Pelvic & Spinal Postures

Clinical Assessment Goals

  • Identify posture/orthopedic asymmetries at each body segment.
  • Is asymmetry reducible or non-reducible?
  • Measure angles in frontal, sagittal, and transverse plane.
  • Absolute angles measure angles between a line connecting 2 points of reference on the body and a neutral/plumb line.
  • Angles which have moved clockwise from neutral axis are (-).
  • Angles which have moved counter-clockwise from neutral axis are (+).
Pelvic and Spinal Postures

Pelvis & Lower Extremities

+ Sagittal Pelvic Angle (Posterior Pelvic Tilt)

+ Sagittal Pelvic Angle (Posterior Pelvic Tilt)

Potential Clinical Causes

  • Low or absent tone in the trunk muscles / low tone / muscle control in pelvis or trunk
  • Abnormal (high, low, or fluctuating) tone in trunk and/or lower extremities
  • Pathological reflexes in lower extremities or trunk / abnormal reflexes in trunk / lower extremities
  • Limited hip flexion
  • Decreased lordosis
  • Decreased pelvic / lumbar spine range of motion
  • Decreased hamstring range of motion

Potential Technical (Equipment) Causes

  • Seat depth too long
  • Footplate position relative to knee does not accommodate tight hamstring
  • Front end angle / hanger angle doesn't accommodate hamstring range
  • Footplates too high (thighs not loaded sufficiently)
  • Footplates too low (feet not loaded sufficiently)
  • Lack of posterior pelvis / sacral support
  • Back support too upright
  • Seat-to-floor height too high for foot propulsion
  • Armrests too low

- Sagittal Pelvic Angle (Anterior Pelvic Tilt)

- Sagittal Pelvic Angle (Anterior Pelvic Tilt)

Potential Clinical Causes

  • Increased lumbar lordosis
  • Tightened paraspinals
  • Weakened abdominals
  • Tight quadriceps
  • Tight hip flexors
  • Obesity

Potential Technical (Equipment) Causes

  • Anterior femoral angle (knees lower than hips)
  • Excessive lumbar contour
  • Trunk not supported
  • Back support too upright

Frontal Pelvic Angle (Obliquity)

Frontal Pelvic Angle (Obliquity)

Potential Clinical Causes

  • Scoliosis
  • Abnormal reflexes in trunk or lower limbs
  • Asymmetrical muscle tone (trunk and / or lower extremities)
  • Asymmetrical trunk muscle strength
  • Asymmetrical soft tissue or muscle mass
  • Asymmetrical pelvic / femur bone structure
  • Asymmetrical hip flexion range of motion
  • Limited hip abduction and / or adduction
  • Limited hip internal or external rotation

Potential Technical (Equipment) Causes

  • Poor base of support - i.e., sling upholstery
  • Footplates, position and / or seat-to-back angle or front end angle may not match client's available range of motion
  • Seat shape does not support trochanters
  • Wheelchair too wide
  • Seat and / or back does not provide enough lateral pelvic support
  • Joystick and / or wheel location inappropriate
  • Armrests too low (upper extremities not supported)

Transverse Pelvic Angle (Rotation)

Transverse Pelvic Angle (Rotation)

Potential Clinical Causes

  • Scoliosis or roto scoliosis
  • Asymmetrical hip flexion
  • Asymmetrical muscle tone (trunk and / or lower leg length discrepancy
  • Posterior dislocated or subluxed hip
  • Limited hip abduction and / or adduction range of motion
  • Asymmetrical muscle mass in the posterior pelvis
  • Unilateral foot propeller (extremities)

Potential Technical (Equipment) Causes

  • Trunk not fully supported
  • Lack of posterior pelvis / sacral support
  • Seat and / or backrest contours too narrow
  • Seat-to-floor height too high for foot propulsion
  • Wheel set up incorrect for hand propulsion

Pelvis & Spine

Sagittal Sternal Angle (Upper Kyphosis)

Sagittal Sternal Angle (Upper Kyphosis)

Potential Clinical Causes

  • Low / absent muscle tone in the trunk muscles
  • Compensation for posterior pelvic lift
  • Diminished head control
  • Postural deterioration over time
  • Extreme hyper mobility
  • Hyper extended cervical spine
  • Diminished disc space in upper thoracic spine

Potential Technical (Equipment) Causes

  • Seat-to-back angle too closed
  • Back support too low
  • Arm support too low
  • Back does not match shape of posterior trunk
  • Head support mounted too far forward or too low
  • Wheel set up incorrect for hand propulsion

Sagittal Trunk Angle (Kyphosis)

Sagittal Trunk Angle (Kyphosis)

Potential Clinical Causes

  • Low tone / poor muscle control in pelvis or trunk
  • Compensation for posterior pelvic tilt
  • Structural spinal deformity
  • Diminished head control
  • Compensation for visual impairment

Potential Technical (Equipment) Causes

  • Back does not match shape of posterior trunk
  • Seat-to-back angle too open or closed
  • Lack of adequate posterior pelvis / sacral support / back does not support posterior pelvis
  • Back support too vertical
  • Back support too low
  • Head support mounted too far forward or too low
  • Arm supports too low

Sagittal Abdominal Angle (Lordosis)

Sagittal Abdominal Angle (Lordosis)

Potential Clinical Causes

  • Low or absent muscle tone in the trunk muscles
  • Tightened paraspinals
  • Hypermobility of lumbar spine
  • Compensation for anterior tilted pelvis
  • Compensation for lumbar instability
  • Obesity
  • Fixed structural deformity

Potential Technical (Equipment) Causes

  • Anterior femoral angle (knees lower than hips)
  • Back too vertical
  • Excessive lumbar contour
  • Back does not match shape of posterior trunk
  • Posterior pelvic support too high
  • Back support too low
  • Orientation in space not optimal (system too upright)

Scoliosis

Scoliosis

Potential Clinical Causes

  • Compensation for pelvic obliquity and / or pelvic rotation
  • Asymmetrical muscle tone or strength in the trunk muscles
  • Decreased trunk balance
  • Structural spinal deformity
  • Asymmetrical upper extremity strength during manual wheelchair propulsion
  • Inability to hold the head in midline

Potential Technical (Equipment) Causes

  • Back does not match shape of posterior trunk
  • Back does not support posterior pelvis
  • Back does not provide enough lateral support
  • Wheelchair does not provide solid base (sling upholstery)
  • Seat cushion does not provide pelvic stability
  • Upper extremity support is too low, too high, or too wide
  • Joystick or wheel location inappropriate
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References

  1. Waugh, K. and Crane, B. (2013). A clinical application guide to standardized wheelchair seating measures of the body and seating support surfaces (rev. Ed.). Denver, CO. University of Colorado Denver. Available from: http://www.ucdenver.edu/academics/AssistiveTechnologyPartners/resources/WheelchairSeating/Pages/WheelchairGuideForm.aspx
  2. Waugh, K. and Crane, B. (2013). Glossary of wheelchair terms and definitions. Denver, CO. University of Colorado Denver. Available from: https://www.ncart.us/uploads/userfiles/files/glossary-of-wheelchair-terms.pdf
  3. Zwick, D. (2014). How Posture Goes Wrong: Body Shape Distortion in Cerebral Palsy. Available from: https://www.omicsonline.org/open-access/how-posture-goes-wrong-body-shape-distortion-in-cerebral-palsy-2157-7595.1000e115.php?aid=25348

Date: 2019-05-16


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