Building on Part 1 of our podcast series (listen here), we delve into the intricacies of postural supports within the realm of mobile chairs, specifically focusing on the various postural presentations encountered in clients. The salient point of our discussion lies in the differentiation between standard backrests and complex postural backrests, which are essential in addressing the diverse needs of individuals with varying degrees of postural challenges. We explore common postural presentations, such as posterior and anterior pelvic tilts, pelvic obliquities, and scoliosis, while emphasizing the clinical benefits of tailored postural accessories. Our discourse further elaborates on the importance of customizing the seating system to ensure optimal support and comfort for users, thereby mitigating associated risks such as pressure injuries and discomfort. We invite listeners to reflect on their experiences with these postural supports and share insights garnered from their own practices.

In this episode of the Enable Lifecare Podcast, we continue our deep dive into mobile seating solutions—specifically, the essential role of postural supports in princess chairs.

We explore a wide range of common postural presentations seen in clinical practice, including:

• Posterior and anterior pelvic tilts
• Pelvic obliquity and pelvic rotation
• Kyphosis, lordosis, and scoliosis

You’ll learn how these postural conditions affect spinal and pelvic alignment and how the right support systems can improve comfort, function, and pressure management.

We also break down the differences between standard backrests and complex postural backrests, helping clinicians determine which solution best suits their client’s needs. Detailed discussion covers:

• Multi-adjustable waterfall backrests
• Cocoon backrests
• Complex winged backrests
• Profiled headrests
• Rigid external lateral supports
• Four-point pelvic positioning belts

You’ll walk away with practical strategies for tailoring seating systems—such as how to accommodate spinal curves, correct for asymmetry, and adjust for fixed versus flexible postures.

This episode is ideal for Occupational Therapists, seating specialists, and carers supporting clients with moderate to high postural needs.

The exploration of postural supports within mobile seating systems unveils a critical discourse on the alignment and stabilization of individuals with diverse postural presentations. We delve into a spectrum of common postural anomalies, including posterior pelvic tilt, anterior pelvic tilt, and various forms of pelvic obliquities and rotations. Each condition presents unique challenges that necessitate tailored interventions to optimize comfort and functionality in seating arrangements. The discussion emphasizes the significance of selecting appropriate postural supports, distinguishing between standard backrests and complex postural backrests, to cater to the specific needs of individuals, particularly those with severe postural challenges.

Throughout this episode, we systematically dissect the functionalities of various postural accessories that can be integrated into mobile chairs, such as multi-adjustable waterfall backrests and cocoon backrests. These supports are meticulously designed to accommodate the nuanced requirements of users, providing adjustable features that can be fine-tuned to enhance comfort, alleviate pressure points, and promote optimal alignment. We also emphasize the importance of considering the user’s unique anatomical and postural characteristics when selecting these aids, thereby fostering a more personalized approach to mobility and seating solutions.

In conclusion, this episode serves as an invaluable resource for practitioners and caregivers who seek to enhance the quality of life for individuals with complex postural needs. The insights shared underscore the imperative of a comprehensive understanding of postural presentations and the remedial options available, thereby equipping listeners with the knowledge necessary to implement effective seating strategies in their practice.

A thoughtful examination of postural supports reveals the intricacies involved in accommodating individuals with varied postural presentations, highlighting the need for a bespoke approach to seating solutions. The episode commences with an overview of the most prevalent postural deformities encountered in clinical practice, such as kyphosis, lordosis, and scoliosis. Each condition is characterized by distinct deviations in alignment, necessitating specific interventions to ensure proper support and comfort. We further elucidate on the critical distinctions between standard and complex postural backrests, elucidating the criteria for selecting appropriate supports based on the severity of the client’s postural requirements.

The discourse progresses to an in-depth examination of the functional attributes of various postural accessories, including adjustable waterfall backrests and rigid external lateral supports. These tools are instrumental in addressing the multifaceted needs of users, particularly those with fixed postural deformities. By employing adjustable features, practitioners can customize the support to counteract the adverse effects of asymmetrical postures and enhance overall stability within the chair. The episode culminates in a synthesis of the discussed concepts, advocating for a proactive approach in assessing and accommodating the diverse postural needs of clients, ultimately fostering their independence and well-being.

In this insightful episode, we engage in a thorough analysis of the intricacies surrounding postural supports utilized in mobile chairs, focusing on the various postural presentations that practitioners frequently encounter. A detailed exposition of conditions such as posterior pelvic tilt, anterior pelvic tilt, and pelvic obliquities is provided, elucidating the implications these presentations hold for the selection of appropriate seating solutions. The conversation underscores the necessity of discerning between standard backrests and those designed for complex postural needs, advocating for a tailored approach to ensure optimal support.

