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Posture, Positioning and the Pelvis

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Why specialist seating is so important
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In everyday life most people make postural changes instinctively.  We shift our buttocks, stretch our legs out, move our head, neck CAREFLEX_009cutout_profile_v3and shoulders… we’re constantly on the move to keep ourselves feeling good… we manage our own comfort, posture and stability… without a second thought.

But when a person’s abilities are reduced or compromised by illness or disability, often they cannot make these voluntary movements themselves.  We need to pay close attention to their lying and sitting positions to maintain their comfort, posture and stability, and to reduce the risk of pressure injuries occurring.

Many people have to spend a lot of time in bed because ordinary chairs and wheelchairs do not give them the appropriate support, but with the right seating choice, a person confined to their bed can re-join their friends and family in daily life.  Their quality of life can be improved immeasurably.

People with kyphotic posture, as often seen in the elderly population, sit in chairs with their head slumped forward or to the side – chin to chest.  Gravity and prolonged abnormal positions can trap people in these destructive postures.  Poor posture can exacerbate changes in body shape due to adaption of tissues and might impact on body systems.  This impairs their breathing, their ability to talk, so communication is poor, and their ability to eat and drink.  Upsetting …and very dangerous.

It is imperative that a full assessment is made to select a chair that is right for the user.  A chair set up for someone else might make things worse.  Important measurements are seat width, depth and height, arm height, back height, along with the correct head and neck support, trunk support and a footplate …to name the basics.   A footplate is essential.  In a normal seated posture, 19% of an average person’s body weight is distributed through the ankles and heels, making the feet a high risk area for pressure injuries.  So if you are provided with specialist seating, consider asking your OT or Physiotherapist to assess whether it is appropriate for you.

A vital consideration is the position of the pelvis.  Gail Russell, an independent OT, says, “The pelvis is the foundation for building a stable seating posture.  Get the pelvis position correct, or, at least, the best you can, and everything above and below has a better chance of improving.”

Together with the correct pelvic and postural support, specialist seating with Tilt in Space (TiS) chair allows you to change the reclining angle of the seat and back without adjusting the user’s hip and knee angle.  As little as a 20° tilt can reduce pressure under the buttocks and thighs.  A TiS chair will not only redistribute body weight but can also help combat fatigue.

Effective repositioning is very important.  Once the chair has been set up with the body loaded for the best distribution of pressure, carers need to check regularly throughout the day to make sure the client has not changed their position to an extent which negates the chair’s benefits, and consider using the chair’s functions to regularly redistrubute pressure.

Sitting for long periods, without specialist seating, in an asymmetrical and unsupported position can lead to skin and soft tissue damage often resulting in pressure injuries, ranging from a slight discolouration of skin to a serious deep wound that may leave many tissue layers exposed.  This process of skin breakdown can be made worse by other factors such as incontinence, immobility, sensory impairment and age.  Pressure ulcers often develop on the buttocks, sacrum, hips, spine, heels, and around the head.  The result is pain and anguish, often in patients already suffering from chronic illnesses.

Pressure injuries often develop on the spine, buttocks, sacrum, hips, heels, and around the head. The result will be pain and anguish, often in patients already suffering from chronic illnesses. With the treatment of pressure ulcers costing the NHS between £1.4 and £2.1 billion each year (Bennett et al), invest in a seating solution that will greatly help reduce the risk of pressure damage.  Choose a chair which offers continuous low-pressure relief for people at medium to high risk of pressure damage.

At the end of the day, it really is all about improving quality of life.  And the right chair can do just that.

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