushion to support the pelvis
FIXEDPOSTURE
Provide a contoured back support to match shape of spine
![Page 45: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/45.jpg)
ANTERIOR PELVIC TILT WITH HYPERLORDOSIS
May present with shoulder retraction
Pelvic to thigh angle less than 90 degrees
May present as exaggerated lumbar lordosis and result in decreased contact with the back support surface
Pelvis tilted anteriorly with ASIS lower than the PSIS
Trunk often extended to compensate for instability from anterior pelvic tilt
CLINICAL PRESENTATION
![Page 46: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/46.jpg)
ANTERIOR PELVIC TILT WITH HYPERLORDOSIS
Consider anterior chest support
Each client will differ in preference of sagittal seat and back support angles, especially those with Muscular Dystrophy and Spina Bifida
Assess small incremental changes to seat slope and angle of back support the move the pelvis and spine into a neutral orientation
Provide back support at level of PSIS to reduce lordosisEarly use of powered seating to allow
independent adjustment for comfort and/or function balance
FLEXIBLEPOSTURE
![Page 47: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/47.jpg)
ANTERIOR PELVIC TILT WITH HYPERLORDOSIS
Angle and depth adjustable back support
FIXEDPOSTURE
Angle rear of the seat lower than the front to balance trunk over the pelvis
![Page 48: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/48.jpg)
PELVIC OBLIQUITY AND SCOLIOSIS
Shoulder often elevated on the oblique side
Increased pressure risk on oblique side
One side of the pelvis is lower than the other
The obliquity is referred to by the lower side of the pelvis
The spine is influenced by the oblique pelvis, resulting in scoliosis.
The spinal curve will be convex on the oblique (lower) side of the pelvis
CLINICAL PRESENTATION
![Page 49: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/49.jpg)
PELVIC OBLIQUITY AND SCOLIOSIS
Lateral supports
Lateral/hip supports
FLEXIBLEPOSTURE
Ensure lateral depth is deep enough to support the trunk
Lateral trunk supports can be used to provide either 3 or 4 key points of control to support or minimise progression of scoliosis
Alternate approach – deep contoured back with lateral contour positioned to support the ribcage
If flexible, build up the cushion under the lowest ischial tuberosity to encourage a level pelvis
![Page 50: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/50.jpg)
PELVIC OBLIQUITY AND SCOLIOSIS
FIXEDPOSTURE
Ensure lateral depth is deep enough to support the trunk
Contoured back with integral lateral support
If fixed, build up support under the highest ischial tuberosity to increase weight bearing on high side
![Page 51: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/51.jpg)
HIP ABDUCTION
Movement of the femur away from midline
Can be unilateral or bilateral
Lower extremities are separated further apart from neutral
CLINICAL PRESENTATION
![Page 52: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/52.jpg)
HIP ABDUCTION
Try to align femurs in neutral using contoured cushion or distal lateral supports
FLEXIBLEPOSTURE
Contoured cushion to align lower extremities
Accommodate with custom contoured seating
FIXEDPOSTURE
![Page 53: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/53.jpg)
HIP ADDUCTION
Movement of femurs toward midline
Can be unilateral or bilateral
CLINICAL PRESENTATION
![Page 54: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/54.jpg)
HIP ABDUCTION
Use seat rigidiser or solid seat pan
Trial distal medial thigh support or contoured seating
FLEXIBLEPOSTURE
Contoured cushion to align lower extremities
Accommodate with custom contoured seating
FIXEDPOSTURE
Cushion rigidiser contoured to eliminate ‘hammock effect’ of sling upholstery
![Page 55: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/55.jpg)
PELVIC ROTATION
One hip is abducted, the other adducted
One knee may appear further forward
One ASIS and therefore hip is further forward in the seat than the other
CLINICAL PRESENTATION
![Page 56: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/56.jpg)
PELVIC ROTATION
Use a contoured cushion to align the pelvis in neutral and support lower extremity posture
FLEXIBLEPOSTURE
Use a pelvic positioning belt to bring hips back into alignment
In order to maintain head and shoulder in a neutral position for function, you may need to maintain some asymmetry in the pelvis
![Page 57: PRESSURE & POSTURE IN WHEELCHAIR SEATING€¦ · Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. _ NPUAP-EPUAP. SEVERITY OF](https://reader034.vdocuments.site/reader034/viewer/2022050208/5f5b150668eb0051d74c110f/html5/thumbnails/57.jpg)
PELVIC ROTATION
FIXEDPOSTURE
Accommodate limited hip flexion by opening seat to back angle
If present, measure the leg length difference
Order cushion for longer leg length and specify amount to cut back on shorter side
Contoured back support rotated to accommodate any mild/moderate trunk rotation, support the spine and distribute pressure