FUNDAMENTAL SEATING PRINCIPLES Power Point PDF Bengt Engström Physiotherapist. Concept ENGSTRÖM
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1 FUNDAMENTAL SEATING PRINCIPLES Power Point PDF Bengt Engström Physiotherapist
2 Starting with a few questions! How are your clients sitting? What kind of problems do you see? How long time are your clients sitting? How do you want your clients to sit? What can you change to improve sitting? What kind of wheelchairs do you work with?
3 ERGONOMICS What influences what? A healthy upright position is a goal. Why are so many clients collapsing? Standard can be quite dangerous!
4 ERGONOMICS An office workplace... WHEELCHAIR- ERGONOMICS
5 LONGTERM SITTING What may become a problem? PRESSURE - TOO HIGH or NOT ENOUGH SHEAR - TOO STRONG SOFT TISSUE DEFORMATION MUSCLES - HIGH TENSION, FATIGUE or INACTIVITY POOR TISSUE FLEXIBILITY (CONTRACTURES) RESULTING IN PHYSICAL INJURY and DECREASE OF FUNCTION!
6 Hmm why? Not sitting properly? WHY? What is the reason?
7 Problem? Potential?! CAUSE SOLUTION WHAT do we see? WHY is it so? HOW can we make a change?
8 SEATING + TIME! HOW is a physical change achieved? Influence The Body System Changing the forces Pressure Shear Gravity by moderating Softness Contours... Angles Materials... Measures... Product DESIGN!
9 NORMAL BEHAVIOUR IN SITTING (compensations) MOVING FORWARD ON THE SEAT ASYMMETRY OF THE TRUNK HEAD POSITION CHANGES LEG and FOOT POSITIONS CHANGE ARM POSITIONS CHANGE COMBINATIONS - MANY!!
10 LEGS AND ARMS IN SITTING MOVING THE FEET... LEGS CROSSED... EXTENDING or BENDING LEGS... KNEES APART or TOGETHER... ARMS AGAINST THE CHEST... ARMS LIFTED UP and BACK... LOGICAL COMBINATIONS!
11 IMPORTANT FACTORS IN SITTING STABILITY FREEDOM - find a stop - for motion EQUILIBRIUM!! CONTROL COMFORT COMFORTABLE? TIME! - static-dynamic muscle activity is a feeling! (like or not like) your senses inform you! muscle tension, joint position... pressure, shear, temp., humidity... communication - head & hands Time Tolerance Level!
12 THE SPINAL COLUMN IN SITTING SPINAL COLUMN MOVEMENTS Forward Bending, Rotation, Side Bending (Scoliotic...), Extension and - Combinations! SYMMETRY OF THE SPINAL COLUMN The core for freedom to move the trunk. ASYMMETRY OF THE SPINAL COLUMN When the trunk moves and for trunk stability
13 DESIGNING IT or RE-DESIGNING IT! We dictate how the user s body is influenced when changing Softness, Contours, Angles and Measures. Never forget! If this is your work, YOU are a designer!
14 BALANCING THE TOWER FOR THE HEAD
15 The Center of Mass of the Head Active and passive stabilize Upright and well balanced position Tendency in a balance position
16 SEATING ADAPTATION GOAL STABILITY THE BASE POSTURE Return FREEDOM Move to Task A Reach for a glas on the table. Task B Scratch your left lower leg. Task C Take an apple on a plate just behind you. Task D Bend forwards and ush the wheelchair with your arms.
17 IMPORTANT SEAT CUSHION FEATURES PELVIS and HIP AREA PELVIC STABILITY Pressure from seat surface Pressure from back support CONTOUR FOLLOW BODY CONTOUR PRESSURE DISTRIBUTION AND LATERAL STABILITY CONTOUR PREVENTION OF FORWARD SLIDING AND POSTERIOR ROTATION
18 Basic Shape of a Seat Cushion / Surface PELVIS & HIPS PELVIS & LEGS s LEGS / THIGHS CONTOUR Pressure Distribution Pelvic Stability CONTOUR Functional Leg Support - for Trunk Stability Slide Prevention CONTOUR Comfortable Leg Support - stabilizing Pelvis and Trunk
19 SEAT-ON-BACK INFLUENCE Comfortable and safe pressure in the buttock area is a must to prevent sliding and shifting of the pelvis (due to discomfort or pain). A functionally stabilized pelvis stabilizes the thorax (downwards). Functional thigh contact against the front area of the seat stabilizes (presses) the trunk/chest against the middle to upper area of the backrest.
