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5 - Seating and positioning

Published online by Cambridge University Press:  22 August 2009

By
Craig A. Kirkwood  and
Geoff I. Bardsley
Edited by
Michael P. Barnes  and
Garth R. Johnson
Craig A. Kirkwood
Affiliation:
Senior Rehabilitation Engineer Wheelchair & Seating Service Tayside Rehabilitation Engineering Services, Ninewells Hospital, Dundee, UK
Geoff I. Bardsley
Affiliation:
Senior Rehabilitation Engineer, Wheelchair & Seating Service Tayside Rehabilitation Engineering Services, Ninewells Hospital, Dundee, UK
Michael P. Barnes
Affiliation:
University of Newcastle upon Tyne
Garth R. Johnson
Affiliation:
University of Newcastle upon Tyne
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Summary

Introduction

Spasticity causes seating challenges for a wide variety of people with disabilities: from children with cerebral palsy, young adults with head injuries, middle-aged people with multiple sclerosis (MS) and older persons who have suffered cerebrovascular accidents (CVAs) and use wheelchairs.

The nature of spasticity is complex and controversial, as discussed elsewhere in this volume. Clinical characteristics described as constituting spasticity and that influence seating include increased muscle tone, hyperactive stretch reflexes, changes in muscle structure and function and abnormal activity caused by posture (e.g. tonic neck and labyrinthine reflexes) (Ford, 1986; Shepherd, 1995).

Spasticity, in itself, is not necessarily a problem and may assist in maintaining a seated posture. This is in contrast to hypotonia, where providing seated support in a functional position is often very difficult. However, there are three key problems that spasticity can cause to the person in a seated position:

  1. Postural instability

  2. Reduced upper limb function

  3. Joint contractures

Correct positioning of the person can assist in reducing these problems (Zollars, 1993). Addressing one of the areas has a largely beneficial effect on the others, so there is little trade-off in strategies to tackle these problems. Barnes (1993) states: ‘positioning of the individual is the most important element in the management of spasticity’(see also Vaughan & Bhakta, 1995).

Appropriate seating should be seen as adjunct to the other approaches discussed in this book which may have greater precedence with increasing severity of spasticity (e.g. pharmacological, surgical) (Richardson & Thompson, 1999).

Keywords

cerebrovascular accidentshead injurieshypotoniajoint contracturesseating challengesspasticitymultiple sclerosis
Type
Chapter
Information
Upper Motor Neurone Syndrome and Spasticity
Clinical Management and Neurophysiology
 , pp. 99 - 112
Publisher: Cambridge University Press
Print publication year: 2008

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  • Seating and positioning
    • By Craig A. Kirkwood, Senior Rehabilitation Engineer Wheelchair & Seating Service Tayside Rehabilitation Engineering Services, Ninewells Hospital, Dundee, UK, Geoff I. Bardsley, Senior Rehabilitation Engineer, Wheelchair & Seating Service Tayside Rehabilitation Engineering Services, Ninewells Hospital, Dundee, UK
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.006
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  • Seating and positioning
    • By Craig A. Kirkwood, Senior Rehabilitation Engineer Wheelchair & Seating Service Tayside Rehabilitation Engineering Services, Ninewells Hospital, Dundee, UK, Geoff I. Bardsley, Senior Rehabilitation Engineer, Wheelchair & Seating Service Tayside Rehabilitation Engineering Services, Ninewells Hospital, Dundee, UK
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.006
Available formats
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  • Seating and positioning
    • By Craig A. Kirkwood, Senior Rehabilitation Engineer Wheelchair & Seating Service Tayside Rehabilitation Engineering Services, Ninewells Hospital, Dundee, UK, Geoff I. Bardsley, Senior Rehabilitation Engineer, Wheelchair & Seating Service Tayside Rehabilitation Engineering Services, Ninewells Hospital, Dundee, UK
  • Edited by Michael P. Barnes, University of Newcastle upon Tyne, Garth R. Johnson, University of Newcastle upon Tyne
  • Book: Upper Motor Neurone Syndrome and Spasticity
  • Online publication: 22 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544866.006
Available formats
×