What's the first thing you notice when you meet a new person..their smile, their eyes, their overall face? That first glance is critical for a person's identity. It demonstrates one of the many reasons for providing optimal head positioning for those in a wheelchair. If head position is poorly addressed, there are a number of adverse effects which can arise.
POSTURAL
Most obvious are the postural deformities that can develop or worsen. Scoliosis, increased thoracic kyphosis, and pelvic obliquities can arise and lead to further secondary complications. Fluctuations in tone and triggers of reflexes (ATNR, STNR) can occur which also lead to challenges with head positioning.
RESPIRATION, SWALLOWING & DIGESTION
Vital functions can also be affected. Overall vital capacity and air exchange can be reduced which can lead to the need for an artificial airway, or increases in risk for pneumonia and other infections. Aspiration can also occur with swallowing dysfunction and impaired ability to manage secretions. Digestion can be affected if postural deformities interfere.
VISION & SPEECH
One can easily see how vision can be impaired with poor head positioning. An individual's awareness of midline can also shift which can lead to further postural deformities and balance deficits over time. Speech production can be reduced and work of speech increased leading to communication issues and fatigue.
CONFIDENCE & SOCIALIZATION
Most importantly, an individual's identity as a person can be affected. Inability to achieve eye contact or to effectively communicate with peers can have far lasting impacts. This can also lead to concerns with behavior, learning and social skills.
So, don't forget the head as you are positioning. Yes, seating the pelvis correctly will help but it may not always be the answer. You may have to balance out the person's needs for positioning, maintaining or increasing function, compliance with use and aesthetics all at the same time. It may not be a simple prescription but giving that person the opportunity for their identity to shine through is always the ultimate goal.
Looking for a head support that can be adjusted vertically, laterally, backwards, and forward to fit the user's needs? BodiLink Head Support is a great choice for addressing head positioning needs.
Paige Thomas, PT-MSR, NCS, MHA
Paige Thomas is a Physical Therapist and the Outpatient Rehab Coordinator for Mcleod Outpatient Rehab and Sports Medicine in Florence, South Carolina. She is also the center coordinator for their Seating and Positioning Clinic serving both adults and pediatric populations. Paige is a Neurological Clinical Specialist with a passion in working for those with ALS. She assisted in founding the University of Cincinnati Health ALS clinic and worked as a staff therapist at the Medical University of South Carolina ALS clinic.