Positioning for Function: The Lower Extremities

Transcription

1 Positioning for Function: The Lower Extremities

2 INTRODUCTIONS Who I am Who are you? Current AT use and experience Goals for today

3 WHAT WE WILL BE COVERING: What is positioning? Why is it important? What is the relation to function? Common positioning challenges Suggested positioning strategies Symmetrix Back

4 OBJECTIVES Participants will be able to list three lower extremity positioning challenges. Participants will be able to describe the clinical implications of a windswept posture on the body. Participants will be able to list three strategies to correct or accommodate hip flexion limitations. Participants will be able to list three strategies to correct or accommodate hip adduction.

5 POSITIONING: DEFINITION Positioning is the practice of determining an optimal body position and supporting it in a static or dynamic means Seating refers to the seating system used to maintain that body position Jay Fit

6 POSITIONING: WHY IS IT IMPORTANT? We position ourselves to best support the task at hand and this varies quite a bit! Our clients often must perform multiple tasks from one primary position

7 GENERAL PRINCIPLES Add in stability for function Modify positioning, as needed, to allow access Stable, but not functional

8 POSITIONING STRATEGIES Not a cookbook approach Can t really look at challenges in isolation Always keep in mind the possible causes and your goals Goals can be used as justifications for funding

9 POSITIONING STRATEGIES Pelvis Trunk Lower Extremities Upper Extremities Head

10 POSITIONING STRATEGIES: LOWER EXTREMITIES Hip flexion Hip extension Hip adduction Hip abduction Windswept posture Knee flexion Knee extension

11 POSITIONING STRATEGIES: LOWER EXTREMITIES, CONT. Ankle limitations Foot deformities

12 HIP FLEXION

13 HIP FLEXION Possible Causes: decreased range of motion of hip flexors fixing with hip flexors due to lack of hip extension or stability poor positioning poor range of motion management

14 HIP FLEXION Interventions: if flexible: superior thigh straps or pads strapping thighs or feet superiorly padded lap tray (underside) if fixed: do not overcorrect and cause anterior pelvic tilt Possibly wedge under distal thighs

15 ANKLE HUGGERS Bodypoint

16 SHOEHOLDERS AEL

17 WEDGED SEAT To accommodate fixed hip flexors Not to prevent forward sliding Poli Foam Wedge

18 HIP FLEXION Goals: prevent anterior pelvic tilt prevent lordosis

19 HIP EXTENSION

20 HIP EXTENSION Possible causes: decreased range of motion of hip extensors increased extensor tone poor positioning poor range of motion management

21 HIP EXTENSION Interventions: if flexible: open seat to back angle if fixed: open seat to back angle increase knee flexion, if hamstrings are tight contoured seating system

22 OPEN SEAT TO BACK ANGLE

23 HIP FLEXION AND EXTENSION ASYMMETRIES If one hip needs to be flexed and one extended, this can be accommodated Invacare InTouch Stabilite OM Positioning Cushion

24 HIP EXTENSION Goals: prevent further loss of range leading to a more reclined, and less functional, position affecting vision, feeding and respiratory avoid putting extensors on stretch

25 HIP ADDUCTION

26 HIP ADDUCTION Possible Causes: extensor tone decreased range of motion of hip adductors

27 HIP ADDUCTION Interventions: medial knee blocks anterior knee blocks leg troughs contoured seat strapping

28 MEDIAL KNEE BLOCK The groin is not a weight bearing surface!

29 ANTERIOR KNEE BLOCKS AES Active Design

30 HIP ADDUCTION Leg Harness can be used to maintain legs in neutral alignment with hips. Strap placement may be different than with pelvic control. Bodypoint

31 HIP ADDUCTION Goals: pressure distribution anatomical alignment prevent stimulation of stretch reflex or initiation of extensor tone patterns prevent hip internal rotation ease ADLs

32 HIP ABDUCTION

33 HIP ABDUCTION Possible Causes: decreased range of motion of hip abductors initial low tone surgeries

34 HIP ABDUCTION Interventions: lateral knee blocks lateral pelvic/thigh supports leg troughs contoured seat

35 LATERAL KNEE BLOCKS AEL

36 LATERAL PELVIC SUPPORTS AEL

37 LATERAL THIGH SUPPORTS RehabiliTech

38 HIP ABDUCTION Goals: anatomical alignment pressure distribution

39 HIPS: WINDSWEPT POSTURE One leg is abducted and the other is adducted Possible Cause: pelvic rotation range limitations

40 HIPS: WINDSWEPT POSTURE Interventions: pelvic rotation interventions hip adduction and abduction interventions May have to let legs windsweep to maintain neutral pelvic rotation and forward facing trunk and head

41 HIPS: WINDSWEPT POSTURE Goals: same as for pelvic rotation

42 KNEE FLEXION

43 KNEE FLEXION Possible Cause: decreased range of motion of hamstrings flexor tone structural knee issues

44 KNEE FLEXION Interventions: if flexible: refer to physician to explore medical or surgical procedures Posterior pads or strapping if fixed: open seat to back angle to relieve hamstrings anteriorly sloped seat place footrests posterior to front edge of seat bevel front edge of seat

45 CALF PADS

46 POSTERIOR CALF STRAP Bodypoint

47 OPEN SEAT TO BACK ANGLE

48 ANTERIORLY SLOPED SEAT PDG

49 PLACING FOOTRESTS REARWARD Various footplate options are available to bring feet back to accommodate limited knee extension Bodypoint

50 BEVELED FRONT EDGE OF SEAT Jay 2 interior

51 KNEE FLEXION Goals: decrease tension in the hamstrings and thus minimize pull into posterior pelvic tilt comfort clear front castors of wheelchair ease transfers

52 KNEE EXTENSION

53 KNEE EXTENSION Possible causes: decreased range in quadriceps over lengthening of the hamstrings structural knee changes extensor tone

54 KNEE EXTENSION Interventions if flexible: refer to physician to explore medical or surgical procedures provide alternative positioning to stretch the quadriceps (outside of the chair) if fixed: elevating legrests custom foot support

55 ELEVATING LEGRESTS Quickie

56 KNEE EXTENSION Goals: alleviate pull on pelvis and lower leg accommodate in extended position, if fixed

57 ANKLE LIMITATIONS Limitations in: Dorsiflexion Plantarflexion Inversion Eversion Causes: Loss of range due to increased tone, lack or range of motion and lack of weightbearing

58 ANKLE LIMITATIONS Interventions: angle adjustable footplates (sagittal and frontal planes) padded foot boxes molded foot support

59 ANGLE ADJUSTABLE FOOTPLACES Accommodate fixed deformities of the foot or ankle Capable of inversion/eversion, plantar/dorsiflexion & depth adjustments Bodypoint

60 PADDED FOOT BOX Rehab Designs

61 ANKLE LIMITATIONS Goals: accommodate fixed deformities prevent pressure to foot protect feet from injury comfort

62 FOOT DEFORMITIES Possible Causes: tonal patterns lack of weight bearing surgery

63 FOOT DEFORMITIES Interventions: angle adjustable footplates (sagittal and frontal planes) padded foot boxes molded foot support adaptive foot wear to pad feet

64 PADDED FOOT BOX Therafin The Comfort Company

65 FOOT DEFORMITIES Goals: prevent pressure to foot protect feet from injury comfort

66 QUESTIONS Any Questions? Thank you for your time and attention!

67 CONTACT INFORMATION For more information please visit our website at: Numotion Customer Care Center Michelle Lange Course transcripts and additional copies of certificates of completion are available upon written request: 5501 Wilshire Blvd NE Ste C ABQ, NM