Applications of Assistive Technology Positioning and Mobility
Slide 2 The Nine Benefits of Proper Positioning 1.Normalize or
decrease abnormal neurological influence 2.Maintain proper skeletal
alignment 3.Manage pressure 4.Enhance freedom of movement through
body stabilization 5.Increase student comfort 6.Enhance autonomic
nervous system functioning 7.Decrease fatigue 8.Facilitate normal
movement patterns 9.Maximize function while minimizing pathology
Slide 3 The Nine Benefits of Proper Positioning 1.Normalize or
decrease abnormal neurological influence Often, poor habitual
patterns develop which lead to muscle contractures and skeletal
deformities. Attempts at voluntary movements, because they are
difficult to perform and involve different movement patters, often
compromise the person's position. Slide 4 The Nine Benefits of
Proper Positioning 2. Maintain proper skeletal alignment Persons
who have poor postural control usually have problems maintaining an
erect sitting posture. This can be seen when you observe the
person: leaning to one side. scooting forward so that they are
sitting on their tail bone (sacral sitting). hooking an arm around
the handles of chairs or desks to gain support. show increased
levels of fatigue. Slide 5 The Nine Benefits of Proper Positioning
3. Manage pressure Pressure sores may develop when person's with
sensory deficits due to an unawareness of body position remain
sitting (or laying) for long periods of time without readjusting
their positions Slide 6 The Nine Benefits of Proper Positioning 4.
Enhance freedom of movement through body stabilization Trunk
support in sitting can be provided by changing to chairs that have
adequate arm support, back support, and provide a good sitting
surface. If this is not sufficient, additional supports, straps or
harnesses can be used to increase stability. Slide 7 The Nine
Benefits of Proper Positioning 5. Increase student comfort Proper
support will increase comfort. Slide 8 The Nine Benefits of Proper
Positioning 6. Enhance autonomic nervous system functioning Proper
support in sitting effects the following functions positively:
Breathing Cardiac function Digestion Eating/Swallowing Slide 9 The
Nine Benefits of Proper Positioning 7. Decrease fatigue The less
someone must use her own muscle strength to hold herself erect, the
less fatiguing sitting erect will be. Proper positioning is
critical to decreasing fatigue so a student has the energy to stay
on task. Slide 10 The Nine Benefits of Proper Positioning 8.
Facilitate normal movement patterns Normal movement components
enhanced are listed below: Proper weight bearing. Weight shifting.
Equilibrium reactions. Slide 11 The Nine Benefits of Proper
Positioning 9. Maximize function while minimizing pathology The
goal of proper positioning is to allow the student maximum
environmental functioning through the use of assistive technology.
Proper positioning also minimizes the abnormal postures and
movements which lead to long term contractures and deformities.
Slide 12 Evaluation for Seating Slide 13 History of the Wheelchair
Slide 14 Slide 15 Slide 16 Slide 17 Slide 18 Slide 19 Slide 20
Slide 21 Slide 22 Slide 23 Slide 24 Slide 25 Slide 26 Slide 27
Slide 28 Slide 29 Slide 30 Slide 31 Slide 32 Slide 33 Slide 34
Positioning Devices Slide 35 Standing Frames Standing frames place
persons who are not able to maintain an upright standing position
in a supported upright position. The upright supported standing
position helps increase participation in activities. The standing
frame comes in three main types: Prone Standers Supine Standers
Upright Standers Slide 36 Prone Standers In the prone standing
position, the person faces forward in a standing frame which gives
front support. The Frame may either be self standing or lean
against a table. This position is well suited for people who have
good head control and need stimulation of the extensor muscles. It
is a functional position for play or work when used with a tray.
Slide 37 Supine Stander In the supine standing position, the
student's back rests against the standing frame. These standers are
often easier to use if the stander can be cranked into position
from supine lying. Supine standers tend to be better suited for
students with decreased head control. Trays are often available for
a work surface. Slide 38 Upright Stander In an upright stander, the
student stands erect with all weight supported through the feet.
This achieves maximum weight bearing. Good head control and trunk
control is a pre- requisite for success Slide 39 Floor Positioners
Prone floor positioners Supine floor positioners Sidelying floor
positioners Slide 40 Prone Floor Positioner The prone floor
positioner plays an important role in normal development. In this
position, students are able to weight bear through their hands
while developing good head control. This position helps to maintain
elongation of muscle groups of the shoulders, trunk, and hips.