We explore a variety of postural accessories that can be integrated into mobile seating systems, emphasizing the importance of customization in achieving the best therapeutic outcomes. The episode elaborates on the functionality of multi-adjustable waterfall backrests and cocoon backrests, which allow for significant adaptability to cater to the specific anatomical and postural characteristics of the user. This adaptability is crucial in enhancing comfort, promoting proper alignment, and mitigating the risk of pressure injuries.

Ultimately, this episode serves as a comprehensive guide for healthcare professionals and caregivers, equipping them with the knowledge to implement effective seating strategies that address the complex needs of individuals with postural challenges. By fostering a deeper understanding of postural supports, we aim to enhance the quality of care provided to those reliant on mobility aids.

Takeaways:

• In this episode, we explored the significance of postural supports for individuals using mobile chairs.
• We analyzed various common postural presentations and their implications for seating solutions.
• The discussion emphasized the differences between standard backrests and complex postural backrests.
• We examined specific postural conditions such as pelvic tilt, obliquities, and scoliosis.
• The episode provided insights into customizing seating to accommodate diverse postural needs effectively.
• We concluded with a recap of strategies for selecting appropriate seating accessories based on individual postural challenges.

Foreign welcome to today's episode.

We will continue our series on talking about mobile chairs or our princess chairs.

In today's episode, we'll focus on postural supports.

So we'll go through some of the common postural presentations that you might see and the different postural accessories or postural supports that you might be able to use within your chair.

We'll go through the difference between a standard backrest and a complex postural backrest, especially if you have a princess chair that has the option of one or the other.

And we'll also go through specific supports for common postural presentations, such as your posterior pelvic tilt, your anterior pelvic tilt, pelvic obliquities, and pelvic rotations.

Okay, so let's jump into our different postural presentations so we can have different postural presentations.

Within our spine, we could have what we call scoliosis, which is where we have an S or C shape of the spine.

If you're looking from the front, we could have a kyphosis, which is if you're looking from a side view, you can see that the person is hunched over.

So they have an in, they have an increased curvature by the neck, their heads typically turned downwards.

This is something you'll see typically in your elderly clients.

And there's also a similar presentation you can see in someone that does have a posterior pelvic tilt.

You'll see that your normal curvatures of the spine will disappear.

So instead of having that lumbar curve, it might be a very flat.

The lumbar area will be very flat.

Then we can have lordosis, which is an increased spinal curvature at the lumbar spine.

So at the lower back.

And this is something that can cause a lot of back pain where, especially if your back rest, pillows or backrest supports aren't fully in contact with the back.

So if there's a gap there, clients either put pillows in that area to try and alleviate that discomfort, or they might just experience a lot of back pain.

Then we can have different presentations of the pelvis where we could have the.

Instead of the pelvis being neutral, we could have a pelvic rotation.

So where the.

Let's say the right side of the pelvis is more forward than the left.

So this could look like a leg length discrepancy if you're looking at the person.

So you might see that one knee is further forward than the other one, but when you actually feel by the pelvis, you can feel that one is further forward.

And then when we have pelvic tilts, we can have a anterior pelvic tilt.

When we have an anterior pelvic tilt, we have someone with their pelvis tilted forward.

And you might have an increased lumbar curve as well.

So you can possibly have that lordosis presentation as well.

Not a very common posture that you'll see.

You'll probably see the posterior pelvic tilt more commonly.

And this is one that a lot of us will go into when we fatigue.

So if we have partial fatigue, if we find that our core strength isn't sufficient or chair is insufficient to keep us help us stay upright, we go into the slouched posture where we have our head turned downwards.

We're very much sitting on our tailbone, and we can call it sacral sitting as well.

And this is a posture where there's going to be a lot of shear and friction because the person's pelvis is going to start sliding more and more forward and kind of down towards down the chair.

And that is going to cause a lot of damage and also have the risk of the person falling or slipping out of the chair.

Then we can have a pelvic obliquity, which is where, let's say the right side of the pelvis is higher than the left side.

So in this case, we'll have more pressure by one of our Iits or isho to varocity.

So one of the sitting bones.

So we have the two sitting bones.

When you palpate underneath the buttocks, you can feel those two pressure points or those two bony prominences.

So if you were to kind of lean towards one side, you can feel that one is going to have more pressure than the other one.

So in a way might sound good that we're taking pressure off from the one side, but now we're not distributing the pressure over both sitting bones.

So we're going to get a pressure injury on the one side.

