Page 80 - Handbook of Electronic Assistive Technology

Chapter 3 • Functional Posture 67

Social and Environmental Factors Affecting Posture

It may be useful to consider the following factors:
• Home and family, carers, respite care, other environments, including school where the
seating may be used.
• Daily routine in different environments.
• How will this equipment be transported?
• Eating and drinking – will this equipment be used for this? What other equipment will
need to be considered?
• How will the person transfer in and out of the equipment?
• What personal care is required?

Next is the physical assessment.

Physical Assessment
It is useful to have a systematic approach to the physical assessment to assess:

• Position of the pelvis.
• Direction of lower limbs in relation to pelvis.
• Movement and position of hips, knees and feet.
• Shoulder rotation and obliquity.
• Movement and position of the spine.
• Movement and position of the arms.
• Position of the head.
• Weight distribution and weightbearing.

This will enable you to gain a picture of the person’s preferred posture, their abilities in
the position with and without support and any limitations of movement they have. When
assessing for seating or standing, it is usually useful first to see how the person is posi-
tioned in their current equipment before taking them out to assess their movements and
posture in the lying, sitting or standing positions.

Understanding the Position of the Pelvis
The pelvis is often referred to as the ‘keystone’ of posture from which the spine, trunk
and limbs move. So, what is a ‘normal’ pelvic position? This is commonly described as a
neutral pelvis (Fig. 3-10); the alignment of the anterior superior iliac spine (ASIS) and the
pubic bone are in line with each other.
The pelvis may be positioned either in posterior or anterior tilt.

Sitting With the Pelvis in Posterior Tilt
One of the most common postural issues you are likely to encounter is when a person sits
with their pelvis posteriorly tilted (Fig. 3-11): on examination, you will find that the ASIS
is higher than the posterior superior iliac spine (PSIS). The pelvis is rolling backward and
this puts the spine into a C-type posture. The lumbar spine is flexed and there is kyphosis