The importance of healthy posture for young wheelchair users
Helping disabled children, teenagers and young people achieve and maintain good posture when sitting in their wheelchair is essential. It involves correct alignment of the head, trunk, spine and pelvis. With effective lumbar and lateral support, occasional or permanent wheelchair users can achieve greater occupational performance. Discomfort, back pain and fatigue can be reduced, whilst the ability to interact, learn and enjoy educational and social environments can be increased.
Seated posture is defined according to the effect of sitting on the lumbar spine curvature. A flex seated posture is one that reverses the individual’s standing lumber curve into a forward slouching/backwards slumping (kyphotic) position. An extended (lordotic) seated posture is one that maintains the lumbar curve close to that of an individual’s standing position (upright/slight rear recline). Hence, good postural health and reduced discomfort arises from maintenance of the extended posture, interspersed with movement.
Frequent young wheelchair users can experience multiple problems associated with poor posture. Without appropriate lateral and backrest support, a juvenile spine may not achieve a natural position, resulting in reduced occupational performance, back pain and increased fatigue. This can also have detrimental effects on growth, development and internal organ function, and exacerbate difficulties with breathing, eating and drinking. It can lead to increased risk of spasm and musculoskeletal deformities such as kyphosis and scoliosis
Promoting healthy growth and development
Effective ergonomics should be taken into consideration when choosing the appropriate wheelchair for a young person. Incorporating a convex contoured backrest to support natural lumbar lordosis should be considered. With traditional vertical backrests, young users tend to slump in their wheelchair and adopt an unhealthy seated position. This is because conventional wheelchair geometry makes effortless upright sitting impossible.
By providing a backrest that is geometrically more in-keeping with the natural curvature of the spine, extended periods of sitting will not result in chronic pain or other associated health and wellbeing problems. Added to this, firm yet appropriate lateral support will keep the pelvis mid-line, so spinal curvature can be prevented in both planes. A well-fitting wheelchair is vital as a young person grows and develops.
Good posture will reduce deformities in young wheelchair users. Consistent and appropriate support of the spine helps children develop and grow as naturally as possible and can avoid skeletal changes or changes to soft tissue. The quality of wheelchair seating materials must also be considered as pressure sores can develop as a result of tissue damage through inadequate support or inappropriate fabrics.
Functional symmetry and balance is important for young people in wheelchairs, to ensure less energy is required to maintain position and therefore allow for maximum function. If a wheelchair is designed well it will promote proximal stability and therefore maximise distal function. A well supported trunk can free up the arms for function so individuals with upper body movement can physically engage at a greater level. Fundamental to good posture is correct alignment of the pelvis. The pelvic area is the body’s main pivotal point and should always be assessed critically during equipment provision.
Good posture in a wheelchair promotes better visual, perceptual and cognitive abilities through improved head movement and a greater field of vision. This healthy upright sitting position also impacts on the perception of the world around and the ability to interpret visual information. As a result, young wheelchair users who can achieve a comfortable, natural seated posture, can benefit from more effective learning processes and can acquire knowledge more readily.
Ailsa Reston is co-founder of RKS Occupational Therapist Services, based in Cheshire, which specialises in wheelchair and seating assessments and provision:
Photo courtesy of TGA Mobility: