When considering and assessing posture for seating, it may not be obvious to look at lying posture, but if we are to complete a thorough and whole assessment, we must include both to fully understand the body segments and their limitations. There is growing evidence that supports the notion that positioning in lying has a direct relationship on the success of postural alignment in sitting. If posture is not examined collectively in each orientation, it can be counterproductive to the provision of postural supports in only one orientation[1]. Not considering position in lying can obstruct the outcome of seating goals, meaning that seating requires additional revisions or replacement that may otherwise not be required[2].

When in a supine lying position, it is possible to assess and feel the relationship between the pelvis and spine without the influence of gravity in seated. This allows us to palpate the pelvis and establish its flexibility, through tilt, obliquity and rotation. The spine can be assessed through feeling, positioning and observing movement to establish its flexibility and constraints. When seated, the spine can present with a scoliosis which may not be structural in origin. If we only assess in a seated position, we may not fully understand this which can lead to choices of seating prescription that are not fully informed. Scoliosis can be compensatory, rather than structural, meaning that is it not caused by bone structure but presents as a result of another postural limitation, for example, a pelvic obliquity or low muscle tone.

Whilst lying, we can also feel around and underneath the individual to gauge their weight distribution, sometimes referred to as “loading”. This can indicate whether there is rotation in the pelvis or spine as one side may be loading more than the other. This can be easily missed if only seated posture is assessed.

In lying, hips and knees can be moved through their full range to identify any limitations that may then impact a seated posture. As we manipulate the joints in one direction, we can identify at which point does this then influence another body segment, indicating there may be a limitation present. For example, whilst assessing hip flexion and extension, you can feel the point at which the pelvis tilts and this indicates the end of range for hip flexion or extension and therefore guides what the seat to back angle should be.

Comparing the lying postural presentation to the seated postural presentation is crucial to identifying which postural deviations require support or accommodations within seating. If a pelvic obliquity is present in sitting but not in lying, then we know it is not fixed and the pelvis can be supported in neutral when seated by providing an obliquity build up under the low side. If it is present in both lying and sitting, then it needs to be accommodated in the seating by providing an obliquity build up under the high side. Without this complete assessment, we could place supports incorrectly and cause further deviation, discomfort, pain or place the individual at higher risk of developing pressure ulcers.

Once we have identified the body’s natural presentation and abilities, we can then translate that into seating choices. For example, if as a result of the hands-on assessment, we find the legs are windswept due to a pelvic rotation, which is present in lying and sitting, the seating needs to respect the body and accommodate this, rather than try to force the person into a “corrected posture” that it cannot achieve.

Only when we complete a thorough hands-on assessment in lying and sitting can we truly understand the body and its segments, along with any constraints. If we prescribe seating without completing a full investigation of the facts, we are putting people at risk of harm. It is essential that Therapists understand their role as guardians of posture, to identify postural constraints and safeguard the people we work with from the harmful effects of gravity that can restrict their ability to lead a comfortable and functional life.

To find out more about how lying posture impacts sitting and the importance of 24-hour postural management, please watch the Careflex Webinar: 24-Hr Postural Management with Simple Stuff Works.

Written by our guest blogger, Lauren Osborne, an Independent Posture & Wheelchair Specialist Occupational Therapist.

Lauren Osborne

 

[1] Osborne LJ, Gowran RJ, Casey J. Evidence for 24-hour posture management: A scoping review. British Journal of Occupational Therapy. 2023;86(3):176-187. doi:10.1177/03080226221148414

[2] Kittleson-Aldred, T. and Hoffman, L. (2017) ’24-Hour Posture Care Management: Supporting People Night and Day’, Rehab Management [Online] URL: https://www.rehabpub.com/conditions/neurological/cerebral-palsy/24-hour-posture-care-management-supporting-people-night-day/?campaign_type=newsletter&_hsenc=p2ANqtz–kUMNQGN4fls7yg0EZgxLeJXrjMIgyQ2sEqx1D8PMd7Kk1PXpcJ_UqwGhuTcTEXKnSc7PLIo3S_1D33BwuqESombGEgA&_hsmi=62856871