We'd rather want to have both be in contact so that we're spreading the pressure.

We ideally do want to have as little pressure by our its and our sacrum as possible, which is why we do have seat cushions that do have what we call the ischial well, where most of the pressure is going through the thighs instead of our tailbone and our sitting bones, but we still want them to be equally distributed.

We don't want that asymmetry.

But if we do have a fixed posture, someone is fixed in that pelvic obliquity.

We do want to make sure that we're customizing our cushion to be able to match that so that both our its are in contact or are supported.

We don't want one that's kind of front free floating.

And we do find that if someone does have that pelvic obliquity, you can see the effect in the spine a lot of times as well.

And this is where you might see that scoliosis, where if you were to tilt your hips to one side, let's say you're putting most of your weight onto one buttock, you can see how your head wants to stay upright and in midline, it doesn't want to follow that lean and that's where you get that scoliosis.

So let's talk through the different postural supports that you can get and what is their clinical benefit.

So we could have what we call a multi adjustable waterfall backrest, which is where we would have about three to four pillows in our backrest that will have a silicone polyester filling or some type of filling in them.

And a lot of times these do have the ability to be positioned at different heights or different settings.

So let's say you want to have the pillow stick out a bit more, you place it lower.

If you want it to lie more flat, you place it higher up.

And then they can kind of water that's kind of this waterfall effect, like they lay on top of each other.

We can change the filling in that.

So if you open up the zip, you can take filling out, you can stuff filling more in one part other than more than another side.

So if you have someone that has a bit of a lean towards one side, you might want to build up that side a bit more.

Or if they do have that pelvic rotation, so one hip more forward, you might want to build up that side that is a bit more forward so that the back is still fully in contact with the backrest.

So this is where the multi adjustable waterfall backrest is very beneficial.

Or you can even increase, increase stuffing in a lumbar area.

If you do have that lordosis, so that increased lumbar spine, you want to make sure that that backrest is fully in contact with that area.

And if you have a very tall client, you'd want to have the ability of adding in an extra pillow so that you have a good separation between your headrest pillow and the pillows just behind your shoulder.

Whereas if you have your headrest pillow all the way down to your shoulders, you won't feel that your head is properly supported and you might even feel like the pillow is pushing your shoulders forward.

And we're getting kind of that internal shoulder rotation, so beneficial to have that additional pillow added.

You can also make it a more concave backrest if you want it to be more immersive.

But you might have a case where someone has a kyphosis and you also want the backrest to be immersive, but you want to make sure that they still have proper lateral support.

We'll get to this a little bit later on how you can do that.

But in some cases, the way you can manage it is by placing your pillows vertically instead of horizontally.

So if you have your free pillows, your headrest pillow will stay in place and your two bottom ones will be placed vertically next to each other.

And then that middle section between the pillows is where the spine can be offloaded and the person can immerse into the backrest.

So instead of that person with that slouched, hunched over, kyphotic posture being curved away from their backrest, they immersed into it.

And then we can even open up the backrest a bit as well to have them fully sink into it.

Then we could get what we call a cocoon backrest, which is where we can have lumbar supports, we can have laterals as well.

So you literally get cocooned into this backrest.

And this can also have adjustability of the stuffing.

So you can add more stuffing into one lateral, let's say your right lateral more than left, or you can add more lumber or less lumber support.

So having that adjustable cocoon backrest is a really good option for someone that has a very severe kyphosis or a very asymmetrical posture, but that just needs that mild to moderate postural support.

The ball, the cocoon backrest is still going to be pillows of fitting, so it's not going to be a rigid support.

We don't have a steel frame that's supporting the person.

So you can.

It still can give way a little bit.

You can also get a more complex winged postural backrest, which is where we have three different sections, a head section, neck, and then torso, that have these wings that can go in or out, or just one goes in and the other one's out and can be adjusted in depth and angle.

And that is to match the person's posture and possibly over time can try and correct posture because it is a more rigid support.

So we actually have the steel frame on the outside of it.

And then where it's in contact with the person, it's foam and it's padding has a nice cover over it.

But that is going to give a lot of postural support.

So for more high knees or complex postural needs, then we could have adjustable laterals, which can be two little loose laterals that can be either added behind the waterfall backrest, which can just add support at certain sections.

But it will be more a encouragement of support.

It won't correct the person's posture.

Then we could have a profiled headrest, which is similar to your airplane pillows.

Your mobile chairs are going to have more contoured ones where there's a lot more stuffing.

So it's a lot more supportive and it really wraps around the person's neck.

We also do have, in some cases with mobile chairs, a option of adding a four point pelvic positioning belt, which can help support pelvic stability and maintain someone's position in the chair.

