Posture and its physical effects on a person’s body shape and position are well accepted; it is clear that an unstable pelvis will affect trunk control, which in turn will affect head position, and so on. But what about the wider impact of destructive postural presentations?

With a complex posture a key objective in postural care that needs clear emphasis is the promotion of good health and enhancement of autonomic nervous system function1; the inability to sit upright can result in decline in overall health, primarily reflecting altered physiological function2. We also cannot underestimate the importance of promoting psychological and cognitive factors; a stable posture can encourage participation in social activities at home or work, and as part of the community. An upright sitting position can also offer a better line of vision for interaction and provide an increased ability to achieve cognitive tasks3.

Interestingly, an article in the Health Psychology journal4 found that a poor posture affects mood, communication, focus, and even self-esteem – all vital components of good quality of life. A holistic approach to posture ensures optimum management – not a narrow focus on the diagnosis but also the consideration of the person’s daily life and wellbeing5. As a result, better compliance and engagement from individuals can be expected as they feel involved in their own care, in turn leading to improved outcomes.

When an individual’s ability to achieve good sitting posture is affected, either through illness, injury, disability or disease, it can have a significant impact on their quality of life. Specialist seating aims to allow individuals, who might otherwise have difficulty, to achieve their optimum sitting posture to sit out comfortably, reduce the risk of body distortion, enhance physiological function, manage pressure injury risk, interact with their environment, and participate in activities of daily living.

What is meant by complex posture?
  • Cases where posture is at risk of significant decline without management.
  • Total support is required to prevent or delay postural deterioration, encourage optimum physiological function and improve their health and wellbeing.
  • Primary goals include comfort, postural control and optimum pressure care.
What are the specialist seating requirements?

Safely and comfortably supports the user to engage in daily living and improve quality of life.

  • Highly flexible and fully adjustable to correct or accommodate complex postural presentations.
  • Range of functions and accessories available to support all body segments.
  • Integrated pressure management to reduce the risk of pressure injury as a result of asymmetrical positioning and unequal loading of tissues.
Who can present with complex postural presentations?

The severity of the signs and symptoms of cerebral palsy can vary significantly; some individuals only have minor problems with limited symptoms, while others may be severely disabled6. Postural challenges can include poor sitting balance, pelvic instability, muscle weakness, abnormal muscle tone and contractures, involuntary movements and fatigue. The optimum chair for an individual with cerebral palsy will not only meet their holistic needs but also the clinical and support network objectives. There is a clear need to ensure adequate postural support at all body segments, as part of a 24-hour postural management care plan.

Individuals with a traumatic brain injury can present with devastating and lifelong challenges7, including cognitive, communication, emotional and behavioural changes. Physical effects can include poor postural control, pelvic instability, muscle weakness or paralysis, spasticity, sensory impairments, physiological dysfunction and fatigue. Specialist seating can enhance an individual’s recovery and rehabilitation.

Prolonged and/or destructive sitting postures as a result of a stroke can cause tension on the body and increase the risk of significant pain. Fatigue can also often be experienced following a stroke and can affect all aspects of an individual’s life; it can significantly restrict their ability to engage in daily living, as well as having a negative impact psychologically and socially8. Ensuring comfort and energy management through specialist seating can ultimately improve a person’s quality of life.

The symptoms of Huntington’s disease vary widely between individuals; however, changes usually affect three main areas: movement, cognition (perception, awareness, thinking, judgement) and behaviour9. Huntington’s disease can challenge seated posture as a result of chorea (involuntary movements) that impairs postural control and pelvic stability. Specialist seating measured for the user with adjustability of seat dimensions is critical, subsequently encouraging normal movement/managing abnormal movements.

Once diagnosed, multiple sclerosis stays with a person for life, but correct support can help them to manage the condition and its symptoms10. The flexibility of specialist seating is key for individuals with primary progressive multiple sclerosis or those who develop secondary progressive multiple sclerosis as it can be adjusted and accessories fitted retrospectively as their needs change. This is also vital to appropriately support individuals who experience relapses, whilst also encouraging active engagement and assisting with their recovery during remissions.

How can CareFlex specialist seating help?

Always thinking holistically, and when used appropriately, CareFlex specialist seating can offer:

  • Adjustability, critical for postural stability and pressure distribution, to ensure that the chair dimensions can be easily configured for individuals of different body shape and size. Every chair must be set-up to fit its user; if it is not then it can cause more harm than good.
  • Flexible postural support throughout, with the ability to support all body segments and even adjust both left and right sides of the chair to uniquely accommodate asymmetries.
  • A range of back supports to promote trunk alignment and physiological function, including a multi-segmental back that can accommodate, or correct where possible, any scoliosis and/or rotation through the spine and pelvis.
  • Tilt-in-space, if safe and appropriate, to promote pelvic stability, energy management and pressure redistribution.
  • Back angle recline for comfort or to support individuals with hip joint problems.
  • A ramped or angled base, graduated at the back, to position the pelvis lower than the knees to promote safety and security for individuals at risk of posterior pelvic tilt and sliding out of the chair.
  • Positioning aids, such as pelvic belts or chest harness following risk assessment, may also be indicated to maximise postural control.
  • A choice of head supports to encourage a midline head position for interaction, engagement and safe eating and drinking.
  • WaterCell Technology as part of a whole-system approach to pressure care, offering a dynamic solution for individuals at risk of pressure injury.
  • Integrated environmental controls within the seating system to enable independence and continuation of activities and/or occupation.
  • A choice of fabrics and colours to enable individualised prescriptions; aesthetics and texture can be key to compliance for individuals with autism, dementia, behaviours that challenge or sensory impairments.

Keep an eye out for our upcoming announcements – an ideal solution for a true holistic approach to complex posture could be around the corner…

References

1
  1. Jones M, Gray S (2005) Assistive technology: positioning and mobility In SK Effgen (Ed) Meeting the Physical Therapy Needs of Children Philadelphia: FA
2
  1. Healy A, Ramsey C, Sexsmith E (1997) Postural support systems: their fabrication and functional use Developmental Medicine and Children Neurology 39:706-710
3
  1. Pountney TE, Mulcahy CM, Clarke SM, Green EM (2000) The Chailey Approach to Postural Management Birmingham: Active Design
4
  1. Nair S, Sagar M, Sollers J 3rd, Consedine N, Broadbent E (2015) Do slumped and upright postures affect stress responses? A randomized trial Health Psychology 34(6):632-41
5
  1. The Health Foundation (2016) Person-centred care made simple, What everyone should know about person-centred care Available from: https://www.health.org.uk/sites/default/files/PersonCentredCareMadeSimple.pdf