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Issues and Strategies for Enhancing Functionality through Optimal Positioning

Issues and Strategies for Enhancing Functionality through Optimal Positioning. CHRIS CEDOTAL, PT 02/24/12. POSITIONING FOR FUNCTION. POSTURE Defined by Webster as: “The position or bearing of the body whether characteristic or assumed for a specific purpose”. POSTURAL ALIGNMENT

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Issues and Strategies for Enhancing Functionality through Optimal Positioning

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  1. Issues and Strategies for Enhancing Functionality through Optimal Positioning CHRIS CEDOTAL, PT 02/24/12

  2. POSITIONING FOR FUNCTION POSTURE Defined by Webster as: “The position or bearing of the body whether characteristic or assumed for a specific purpose”. POSTURAL ALIGNMENT • Refers to the alignment of body segments in relation to each other and the support surface POSTURAL CONTROL • Postural control is defined as the act of maintaining, achieving or restoring a state of balance during posture or activity. It is activity that supports movement. Postural control is a critical part of motor development. It contributes to the emergence of stability and mobility skills

  3. POSTURAL ALIGNMENT

  4. BENEFITS OF NORMAL POSTURAL ALIGNMENT • Normalization of neurological influence on the body • Prevention of contractures and deformities • Decrease fatigue • Promote maximum function with minimal pathology • Improvement in functional activities

  5. DEVELOPMENT OF POSTURE

  6. NEONATAL RIBCAGE

  7. ADULT RIB CAGE

  8. POSTURAL REFLEXES IN DEVELOPMENT ATTITUDINAL REFLEXES Change in the body posture in relation to a change in head position Asymmetrical Tonic Neck Reflex Symmetrical Tonic Neck Reflex Tonic Labyrinthine Reflex

  9. ISSUES INFLUENCING DECISION MAKING FOR ADAPTIVE EQUIPMENT • REFLEX PATTERNS • SOFT TISSUE SKELETAL ABNORMALITIES • MUSCLE TONE • TRUNK STABILITY • PHYSIOLOGICAL NEEDS - TRACHEOSTOMY, FEEDING TUBES, - VENTILATORS,CATHETERS,MONITORS,ETC. **** MOST CRITICAL- CLIENT AND FAMILY’S WANTS/NEEDS WITH THE GOAL BEING TO INCREASE FUNCTION AND ALLOW PARTICIPATION IN LIFE/SOCIAL ACTIVITIES

  10. POSTURAL REFLEXES IN DEVELOPMENT • Asymmetrical Tonic Neck- produces extension in the face arm and legs and flexion in the skull arm and leg when the Head is turned. (integrated by 2-3 months) • Symmetrical Tonic Neck Reflex-results in extension in the arms and flexion in the legs when the head is extended. Flexion in the arms and extension in the legs when the head is flexed. integrated by 12 months) • Tonic Labyrinthine Reflex- produces an increase in extensor tone when the body is supine and flexion when prone.

  11. ASYMETRICAL TONIC NECK REFLEX

  12. SYMETRICAL TONIC NECK REFLEX- POSTURAL INFLUENCES

  13. MOTOR ABNORMALITY • Tonal Abnormalities - High tone or low tone – commonly a result of insult to central nervous system - Can appear late in infant development as nerve pathways become more functional - Abnormal motor features emerge as the damaged nervous system matures • Examples: • CEREBRAL PALSY - evidence of spasticity may be first noted at 7-9 months of age • DYSTONIA- generally not apparent before 18-24 months • ATAXIA –frequently not manifest before 30-36 months

  14. TONE MUSCLE TONE The resistance encountered when a muscle is passively lengthened or stretched. Abnormal tone may occur in the form of HYPERTONIA or HYPOTONIA

  15. HYPERTONIA • a velocity dependent increase in muscle tone accompanied by hyperactive tendon reflexes • Key sign of spasticity is a velocity dependent increase in resistance of a muscle or muscle group to passive stretch • May vary markedly, depending on the extent and site of the CNS damage • Degree may temporarily fluctuate with each individual- may transiently increase in response to changes in position of the body, physiologic excitation, sensory stimulation and voluntary effort involving the affected muscle groups

