North Carolina Physical Therapy Ebook Continuing Education

Kyphosis Kyphosis is forward flexion of the trunk. It can occur at various levels of the spine (Figure 28) and may be combined with hyperextension of the neck (Minkel, 2018). Kyphosis is often caused by osteoporosis in the geriatric population. In clients who require wheelchair seating, kyphosis may result from flexion at the hips or thoracic area; postural collapse forward (particularly in clients with low tone or weakness); posterior pelvic tilt; or the client intentionally assuming this position in an attempt to increase stability. If the forward flexion is reducible, anterior trunk support is used. For the anterior trunk support to be effective, the posterior trunk also needs to be well supported. For example, sling seats and sling backs position the client in a posterior pelvic tilt and kyphosis, exacerbating the problem. Anterior trunk supports include chest straps, shoulder straps, shoulder retractors, vests, and abdominal supports. Chest straps (Figure 29) keep the client from falling forward to the point where he or she is unable to resume an upright posture. Chest straps do not promote trunk extension, and care must be taken to make sure the client does not collapse into this support and just “hang” there. Shoulder straps promote trunk extension and scapular retraction and are effective in reducing reducible kyphosis (Figure 30). Vests tend to provide the most support at the sternum and so are not as effective for forward trunk

flexion (Figure 31). Shoulder retractors provide support similar to shoulder straps but are rigid (Figure 32). Whenever an anterior trunk support is used, it is critical that a pelvic positioning belt is also used. Otherwise, the client is at risk of sliding downward and choking on the anterior trunk support. Figure 28: Kyphosis

Figure 29: Chest Strap

Figure 30: Shoulder Straps

Note . From Bodypoint, n.d., retrieved from http://www.bodypoint.com. © Bodypoint. Reprinted with permission.

Figure 31: Anterior Trunk Vest

Figure 32: Shoulder Retractors

Note . From Bodypoint, n.d., retrieved from http://www.bodypoint.co . © Bodypoint. Reprinted with permission. If a kyphosis is non-reducible, the client may tend to look downward most of the time. In order to look up, breathe, and swallow, the client must lift his or her head on top of that flexed trunk, resulting in a hyperextended neck. To allow the client to maintain an upright head without hyperextension, two primary strategies are used. First, open the seat-to-back angle to the point where the client’s head is above or just behind (posterior to) the pelvis. Second, place the client in a tilt-in-space wheelchair and tilt the client to the point where the head is over or just behind the pelvis.

Note . From Stealth Products, n.d., retrieved from http://www. StealthProducts.com . © Stealth Products. Reprinted with permission. If a kyphosis is reducible, it is important to correct this to anatomical alignment to also align the head. In a non-reducible kyphosis, it is important to provide an upright and aligned head to promote vision, improve breathing, and increase safety in swallowing. Lordosis Lordosis is a hyperextension of the lumbar area of the spine (Figure 33).

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Book Code: PTNC1023

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