Wheelchair Positioning: The Trunk
Presented by Michelle L. Lange
What needs to be considered when positioning the trunk in wheelchair seating? If asymmetries are reducible, the goal becomes achieving symmetry as close to neutral as possible. If the asymmetries are nonreducible, then the seating system must accommodate the shape of the spine and rib cage to distribute pressure and reduce the risk of further loss of range as well as pressure injuries. This course will present common trunk asymmetries with suggested strategies to address each challenge. Providing as neutral a trunk position as possible improves overall posture, stability, and function. This course is applicable to occupational and physical therapists who work with clients using wheelchairs and applies to multiple practice settings.
Learning Objectives
- Apply appropriate wheelchair seating interventions for a client with a kyphotic trunk position
- Apply appropriate wheelchair seating interventions for a client with a lordotic trunk position
- Apply appropriate wheelchair seating interventions for a client with trunk rotation
- Apply appropriate wheelchair seating interventions for a client with a laterally flexed trunk position
- Implement appropriate wheelchair seating interventions to improve mobility to enhance participation in desired daily occupations, and reduce the risk of complications such as skin breakdown or limb contractures
Meet your instructor
Michelle L. Lange
Michelle Lange is an occupational therapist with more than 38 years of experience. She has been in private practice at Access to Independence for more than 19 years. She is a well-respected lecturer, both nationally and internationally, and has authored numerous texts, chapters, and articles. She is the coeditor of Seating…
Chapters & learning objectives
1. Positioning the Trunk: Kyphosis
Kyphosis can occur at various levels of the spine and may be reducible or nonreducible. Reducible kyphosis is addressed by providing appropriate anterior, posterior, and lateral trunk support. Nonreducible kyphosis is accommodated through pressure distribution and by positioning the head over the pelvis through an open seat-to-back angle and/or tilt in space.
2. Positioning the Trunk: Lordosis
Lordosis can be seen at various levels of the spine but is most often seen at the lumbar area in conjunction with anterior pelvic tilt or at the neck, seen as hyperextension of the cervical area. If this is reducible, anterior and posterior support are used at appropriate angles to reduce the lordosis. If this is nonreducible, adequate pressure distribution is required.
3. Positioning the Trunk: Rotation
Trunk rotation is often seen in combination with lateral flexion. If reducible, anterior support is required on the forward side in conjunction with posterior trunk support. If nonreducible, the priority is to ensure the client is facing forward.
4. Positioning the Trunk: Lateral Flexion
Lateral flexion of the spine is often seen with distortions of the rib cage. Three-point lateral control is often required to reduce this tendency.
More courses in this series
Wheelchair Positioning: The Mat Exam
Michelle L. Lange
Wheelchair Positioning: The Pelvis
Michelle L. Lange
Wheelchair Positioning: The Trunk
Michelle L. Lange
Wheelchair Positioning: The Extremities
Michelle L. Lange
Wheelchair Positioning: The Head
Michelle L. Lange
Wheelchair Positioning: Tying It All Together—A Series of Case Studies
Michelle L. Lange
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