  16. Extensor Posturing

  17. POSITIONING DEVICES

  18. Positioning For Play

  19. Low-tech Devices

  20. HYPOTONIA • A decrease in the normal resistance offered by muscle to passive elongation and is usually associated with a reduction in the amplitude of deep tendon reflexes • Significant hypotonia is associated with joint instability particularly when dynamic muscle activity contributes to joint integrity. • Appears to influence the control of voluntary movements, associated with decreased postural control, difficulty initiating movements, weakness, decreased endurance and decreased coordination

  21. POSITIONING FOR HYPOTONIA

  22. SEATED POSTURE STABLE BASE • well supported pelvis-contoured cushion • Lumbar support • Pelvic/hip belt • Feet in contact with the surface

  23. SEATED POSTURE STABLE TRUNK -Achieved with side supports, vest/harness. - Seat inclination to minimize effect of gravity.

  24. SEATED POSTURE

  25. POSTURE AND FEEDING • Alignment of the oral structures for feeding is related to head and trunk stability • Head position influences swallow • Position for safe swallow is a “chin-tuck” (Head upright ,midline with neck flexion and chin downward and inward)

  26. POSTURAL CONTROL FOR FEEDING • Head position is dependent on trunk control (Herman & Lange:Logeman,1998) • Pelvis must be stabilized to allow alignment of the head with the trunk • Impairments of the fine movements of the jaw and tongue needed for feeding results if the head is not stable (Jones-Owens,1991;Seikelet al., 2000)

  27. IDEAL FEEDING POSTURE • Hips, knees and feet to be at 90 degrees with weight evenly distributed-feet stabilized • Head in midline with chin pointed downward slightly (chin-tuck) • Symmetrical alignment • Pelvis stabilized-Use of seat belt anchored below the seat and extended over the pelvic region

  28. UPRIGHT POSITIONING

  29. SUPPORTED STANDING BENEFITS: Improve cardiopulmonary function Decrease joint contractures Increase bone density Improve digestion Increase alertness Increase bone growth Allows for greater participation in functional activities

  30. SUPPORTED STANDING • Mobility in supported standing

  31. SUPPORTED STANDING

  32. UPRIGHT POSITIONING

  33. Issues to Be Considered in Obtaining Adapted Positioning Equipment • Team Decision • Client and Family Priorities/Resources • Funding Sources • Trial on Demo Equipment when possible • Proper Fit and Training • Reliable Follow-up/Repair with DME supplier

  34. AND THAT’S WHAT IT’S ALL ABOUT!!!!!!

  35. THE END!!!!!

  36. REFERENCES • Bergen AF, Presperin JT • Positioning for Function:Wheelchair and Other Assistive • Technologies. Valhalla, NY:Valhalla Rehabilitation Publications LTD.1990 • Cook AS, Woolacott • Motor Control- Theory and Practical Applications. Philadelphia: • Lippincott Williams and Wilkins.1995 • McEwen, IR • Assistive positioning as a control parameter of social-communicative interactions between students with profound multiple disabilities and classroom staffPhysical Therapy 1992 72: 634-644. • Redstone F The importance of postural control for feeding. • Pediatric Nurs 2004 • McNamara L, Casey J. • Seat inclinations affect the function of children with cerebral palsy: a • review of the effect of different seat inclines. • Disabil Rehabil Assist Technol. 2007 Nov:2(6):309-18 • Stayness C • The effect of positioning for children with cerebral palsy on upper extremity • function: a review of the evidence. Phys Occup Ther Pediatr. 2006:26(3):39-53 • Chung J, Evans,J. Lee C, Lee J, Rabbani Y, Roxborough L, Harris S • Effectiveness of Adaptive Seating on Sitting Posture and Postural Control in • Children with Cerebral Palsy. Pediatric Phys Ther 2008 Vol. 20(4):303-317

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