The importance of posture for SCI clients
The goals of spinal seating are often expressed as postural support, pressure management, comfort and functional capability. These goals are interrelated and, more often than not, a seating setup is often a careful compromise between these four goals; designed to allow the client to participate in the community as fully as possible while reducing the risks of acute injury or chronic problems.
Posture can influence the client’s:
- Pressure management and weight distribution on the support surface
- Balance, stability and control for safe wheeled mobility
- Vision and interaction with the environment
- Respiration and digestive systems
- Comfort, and
- Self-perception and body image.
Each client has individual needs and limitations that determine which postural support is essential and what further postural support may be considered. These are ascertained through the client-centred assessment process covered in Module 2, Module 3, Module 4, and Module 5.
Indicators for seating assessment and intervention:
- Current or recurring pressure injuries
- Pain and discomfort with sitting
- Risk of falls and safety concerns of client or carers
- Postural asymmetry and risk of fixed deformity
- Difficulty with balance during static sitting, dynamic tasks or when attempting weight shift for pressure management
- Changes in body size
- Reduced function
- Replacement of seating and wheeled mobility system
- Posture related aspirations, and
- Respiratory restrictions.
In some instances there may be complicating factors, and local therapists may require support. In these cases, the client can be referred to a Spinal Seating Service.
Referrals to a Spinal Seating Service are indicated for clients with:
- Significant postural deformities
- An inability to maintain a good seating posture throughout the day
- Complex postural and functional needs where commercial products are not able to meet the desired outcome
- Custom-fabricated products that require replacement, such as: cushions, custom-made backrests, armrests and foot supports
- Unmanageable discomfort or skin marking
- Non-healing, sitting-acquired pressure injuries
- A history of recurrent pressure injuries
- Previous surgical interventions relating to pressure injuries, or
- Dependence on a respiratory ventilator.