Seating and positioning

doi:10.1017/CBO9780511544866.006

5 - Seating and positioning

Published online by Cambridge University Press: 22 August 2009

Craig A. Kirkwood and

Geoff I. Bardsley

Edited by

Michael P. Barnes and

Garth R. Johnson

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Craig A. Kirkwood: Affiliation:
Senior Rehabilitation Engineer Wheelchair & Seating Service Tayside Rehabilitation Engineering Services, Ninewells Hospital, Dundee, UK
Geoff I. Bardsley: Affiliation:
Senior Rehabilitation Engineer, Wheelchair & Seating Service Tayside Rehabilitation Engineering Services, Ninewells Hospital, Dundee, UK
Michael P. Barnes: Affiliation:
University of Newcastle upon Tyne
Garth R. Johnson: Affiliation:
University of Newcastle upon Tyne

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Summary

Introduction

Spasticity causes seating challenges for a wide variety of people with disabilities: from children with cerebral palsy, young adults with head injuries, middle-aged people with multiple sclerosis (MS) and older persons who have suffered cerebrovascular accidents (CVAs) and use wheelchairs.

The nature of spasticity is complex and controversial, as discussed elsewhere in this volume. Clinical characteristics described as constituting spasticity and that influence seating include increased muscle tone, hyperactive stretch reflexes, changes in muscle structure and function and abnormal activity caused by posture (e.g. tonic neck and labyrinthine reflexes) (Ford, 1986; Shepherd, 1995).

Spasticity, in itself, is not necessarily a problem and may assist in maintaining a seated posture. This is in contrast to hypotonia, where providing seated support in a functional position is often very difficult. However, there are three key problems that spasticity can cause to the person in a seated position:

Postural instability
Reduced upper limb function
Joint contractures

Correct positioning of the person can assist in reducing these problems (Zollars, 1993). Addressing one of the areas has a largely beneficial effect on the others, so there is little trade-off in strategies to tackle these problems. Barnes (1993) states: ‘positioning of the individual is the most important element in the management of spasticity’(see also Vaughan & Bhakta, 1995).

Appropriate seating should be seen as adjunct to the other approaches discussed in this book which may have greater precedence with increasing severity of spasticity (e.g. pharmacological, surgical) (Richardson & Thompson, 1999).

Keywords

cerebrovascular accidents head injuries hypotonia joint contractures seating challenges spasticity multiple sclerosis

Type: Chapter
Information: Upper Motor Neurone Syndrome and Spasticity
Clinical Management and Neurophysiology
, pp. 99 - 112

DOI: https://doi.org/10.1017/CBO9780511544866.006 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2008

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5 - Seating and positioning

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