13 STEPS TO A BASIC SEATING POSTURE Passive
Contents
1. Confidence in posture solutions 13 STEPS TOA BASIC SEATING POSTURE Passive Wheelchairs Q Introduction This checklist has been devised as a tool to aid the basic assessment of a client in a passive or comfort wheelchair There are multitude of accessories available for this process and we have chosen to focus on a small selection For more information about accessories please refer to the Invacare Rea sales literature or go to www invacare rea com or www INvacare co uk Thanks for contributing to safer seating posture Q Goal e o evaluate the posture of the client e o have a logical sequence in adjusting a seating system for your client e o check how the client is seated after you have made a change in the existing seating system e o be able to measure differences before and after a fitting assessment The first column of the checklist explains the 3 steps It contains the main questions and hints on how to check the critical areas The next column tells you what to adjust refer to the user manual for product specific information and what to aim for The final column identifies possible problem areas and considerations if something does not work during one of the steps the problem area will give solution suggestions The checklist takes assumes that you are aware of the way the pelvis and spine interface with each other and with the rest of the body Q Points to remember e he client must sit in a whe2. Yes you can I3 STEPS TOA BASIC SEATING POSTURE Passive Wheelchairs Checklist I I Lateral trunk support Create upper body stability 12 Head support Check the reason Support during transportation 2 Tilt in space 13 Tilt in space Check interval of relevant use Make a final check with your hand around the user for distribution of pressure this will indicate if optimum support is being given What to adjust and the aim Adjust the depth and height The body posture should be stable thanks to rear rather than side support Adjust height and angle and loosen all screws then adjust from the bottom to the top Neck and headrests should be used when seat angle is gt 105 Adjust the backrest angle with the lever at the rear Tilt should be used in short periods for weight and pressure distribution purposes Invacare International Sarl 2009 Possible problem areas Considerations Could another backrest cushion backrest base give better support Support area for car transportation Support area for normal use As tilt increases the pressure distribution transfers from the seat to the backrest area Please note that a greater tilt angle increases drowsiness and decreases activity levels Yes you can
3. as narrow as possible without allowing direct pressure Possible problem areas Considerations Remember that the client relatives therapist etc may have different opinions about goals The hamstrings should be relaxed This is achieved naturally if the user can move their feet to a preferred position Check pressure distribu tion of the buttocks with your hand comparing backrest with seating The upper inside of the calf should not touch the seat cushion Strive for a 2 3 cm space Kneel in front of the client so you are at eye level with your hands when palpating SIAS ASIS The armrest sides should just touch the buttock sides at Irochanter area Yes you can I3 STEPS TOA BASIC SEATING POSTURE Passive Wheelchairs Checklist 4 Position of the feet Check hamstring tightness 2 Choose and add legrests that correspond to the preferred position that the client has selected 3 Check if the feet are bearing weight 4 Check height of foot plate 5 Check pelvic position by SIAS 5 Position of thighs Check if the thighs are parallel and straight and facing forward Check that the hamstrings are relaxed 6 Seat angle and cushion Assess how the body pressure should be divided between seat and backrest 2 Create a stable sitting position 3 Insert your hand between client and seat little finger first and Teel the pressure both before and after the adjus
4. elchair e Examination explain what you want to check and that you will need to touch them with their permission e The wheelchair sizes should correspond to the size of the client e As the different body parts are interconnected a change in one position may have consequences on previous adjustments e Make one adjustment at a time Analyze the results before each adjustment Invacare International Sarl 2009 Yes you can I3 STEPS TOA BASIC SEATING POSTURE Checklist I Mapping the user A Activities in daily living B Physiological condition C Psychological factors D Social situation E Economical factors 1 2 Preparations Tilt and recline the chair slightly 2 Remove the legrests 3 Put a cushion or support under the feet 2 Position of buttocks in the chair Is the client sitting as far into the seat as possible Should the backrest be slightly reclined Lean the client forward and check the position from above by palpating the buttocks To be done before and after the adjustment 3 Pelvic symmetry Palpate SIAS ASIS Check whether the two upper pelvic edges are level After adjustment check pressure with two fingers between side guard and Trochanter Invacare International Sarl 2009 Passive Wheelchairs What to adjust and the aim Relaxed feet position Seat depth The client should sit as far back as possible Seat width Should be
5. nsiderations Checklist Adjust the backrest angle with the lever at the rear to a relaxed position 7 Back angle To avoid sliding out of the chair have the backrest as upright as possible Check position of head and how tt is balanced in the spine 2 Lean the client forward and check the position from above by palpating the both buttocks Check for comfort Ears and eyes should be parallel with the floor and the complete backrest should support the backrest of the client 8 Back height Adjust the backrest height Check for comfort and Make sure that mobility the shoulder blades are Check with your hand for not pushed forward pressure distribution The support should be at least up to the client s arm pits If not sufficient adjust 9 Back shape with wedges and or the Strive for a natural pelvic Check support of tension adjustable position Ensure that firm preferred posture backrest support Is given just at the Use your hand for upper pelvis sacrum iliac pressure evaluation Strive for mobility joint to avoid backward movement without rotation of pelvis locking the posture 10 Arm rest Adjust height and depth Evaluate the support both Does it give support for upper and lower trunk during transferal body by giving stabilisation with Shoulder area should shifting your hands be relaxed Invacare International Sarl 2009
6. tment 4 Check patient for comfort 5 Check risks of decubitus pressure ulcer use the Norton scale or similar and proceed accoraingly Invacare International Sarl 2009 What to adjust and the aim Footrest height angle and depth Legrests angle Calf pad support adjust height and depth The feet should be positioned so the pelvis is in a natural position Adjust the width of the legrests to avoid pressure on knees The legs should be as straight as possible Adjust the seat angle tilt with the lever at the rear of the backrest There should a large contact area between seat and backrest Possible problem areas Considerations Hamstrings should never be tight it will pull the pelvis into a backward rotation Check hamstring tendons for relaxed position Pressure applied under the soles of the feet stimulate upright posture and help to keep them on the footplates Use two fingers for pressure checks at cushion level both top and front The upper legs should not be abducted adducted or wind swept Make sure that you have a seat cushion that allows enough space for the ischial tuberocities The seat should be tilted just enough to maintain balance and feel secure Check that eyes and ears are level this ensures that the client remains alert Yes you can I3 STEPS TOA BASIC SEATING POSTURE Passive Wheelchairs What to adjust and Possible problem the aim areas Co
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