Figure 25: Wedge for Pelvic Obliquity
Figure 26: Lateral Scoliosis
Note . From “Questions and Answers About Scoliosis in Children and Adolescents,” by the National Institutes of Health, National Institute of Arthritis and Musculo Scoliosis may be caused be an imbalance of strength or muscle tone on either side of the spine. Decreased tone or strength can lead to postural collapse to one side or the other. Some clients assume this asymmetrical posture intentionally to stabilize themselves or achieve certain functional tasks. Many off-the- shelf back rests have a generic contour to encourage a midline position of the trunk. If such a back rest is insufficient, lateral trunk supports are required (Figure 27a). Often these trunk supports are curved to provide better contact with the rib cage. If more significant support is needed to reduce a scoliosis, the lateral supports may be placed asymmetrically in conjunction with lateral hip supports to provide 3-point control of the curvature. (One lateral support is placed lower than the other, on the apex of the convex portion of the curve; see Figure 27b.) This force/counterforce is often employed in seating systems to achieve alignment. If a reducible curvature cannot be corrected with a reasonable amount of lateral support, a molded system may be required to better distribute pressure and provide intimate contact with the trunk. This intimate contact may also slow the progress of the curvature. If the client has a non- reducible scoliosis, it is important to ensure that he or she can balance the head over the trunk. Correcting a reducible scoliosis provides neutral alignment over the pelvis, and accommodating a non-reducible scoliosis distributes pressure over the trunk and levels the client’s head.
Note . From Invacare, n.d., retrieved from http://www.invacare.com/ product_files/Stabilite-OM-2inch-Spine-Cushion400.jpg. © Invacare Corporation. Reprinted with permission. Correcting a reducible obliquity within available tolerance or accommodating a non-reducible obliquity provides the best spinal alignment for biomechanical function. Specific goals include leveling the head over the trunk and leveling the pelvis to distribute pressure between the two ITs (if possible while leveling the head over the trunk). Trunk After positioning the pelvis in as neutral a position as possible, the evaluator determines if the trunk requires specific positioning strategies. Common positioning challenges of the trunk include lateral flexion (scoliosis); forward flexion (kyphosis); extension (lordosis); and rotation. Each of these may be reducible, partially reducible, or non-reducible. Any asymmetry of the spine leads to distortion of the rib cage. Scoliosis Scoliosis is a lateral flexion of the trunk and is commonly seen in conjunction with pelvic obliquity (Figure 26). The curvature may be C-shaped or S-shaped. The S shape often is the result of the client attempting to right his or her head over an initial C curvature (Minkel, 2018).
Figure 27a: Lateral Trunk Supports
Figure 27b: 3-Point Lateral Control of Scoliosis
Note . From Sunrise Medical, n.d., retrieved from http://www.sunrisemedical.com. © Sunrise Medical (US) LLC. Reprinted with permission.
Note . From “Mygo Seating System: Posture & Function, by Leckey, n.d., retrieved from http://www.leckey.com/products/mygo-seating-system/ show/posture-function . Reprinted with permission.
EliteLearning.com/Physical-Therapy
Book Code: PTNC1023
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