20 COMBINATION SEAT CONTOUR and SEAT ANGLE NEUTRAL GOAL: Pressure distrubution and trunk stability. Lower under the pelvis (knees higher than hips) increases the collapse of the trunk. A sacral support stabilizes! GOAL: Pelvic stability and trunk freedom. The seat lower under the pelvis combined with forward angle, frees the trunk in direction forward and makes it also easier to extend the trunk. GOAL: Creating more trunk stability. Knees still higher than the hips means a stronger trunk collapse and sacral support is highly necessary to stabilize the (weak) trunk!
21 1-2 POSITION OF THE PELVIS / THE SACRUM By allowing room behind the pelvis for placing it and the Sacrum in space, the base for L5 is decided for an optimal alignment of the rest of the vertebras of the Spinal Column. With a stable pelvis it is easier to maintain the trunk in an upright position - the vertical collapse of the spine is more or less blocked. This is the first and second KEY-ADAPTATION!
22 3 EXTENSION OF THE THORACIC SPINE Make room for a personal extension of the trunk and support comfortably against the Thorax, behind and sides. This balances the weight of the upper trunk and, when assisted by gravity, its contact against the back support is maintained. It stabilizes the pelvis and prevent a negative, posterior rotation. Placing the chest places the neck, head and shoulders in space. This is the third KEY-ADAPTATION!
23 4 CONTOURING FOR THE LOW BACK The size of the Lumbar Lordosis is dictated by the position of the sacrum in space AND the extension of the thoracic spine (the position of the chest in the sagital plane). Follow the Curve of the Lumbar Lordosis. Observe, not too much pressure! The fourth KEY-ADAPTATION!
24 SYMMETRIC STABILITY OF THE TRUNK Supporting in the midline and from the sides against the Pelvis and Thorax stabilizes the chest and spinal column, making it easier to keep the trunk symmetrically upright. Contact Contact = Key support areas
25 TRUNK STABILITY / SHOULDER & HEAD FREEDOM Supporting in the midline, just below* the scapulas, the Scapula Triangle, stabilizes the trunk while allowing the upper trunk and the shoulders more funtional freedom**. This adaptation also improves the head s overall freedom for easier movement and control. Even better when the head is well balanced! * For users who need a high back support. ** The top of the back should be arched, higher in the middle and lower on the sides.!!
26 CONCLUSION OF THE PRINCIPLES BACK SUPPORT Extension of the Spine and Thorax-Support Contouring for the Low Back Stabilizing Pelvis and Sacrum BACKREST SEAT Placing Pelvis and Sacrum SEAT Pressure Distribution for Pelvis Positioning and Stability Pelvic Stability Preventing Forward Sliding on the Seat Comfortable Leg Support for Pelvis Positioning and Trunk Extension Copyright 2001
27 Wheelchair Education since
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TRAINING SESSION OPEN DOORS DESCRIPTION PICTURE PICTURE PICTURE COUCH STRETCH Bring your knee as close as possible to the wall and straighten upper body backward; you need to be able to activate your glutes
American Council on Exercise
American Council on Exercise February 23, 2015 Fitnovatives Blog Exercise Progressions for Clients Who Are Overweight or Are Affected by Obesity While there is no single right way to train clients who
FEEL GOOD GLOW Low intensity workout
Welcome to the low intensity workout, Feel good glow. If this is your first time doing one of our workouts, we recommend you check out the introductory video at www.healthier.qld.gov.au to get more information
INTRODUCING THE FROM
INTRODUCING THE FROM ERGONOMICS; A MEDICAL DEFINITION HUMAN ENGINEERING OR HUMAN FACTORS ENGINEERING An applied science concerned with the characteristics of people that need to be considered in designing