an asymmetrical seat depth (Figure 24). If pain is the culprit, work with the medical team to determine the source and remediate, if possible. Finally, if the cause is increased tone or reflexes, increasing flexion, external rotation, and abduction may “break up” tone. The angle of the pelvic positioning belt is not as important as the direction in which it is tightened. If the client rotates forward on the left side, the pelvic belt should “pull down” on the left to tighten the belt – de-rotating the pelvis. An antithrust seat can also be helpful, as this blocks forward movement of the ITs. Figure 24: Asymmetrical Seat Depth
Figure 22: 30° Pelvic Positioning Belt
Note . From “Pelvic Support User’s Guide,” by Bodypoint.com, 2011, retrieved from http://bodypoint.com/data/default/assets/public/ BMM044%20Pelvic%20Support%20Users%20Guide_low.pdf . © Bodypoint. Reprinted with permission. Figure 23: Abdominal Panel
Note . From Motion Concepts, n.d., retrieved from http://www.motionconcepts.com. © Motion Concepts. Reprinted with permission.
Goals of addressing pelvic rotation include neutral alignment of the pelvis to support the anatomical curvatures of the spine, promotion of weight- bearing on the ITs, achievement of alignment for biomechanical function, provision of proximal stability for function, prevention of trunk rotation, and increased pressure distribution over the posterior trunk. Pelvic obliquity Pelvic obliquity is when one side of the pelvis is higher than the other. This obliquity results in a lateral curvature of the spine. A common pressure injury location is under one IT and nearly always results from pelvic obliquity. Pelvic obliquity may be the result of lateral scoliosis or part of the cause. ATNR can also lead to this posture. Hip dislocation or hip surgeries may cause a pelvic obliquity. Additionally, a client who is uncomfortable may assume an obliquity in an attempt to unweight a painful hip (Minkel, 2018). Activity idea: Sit on your hands and feel for two bony prominences called the ITs (Figure 19). Cross one leg over the other. The ITs should still be in both hands, but more pressure will be felt over one side. In a reducible obliquity, changing the angle of the pelvic positioning belt to 90° (over the lap) may be all that is required. If the client has a dislocated hip, this action will not be effective. If rotation or a posterior pelvic tilt is also present, a 4-point belt may be indicated to limit movement in more than one angle. The other primary intervention for obliquity is wedging. If the obliquity is reducible, a wedge is placed under the seat on the low side to level the pelvis. In a non-reducible obliquity, a wedge is placed under the seat on the high side to better distribute pressure between the ITs (Figure 25). A pressure map can be very helpful to determine if the pressure is well distributed. Sometimes correcting a reducible obliquity causes too much force on the lower IT, and therefore the seating needs to accommodate this side to achieve good pressure distribution or the IT must be off-loaded through another type of cushion. After wedging a non-reducible obliquity, if the client now is unable to laterally balance his or her head (dependent on the amount of lateral scoliosis), a lateral tilt may be required to level the head over the pelvis.
Note . From “Aspen Seating Clinic,” by Ride Designs, n.d., retrieved from http://www.ridedesigns.com. © Ride Designs. Reprinted with permission. Pelvic rotation Pelvic rotation is when one ASIS is forward of the other. As a result, the spine most likely is rotated as well. Activity idea: Sit on your hands and feel for two bony prominences called the ITs (Figure 19). Move one knee ahead of the other. One of your ITs moves forward and rotates the pelvis. Rotation is often caused by range-of-motion limitations in the hips, including reduced hip flexion, abduction, and/or adduction. Rotation can also be caused by a leg length discrepancy that has not yet been addressed in the seating system. This leg length discrepancy is sometimes the result of hip dislocation rather than an actual difference in femur length. Discomfort can lead to the client rotating the pelvis to alleviate the pain. Finally, muscle imbalance; tone; and reflex activity (e.g., asymmetrical tonic neck reflex [ATNR]) can pull the pelvis into rotation. If hip range of motion is limited, placing the lower extremities directly in front of the client may actually pull the pelvis into rotation. The legs may need to assume an asymmetrical posture (often called a windswept posture ) in order for the pelvis to remain in neutral (Sutherland, 2018). Keeping the pelvis in neutral facilitates spinal alignment and may help reduce the development of scoliosis. A leg length discrepancy, if present, can be accommodated with
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Book Code: PTNC1023
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