Page 77 - Handbook of Electronic Assistive Technology

64 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

The fundamental overarching aim of a postural management programme is to improve
and enable an individual’s activities and participation by promoting efficient movement,
limiting deformity, reducing pain and facilitating social inclusion.
A postural management programme may assist in achieving this aim by (ISPO, 2009;
Jones and Gray 2005):
• Promoting normal development and patterns of movement by maintaining postural
alignment and reducing unhelpful muscle tone and reflexes.
• Enhancing postural stabilisation of the trunk as a prerequisite to functional
movement and performance of upper limb movements.
• Assisting in preventing or delaying the development of deformity or muscle
contractures by maintaining postural alignment.
• Optimising the position for feeding, respiratory or digestive function.
• Enabling and assisting the exploration of the environment.
• Improving head control and position, which is essential for orientation, socialisation
and communication skills.
• Promoting comfort and relaxation and decreasing fatigue.
• Managing pressure distribution and reducing the potential for tissue damage to occur.

What Is a Functional Posture?

Regardless of ability and impairment, a functional posture will vary greatly not only between
individuals, but there will also be a significant degree of internal variation depending on
the task that the individual is required to do. A position used for writing, for example, will
most likely be different to a position for relaxation and may differ again to a position for
feeding. The number of differing activities and postures that we all undertake during the
day is almost limitless. This becomes a real problem for individuals with postural control
issues who are restricted in their ability to move between positions or may be confined to
one specific seat for most of the day.
A functional posture is one that not only offers stability and maintains alignment but also
enables functional movement wherever possible with energy efficiency to enable sustaining
the posture for any length of time. In sitting, it is generally suggested that this is achieved
through the stabilising of proximal body parts such as the pelvis, spine and shoulders, as a
prerequisite for achieving distal control, e.g., of the head, neck and upper limbs. For example,
stability at the pelvis, trunk and shoulder girdle is required for fine motor and hand control.
Traditional seating and positioning theories have focused on achieving an upright
symmetrical posture with 90 degrees of flexion at the hips, knees and ankles (commonly
referred to as the 90,90,90 position). However, while this may be considered a useful base
to start from, it is more widely accepted that this position is not always the most functional
position for an individual to sustain and that positioning solutions are likely to require a
delicate balance (and often compromise) between achieving an upright symmetrical pos-
ture and an individual’s ability to function (Pope, 2002).