Part 2 in our series 24 Hour Positioning: Why Wheelchair Seating Can Only Do So Much by guest author Tamara Kittelson-Aldred, MS, OTR/L, ATP/SMS. See Part 1 here.
In Part 1 of this series I mentioned the three postural orientations that we humans use – lying, sitting and standing – and how in the wheelchair seating and positioning world, we have typically overlooked the first and most basic one. But that does not mean gravity goes away when we are lying down! A person needing postural support to sit and stand almost assuredly will need support when lying as well.
But why is lying down posture so important?
Fulford and Brown (1976) published findings on motor development and body symmetry in children with cerebral palsy. They tied together gravity, immobility and time as a trio that often leads to devastating consequences. While studying two groups of babies – typically developing and with cerebral palsy – they noticed that both groups showed some similar postural asymmetries early on when their movement was limited. The big change came as able-bodied children learned to roll, sit up, crawl and so on because at that point the similarities diverged. The babies with cerebral palsy developed worsening postural problems whereas the asymmetries largely disappeared in the able-bodied ones. Therapeutic positioning was suggested as a possible remedy.
Fulford and Brown were talking about babies with CP, but the concept is universal because a human body is a human body no matter the condition or diagnosis. Bodies react predictably to an asymmetrical posture and the force of gravity. This is worsened when a person cannot change position easily and often. Think about head flattening – positional plagiocephaly is the term – in babies who spend long hours sleeping on their backs and sitting in car seats or strollers with their head turned in one direction. The head may start off turning to one side for many different reasons, but once the head shape changes, it becomes harder for the baby to straighten the head position and lie symmetrically. At this point there is a snowballing affect.
This happens not only to babies’ heads, but to other body parts as well. In children and adults with impaired movement these same forces of preferred asymmetrical postures acted on by gravity over time can affect the body in potentially devastating ways.
Who would think that sleeping and resting could be contributing to scoliosis and windswept postures? But that is exactly what can happen over time while a person is asleep at night in a place where they should feel safe – their bed.
Fulford, G.E., Brown, J.K. (1976). Position as a cause of deformity in cerebral palsy. Developmental Medicine and Child Neurology, 18, 305-14.
Gericke, T. (2006). Postural management for children with cerebral palsy: Consensus statement. Developmental Medicine & Child Neurology, 48(04), 244.
Hare Association for Physical Ability. http://www.hafpa.info/. Accessed June 2017.
Hill S., Goldsmith J. (2010) Biomechanics and Prevention of Body Shape Distortion. Tizard Learning Disability Review, 15 (2), 15-29.
Montana Postural Care Project. https://posture24-7.org/. Accessed June 2017.
Pope, P. (2007) Severe and Complex Neurological Disability: Management of the Physical Condition. Butterworth-Heinemann Publishers.
Tamara Kittelson-Aldred, MS, OTR/L, ATP/SMS
Project Director - Posture 24/7
Tamara Kittelson-Aldred is an occupational therapist, Assistive Technology Professional/Seating and Mobility Specialist. She earned certificates in advanced postural care through the Open College Network West Midlands in England. She directs the Montana Postural Care Project, promoting postural care and responsible wheelchair provision. Kittelson-Aldred has written and presented on these topics in the United States, Jordan, Peru, and Colombia and has served individuals with complex neurodisabilities in Montana since 1983. She credits her daughter Eleanore, born with cerebral palsy and profound deafness, as her best teacher.