Dedicated to seating and mobility solutions Assist wheelchair

Dedicated to seating and mobility solutions • Assist wheelchair users in achieving their goals • Respect lifestyle, function, posture, skin protection • Provide simple, effective and safe seating solutions Invacare Matrx Seating objectives • Encourage postural stability and allow for functional movement • Promote activity and support healthy resting postures • Work for optimal support and pressure distribution • Use additional external components only as needed.

Invacare Matrx Guiding Principles • Consider breathing and swallowing • Secondary complications: tissue trauma, pain, deformities, and contractures • A full evaluation • The position of the pelvis directly impacts the spine (and head, extremities) • The pelvis is the foundation for seated function • Determine if a posture is fixed or flexible • Test seating solutions in motion

POSTERIOR PELVIC TILT WITH KYPHOSIS

POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS CLINICAL Presentation Hyperextesion of neck to elevate head Shoulder blades slide forward and apart, impeding shoulder elevation Flattened lumbar spine and hyperkyphosis of the thoracic spine IT’s slide forward Pelvis tilts posteriorly resulting in increased load on the sacrum

POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS Potential Causes Wheelchair fit Seat depth too long/short Foot rest too high/low Inadequate support for sacrum In manual wheelchair, hard to reach wheels Seat-to-floor height too high/low Clinical High or low tone in upper body Limited hip flexion (< 90 degrees ) Weak muscles: abdominals/back extensors Shortened/tight hamstrings Lack of balance/postural control

POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS POTENTIAL Solution Flexible posture Possible use of harness Possible use of table/tray Contoured cushion helps stabilize the pelvis in a neutral position Stable back support that stabilizes the pelvis at the PSIS Place a positioning belt beneath the ASIS or across thighs

POSTERIOR PELVIC TILT WITH HYPERKYPHOSIS POTENTIAL Solution Fixed posture Use tilt to increase trunk extension and improve visual field Contoured cushion to support the pelvis Provide a contoured back to match shape of spine Utilize lateral support for increased immersion and pressure distribution If hip flexion is limited, open the back angle and/or adjust the cushion to achieve a level pelvis

ANTERIOR PELVIC TILT WITH HYPERLORDOSIS

ANTERIOR PELVIC TILT WITH HYPERLORDOSIS CLINICAL Presentation Trunk overextended to prevent forward collapse Pelvic to thigh angle less than 90 degrees Possible that shoulder blades are pulled tightly together to maintain an upright position, limiting arm function Increased lumbar curve and decreased contact with the back support Pelvis tilted anteriorly (forward)

ANTERIOR PELVIC TILT WITH HYPERLORDOSIS Potential Causes Wheelchair Fit Back support too upright Excessive lumbar contouring Clinical Tight quadriceps/hip flexors Weak abdominal musculature Obesity

ANTERIOR PELVIC TILT WITH HYPERLORDOSIS POTENTIAL Solution Flexible posture Consider a chestbelt or harness Make small, gradual changes to seat and/or back angle to reposition the pelvis and spine into a neutral position Lower back support to tailbone to balance curvature of the lower spine

ANTERIOR PELVIC TILT WITH HYPERLORDOSIS POTENTIAL Solution Fixed posture Extra foam insert can be added to increase contact and contour Angle back support forward to compensate limited hip extension Lower rear seat height to help balance the trunk over the pelvis in an upright position

PELVIC OBLIQUITY AND SCOLIOSIS

PELVIC OBLIQUITY AND SCOLIOSIS CLINICAL Presentation The spine is influenced by pelvic asymmetry, resulting in a scoliosis. The lumbar curve will be convex on the oblique (lower) side of the pelvis One shoulder often higher on the weightbearing side Palpation of the Iliac crest reveals that one side of the pelvis is lower than the other Increased risk for pressure sore on lower IT

PELVIC OBLIQUITY AND SCOLIOSIS Potential Causes Wheelchair fit Sling or stretched seat upholstery Seat width too wide and/or arm supports too low Cushion does not offer adequate support/contouring Back angle does not accommodate for limited hip flexion Back support too wide Clinical Pain Issues with muscle tone/weakness Limitations of hip movement Scoliosis

PELVIC OBLIQUITY AND SCOLIOSIS POTENTIAL Solution Lateral trunk supports can be used to provide 3 or 4 points of support Flexible posture Alternate approach – Deep contoured back with built-in support Lateral support Build up the cushion under the lower IT to balance obliquity

PELVIC OBLIQUITY AND SCOLIOSIS POTENTIAL Solution Fixed posture Build up under the higher IT to balance weightbearing Backrest must be deep enough to support the trunk and may have to be mounted in a rotated position

PELVIC ROTATION

PELVIC ROTATION CLINICAL Presentation One hip is usually adducted and internally rotated One ASIS and hip is further forward in the seat One hip is usually abducted and externally rotated Note that asymmetry in the forward position of the knees can also be due to leg length discrepancy or a dislocated hip

PELVIC ROTATION Potential Causes Wheelchair fit Poor wheel placement on manual chair Seat-to-floor height too high for foot propulsion Clinical Limited hip flexion, abduction, adduction Leg length discrepancy and/or dislocated /subluxed hip Unable to reposition after foot propulsion

PELVIC ROTATION POTENTIAL Solution Flexible posture Contoured cushion helps stabilize the pelvis in a neutral position In order to maintain a functional head and shoulder position, you may need to allow for some asymmetry in the pelvis Align the pelvis and lower the backrest to stabilize at the PSIS level. A pelvic positioning belt can help maintain hip alignment

PELVIC ROTATION POTENTIAL Solution Fixed posture Positioning the backrest so that it follows the contours of the pelvis will increase the surface contact area, give more support, and help prevent further rotation. Consider using a cushion that can be adapted to accommodate functional leg length discrepancy

HIP ABDUCTION

HIP ABDUCTION CLINICAL Presentation Movement of the femur away from midline Can be on one or both sides Legs are wide apart – Can cause pressure against legrests.

HIP ABDUCTION Potential Causes Low or high tone Shortened abductor muscles Obesity Inadequate seat depth Seat width too wide Posterior tilt in pelvis

HIP ABDUCTION POTENTIAL Solution Flexible: Use a contoured cushion to support the pelvis in a neutral position. If needed, use additional lateral support to realign the femurs Fixed: Adapt a contoured cushion so that it conforms to the user’s posture. Modify the wheelchair configuration to prevent secondary pressure issues.

HIP ADDUCTION

HIP ADDUCTION CLINICAL Presentation Movement of the femur toward the midline

HIP ADDUCTION Potential Causes Hammock effect from sling upholstery High tone Shortened/overactive hip adductors Anterior tilt in pelvis

HIP ADDUCTION POTENTIAL Solution Flexible: Use a contoured cushion that enhances abduction Fixed: Modify abductor height to prevent pressure build up between knees Cushion ridgidizer contoured to eliminate “hammock effect” of sling upholstery