International Seating Symposium
Considering another angle – seating solutions to anterior pelvic tilt
Elizabeth Nade, Occupational Therapist
Lindsay Briscoe, Occupational Therapist
Abstract
An individual’s level of functioning is dependent upon the relationship between
physical body functioning and structures, activities and participation, and personal
and environmental factors. (WHO, 2001). This paper will explore the complexities of
designing and fabricating custom moulded seating solutions for individuals with
cerebral palsy who present with an anterior pelvic tilt. From a body structures
perspective, anterior pelvic tilt is characterised by an anterior rotation of the pelvis;
the upper sacrum tilts anteroinferiorly at the hip joint producing an abnormal increase
in the lumbar curvature; the vertebral column curves more anteriorly (Moore &
Dalley, 1999). The aim of custom moulded seating is to optimise a body attitude that
facilitates optimal functional performance whilst minimising energy consumption and
without causing damage to the body system (Pope, 1997). Challenges of fabricating
seating solutions for individuals with an anterior pelvic tilt can include providing
increased surface contact and pressure distribution, addressing the effects of gravity,
managing pain, accommodating limited hip flexion and preventing the exacerbation
of extensor tone and the feedback cycle of the opisthotonic reaction (Kangas, 2005);
all whilst aiming to facilitate functional performance and outcomes specific to the
individual. This is particularly challenging with this client group as any instability in a
postural set will nearly always equate to inefficient function. There is currently limited
evidence to guide intervention in this area of custom moulded seating for this specific
client group. Case study examples will illustrate how the custom seating service
(TASC) within Cerebral Palsy Alliance of New South Wales, is addressing these
complex challenges in fabricating long term seating solutions for individuals with an
anterior tilt of the pelvis and associated issues. Specific information regarding the
benefits of thorough assessment and appropriate outcome measurement selection
will be explored and detailed.
References
Kangas, K. M. (2005). Hyperextension, Obligatory reflexes or the opisthotonic
reaction? Facing the seating challenges of children who seating systems do not
recognize this body posture. Proceedings from the 21st International Seating
Symposium
Moore, K.L. & Dalley, A.F. (1999). Clinically Oriented Anatomy 4th Edition. Lippincott,
Williams and Wilkins
Pope, P. (1997). Management of the physical condition in people with chronic and
severe neurological disabilities living in the community. Physiotherapy 8(3): 116-122
World Health Organisation (2001). International Classification of Functioning,
Disability and Health. Retrieved November 11, 2009, from
http://www.who.int/classifications/icf/en/
Presentation Learning Objectives:
1. Participants to identify and evaluate a fixed anterior pelvic tilt and resultant
associated body postures that impact upon the person’s functional
performance.
2. Participants to identify the specific challenges of seating people with a fixed
anterior pelvic tilt in order to maximise their functional performance
3. Through case study application participants will apply and generalise their
knowledge of the specific challenges of seating people with fixed anterior
pelvic tilt to determine particular components required in seating systems to
maximise their functional performance.