In last month’s article, I talked about the goals of seating and considerations for generic seating product parameters to achieve seating goals for your client.
This month, I would like to take a practical approach so that you can see how choice of a cushion can help to achieve seating goals. Let’s take the example of a client with a pelvic obliquity.
Right Obliquity Compensating Scoliosis
The figure on the left shows a client with a Right Pelvic Obliquity – the right ASIS is lower than the left ASIS. The figure on the right shows the compensating scoliosis that is seen with a pelvic obliquity. In doing your hands-on assessment with your client, you must determine whether the pelvic obliquity is a fixed or flexible posture for your client, as the answer to that will determine how you address it.
If the client's pelvic obliquity is flexible, due to poor or absent muscle strength or tone, and if the client can tolerate correction, you should consider selecting a cushion in which you can build up under the low side of the pelvis with pressure relieving material to provide support to maintain the pelvis in a level position. (See figure below.) In this way, you are bringing the client's pelvis to a neutral position. You will see that overall posture improves by correcting the flexible pelvic obliquity - the client may no longer present with a compensating scoliosis.
Flexible Pelvic Obliquity –
Build up under the low side
If the client's pelvic obliquity is fixed, due to muscle or joint contractures, you should consider selecting a cushion in which you can build up under the high side of the pelvis with pressure relieving material to accommodate this posture. (See figure below.) Building up under the high side of the pelvis allows the pelvis to be fully supported, offering a stable base of support in which pressure is redistributed over a greater surface area. If the fixed pelvic obliquity is not addressed through seating, peak pressures will be found at the low ischial tuberosity.
Fixed Pelvic Obliquity –
Build up under the high side
Now, remember that for the client with the fixed pelvic obliquity, the accompanying scoliosis will not be corrected by the cushion. The scoliosis will need to be addressed through positioning with the backrest and associated components – but that is a topic for a future Clinical Corner article!
As always, please provide your comments, questions and suggestions regarding Clinical Corner on my blog. I look forward to hearing from you!
Sheilagh Sherman, BA, BHScOT, OT Reg. (Ont.)
Sunrise Medical Canada
Note: The content of this article is not meant to be prescriptive; rather, it is meant as a general resource for clinicians to then use clinical reasoning skills to determine optimal seating and mobility solutions for individual clients. Sheilagh is unable to answer questions from members of the general public. Members of the general public are directed to their own therapists or other health care professionals to ask questions regarding seating and mobility needs.
This article is © Sunrise Medical, Inc., 2011 and cannot be copied, distributed, or otherwise reproduced in whole or in part without the express written permission of Sunrise Medical Canada.