Especially if you have that person that tends to slide out of the chair.

That might just help to keep them in the chair because it's blocking the pelvis from sliding forward.

Something that is important to note though with the four point pelvic positioning belt is that it does usually have a button.

It's a very easy release button.

But if your client doesn't have the ability to do that themselves, it can be seen as a restrictive practice.

So in some cases, using your tilt and space first to see if that is sufficient to keep the person from sliding out of the chair.

And if that doesn't work, you can motivate for the four point pelvic positioning belt as a way to support the person's position and as a safety mechanism.

Then we could have what we call rigid external lateral supports.

The rigid laterals are independent and come from outside, so they aren't underneath the pillows.

They are by themselves.

And they will have the ability to be adjusted in terms of how deep they are, so how far they come out forward or backwards, and their angle.

So these are a good option for someone that needs a lot more lateral support than what the adjustable lateral supports can give you.

Because the adjustable ones are usually Velcro, where the rigid external laterals are fixed onto the frame of the chair.

How do we choose between a standard backrest and a complex postural backrest?

When we think of our standard backrest, this is for someone with minimum to moderate assistance needs.

Where your complex is for someone that needs more complex support.

So they're your moderate to high postural needs.

So they're usually clients that are dependent on assistants to maintain the trunk and midline.

So when you are doing your mat evaluation, you'll Possibly need to have a second person to try and get them into a support supported sitting posture.

Whereas in your standard backrest, when you're doing this person's mat evaluation, they can possibly sit unsupported.

So good trunk control and they might just have a little bit of a lean towards one side and then might, with fatigue, go into a worse posture.

But for the first few seconds of your assessment, they might be able to sit in a really good supportive posture.

Your client using standard backrest might have some activity limitations.

They might have some abnormal curvatures of their spine, whereas your complex partial back rest clients are going to have very limited movement with a fixed postural deformity.

So let's just go through some of our main postural presentations and what are the things that you need to take into account on how to support this client?

So, posterior pelvic tilt, sacral sitting posture, where we're kind of sliding downwards.

Ensure that you have a good or correct seat depth to prevent them from sliding forward.

Because you will find that the seat is too deep, the person can't fully sit towards the back of the backrest.

And then when they sit back to the backrest, they slide forward.

Consider a backrest with rigid supports around the hips to stabilize the pelvis into a neutral position.

And you might want to make sure that you match any range of motion limitations by using things like your tilt and space and opening up your backrest angle for that client that has the posterior pelvic tilt.

Because in some cases it could be that they are trying to use their leg elevation, but they have tight hamstrings and that then pulls the pelvis forward and gets them into that posterior pelvic tilt.

Then when we think of our anterior pelvic tilt, we want to provide full back support that is tall enough for the person.

We want to make sure we use a modular back support so that we can conform to the curvatures of the spine.

Because the client with the anterior pelvic tilt going to not have the normal curvature by their lumbar spine.

So we want to be able to adjust the pillows to support that person's back.

When we have a pelvic obliquity where one hip is higher than the other one, we want to ensure the pressure is distributed evenly along our.

It's our ischial tuberosities or sitting bones.

We want to level the pelvis by building up the lower side.

Then we want to accommodate our possible scoliosis through lateral supports.

And we need to have at least three points of control for scoliosis.

So you might have a support by the shoulder, support by the torso, and on the other side of the body, you will have almost like a counterforce.

Then you want to make sure that you're supporting the person if they have that lateral flexion of the neck, which is something you will see with that pelvic obliquity.

So this is where you could consider your profiled headrest to support the head and the neck.

Then lastly, our pelvic rotation, where one hip is further forward than the other one.

We want to first make sure that it is the pelvis and it's not just the leg length discrepancy.

But want to make sure we stabilize the pelvis in the most neutral position we can.

We're going to consider using tight tilt and space to further prevent any rotation.

So tilt and space can help possibly get that pelvis to go further back towards the very back of the back rest.

And then we want to consider cushions which stabilize any lower limb alignment.

And the thoracic spine also usually rotates as a result of the the pelvic rotation.

So we then want to mold the back rest to the shape of the trunk to accommodate for that deformity.

So, just the recap.

On today's episode, we went through some of the common postural presentations.

We went through how you would choose between a standard and a complex backrest.

We talked about some of the accessories that you could use for these different postural presentations, and then went through those most common postural presentations and how you can support them in their seating system.

If you have any experiences with these different postural presentations, if you've had a chance to trial any of these accessories, we'd love to hear your thoughts.

Thank you.

See you in the next episode.

Bye.