Balance, weight shifting, and shoulder mobility develop as the
student reaches for objects Slide 41 Supine Floor Positioner This
positioner helps promote symmetry, is easy to maintain, and is
relatively safe. Motor function requirements in this position are
minimal. Slide 42 Side Floor Positioner Side lying promotes
elongation of the weight bearing side and shortening of the
non-weight bearing side. Muscle balance between the extensor and
flexor groups is developed and side lying can also decrease
extensor hypertonicity. When positioning students, the goal is to
maintain the head in midline with the shoulders protracted and the
hands toward midline within the visual field. Slide 43 Factors
effecting positioning Structural Abnormalities Muscle Tone
Imbalances Abnormal Postural Reflexes Alignment in Sitting Slide 44
Structural Abnormalities Scoliosis - a curvature of the spine
Kyphosis - Excessive rounding of the back and shoulders. Dislocated
hips - This condition requires customized cushions to assure
comfort. Muscle contractures - Increase in seat to back angle of a
wheelchair may accommodate hip contractures. Changing the angle of
the foot plate may accommodate contractures of the ankle and knee.
Slide 45 Muscle Tone Problems Muscle tone is defined as the tension
or resistance present in our muscles at all times Abnormal muscle
tone includes too much tone (hypertonicity), too little tone
(hypotonicity), or a combination of both. Slide 46 Abnormal
Postural Reflexes Asymmetrical Tonic Neck Reflex (ATNR) Slide 47
Abnormal Postural Reflexes Symmetrical Tonic Neck Reflex (STNR)
Slide 48 Abnormal Postural Reflexes Tonic Labyrinthine Reflex (TLR
) Slide 49 Alignment in Sitting. Due to the amount of time students
with severe disabilities spend seated, either in a wheel chair or
supported seating system, it is imperative that how they sit be
examined. The goal of proper seating is to provide enough support
for postural stability using a minimum of external supports. Slide
50 Positioning Pelvis Positioning Trunk Positioning Lateral Trunk
Flexion Forward Trunk Flexion Slide 51 Pelvis Positioning Slide 52
Trunk Positioning Slide 53 Lateral Trunk Flexion A student may
exhibit leaning to one side of the body. This may be due to
abnormal muscle tone that pulls the body to one side or muscle
weakness that does not provide adequate support to one side of the
body. Leaning to one side can also be the result of over using one
side of the body because it is more functional. Slide 54 Forward
Trunk Flexion Students may bend forward in their seating systems
due to several causes: Poor muscle strength in their backs
Compensation for sitting with a posterior pelvic tilt Attempts to
overcome the effects of a seating system that is improperly
reclined Slide 55 Seating Systems Seat/back angle Tilt in space
Back support Base of support Lower extremity positioning Shoulder
Support Head Support Placing someone in seating system Slide 56
Seat/back Angle The seat and the back of a seating system helps to
maintain the pelvis in the optimum position. The seat/back angle
should be whatever is needed to maintain the pelvis in neutral or
slightly anterior tilt, achieve proper lumbar curve and provide a
base for good spinal alignment Slide 57 Tilt in space system The
original intention for a tilt system was to address issues such as
physiological needs; and problems with pressure, muscle tone,
respiration and digestion. Tilting also enhances daily living
skills of wheelchair users by making eating and communication
easier and making them more comfortable Slide 58 Back Support
Persons with poor trunk control and/or increased extensor activity
require a seat back that rises to shoulder height. Additional
supports to both sides of the trunk may also be needed to provide
more support. A three point lateral system may be used to provide
support. In this system, two supports counter each other on each
side of the trunk. The third support is placed lateral to the
pelvis to keep the pelvis from shifting. These trunk supports must
be properly padded to prevent skin break down or injury. Slide 59
Base of Support A firm sitting base is important in evaluating a
person's seating system. The sitting surface should be firm
providing a good base of support. A soft or hammock type surface
tends to adduct the person's legs and cause the person to sit
asymmetrically. The surface should consist of a firm structure with
some type of cushioning. Slide 60 Lower Extremity Positioning Once
the trunk and pelvis are properly positioned, the lower extremities
need to be positioned. If a person exhibits a posterior tilted
pelvis with an increase in extensor tone, the legs are often
adducted into a scissoring position. A knee spacer or medial knee
support may be necessary to maintain the legs in neutral abduction.
This medial support should extend from the front of the knee to one
third distance of the thigh. This support should be removable so
the person can transfer out of the wheelchair. Slide 61 Shoulder
Support Persons who exhibit poor trunk control often require
additional upper extremity support to maintain proper align in
their seating systems. When a person has forward trunk flexion that
comes more from the shoulder girdle area, shoulders straps can be
used to maintain alignment. Slide 62 Head Support In attempting to
provide support for the head, it is best to use the minimal
correction equipment as possible. The more support provided, the
less independent use of the head the person will have Slide 63
Placing a person in the Seating System A good seating system that
provides proper alignment to a person is only effective if the
person is placed properly in the system. The key to proper
placement in the system is correctly positioning the pelvis.
