Page 88 - Handbook of Electronic Assistive Technology

Chapter 3 • Functional Posture 75

be used to determine the child’s postural ability in differing positions; the Oxford Centre
for Enablement Management of Physical Disability 24-7 (Pope et al., 2007), which is a com-
prehensive and systematic postural assessment format, and the Seated Postural Control
Measure (Gagnon et al., 2005), which is designed to demonstrate functional outcomes
from seating provision.

Case Studies

Alan’s Case Study (Adult)

Alan is a 79-year-old male with a dense, left-sided hemiplegia following a stroke. He is
currently using a self-propelling wheelchair as his main form of mobility but is highly reli-
ant on care staff to assist him. Alan is attempting to move his chair using his right foot
and arm, but this is causing him to slide in his seat, causing shoulder pain and he is then
requiring assistance to be repositioned. He has also developed an area of redness on his
sacrum, which is causing discomfort.

Key Assessment Data
MEDICAL
Alan has a dense, left-sided hemiplegia following a haemorrhagic stroke due to an arte-
riovenous malformation. He is able to communicate verbally, although his speech can
be slow at times. He has no active movement of his left arm and little use of his left leg.
He has a history of pressure areas on his sacrum, which have resulted in periods of
bed rest in the past and has left this area of skin highly vulnerable to further pressure
damage.

Social/Environmental/Psychological
Alan lives in a large residential care setting that is fully adapted and wheelchair accessible.
Prior to his stroke he was very fit and active and he is becoming increasingly depressed by
his lack of independent mobility and inactivity. Alan has been able to do an assisted stand-
ing transfer; however, the height of his wheelchair is very low to enable him to foot propel
so this is becoming increasingly difficult.

Physical
Key findings of the physical assessment are:
• Alan has very limited active movement in his left arm and leg.
• Low tone through the left side of his trunk and lower limb with significant spasticity in
his left upper limb.
• Scoliotic spinal curve convex to the right (this is correctable).
• Predominantly sits in posterior pelvic tilt with subsequent kyphotic spinal curvature –
he is able to correct this but cannot maintain it in his current seating.
• Right shoulder pain due to overuse from self-propelling and also from holding onto
the armrest of his chair to prevent him from leaning to the left.