In rotation, one side of the trunk pulls forward. Interventions are primarily anterior trunk supports, such as shoulder straps, to pull this side of the trunk back. If rotation is non-reducible, the client and the seating system may need to be placed asymmetrically on the mobility base so that the client can face forward. Significant non-reducible rotation may also require a molded back to achieve adequate pressure distribution and support. As with other trunk asymmetries, the goal is neutral alignment of the trunk. It is also important to correct any pelvic rotation. Case study Taylor is a 14 year old with cerebral palsy. He has a combination of spinal asymmetries, including lordosis (Figure 35); kyphosis (Figure 36); and lateral scoliosis (Figure 37). He is seated in a molded seating system but is no longer matching these contours as his asymmetries have worsened. Taylor is not a candidate for a spinal fusion due to medical fragility. On the mat exam, the team attempted to identify a position that would allow Taylor to balance his head over his trunk. They discovered that this would require a very open seat-to-back angle. A new shape was captured (Figure 38), and Taylor tolerated his new seating system very well. Note in Figure 38 how well aligned Taylor is with the correct seated angles and intimate contact of the molding bags. Figure 35: Lordosis
Figure 33: Lordosis
Note . From “Trunk Loridosis,” by Bodypoint, n.d., retrieved from http://bodypoint.com/data/default/assets/public/BMM037%20 Anterior%20Trunk%20Suport%20User’s%20Guide_low%20res.pdf . © Bodypoint. Reprinted with permission. Lordosis can be caused by a number of factors. If tight hip flexors are overcorrected (moved downward in seating), the pelvis will be pulled into an anterior pelvic tilt, resulting in lordosis (Minkel, 2018). Increased tone may pull the pelvis into this posture. Some clients assume this posture intentionally, as is sometimes seen in young men with Duchenne muscular dystrophy as they continue to lean forward in an attempt to balance the head. If this lordotic posture is reducible, it is important to provide both posterior and anterior support to the trunk, particularly the lower spine. Available hip flexion and extension should be evaluated and the seat-to-back angle set to respect any limitations. Anterior trunk support may reduce the lordosis. Anterior vests, which provide pressure over the sternum, can be helpful (see Figure 31). Abdominal panels (see Figure 23) were discussed in the section on anterior pelvic tilt and can be very effective in correcting a reducible lordosis. If the asymmetry is non-reducible, a molded back is often required to provide adequate pressure distribution and support. If the lordosis is reducible, the goal is neutral alignment of the trunk over the pelvis and improved pressure distribution. If the lordosis is non- reducible, the primary goal is pressure distribution. Rotation Trunk rotation is rarely seen in isolation but is commonly part of lateral flexion of the spine and pelvic rotation. Rotation is also seen as a component of certain reflexes, particularly ATNR (Figure 34). Figure 34: Trunk Rotation Resulting from Asymmetrical Tonic Neck Reflex
Figure 36: Kyphosis
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Book Code: PTNC1023
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