Power Point PDF Concept - engstromconcept.com · ConceptENGSTRÖM GOAL: Pelvic stability and trunk...
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Transcript of Power Point PDF Concept - engstromconcept.com · ConceptENGSTRÖM GOAL: Pelvic stability and trunk...
Starting with a few questions!
How do you want your clients to sit?
What kind of problems do you see?
How are your clients sitting?
How long time are your clients sitting?
What can you change to improve sitting?
What kind of wheelchairs do you work with?
ENGSTRÖMConcept
ENGSTRÖMConcept
A healthy upright
position is a goal.Why are so many
clients collapsing?”Standard” can be quite dangerous !
What influences what?ERGONOMICS
LONGTERM SITTING
What may become a problem?
l PRESSURE - TOO HIGH or NOT ENOUGH
l SHEAR - TOO STRONG SOFT TISSUE DEFORMATION
l MUSCLES - HIGH TENSION, FATIGUE or INACTIVITY
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RESULTING IN
l PHYSICAL INJURY and DECREASE OF FUNCTION!
l POOR TISSUE FLEXIBILITY (CONTRACTURES)
SOLUTION
WHATdo we see?
WHYis it so?
HOWcan we make a
change?
CAUSEProblem?
Potential?!
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SEATING
HOW is a physical
change achieved?
Product
DESIGN!
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Pressure
Shear
Gravity
Softness…
Contours...
Angles…
Materials...
Measures...
Influence
The Body
System
+ TIME!
Changing the forces by moderating
NORMAL BEHAVIOUR IN SITTING(compensations)
MOVING FORWARD ON THE SEAT
ASYMMETRY OF THE TRUNK
LEG and FOOT POSITIONS CHANGE
ARM POSITIONS CHANGE
COMBINATIONS - MANY!!
HEAD POSITION CHANGES
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LEGS AND ARMS IN SITTING
MOVING THE FEET...
LEGS CROSSED...
KNEES APART or TOGETHER...
ARMS AGAINST THE CHEST...
ARMS LIFTED UP and BACK...
EXTENDING or BENDING LEGS...
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LOGICAL COMBINATIONS!
IMPORTANT FACTORS IN SITTING
STABILITY - find a ”stop”
FREEDOM - for motion
CONTROL - static-dynamic muscle activity
TIME!
COMFORT
COMFORTABLE?
l muscle tension, joint position...
l pressure, shear, temp., humidity...
l communication - head & hands
EQUILIBRIUM!!
Time Tolerance Level !
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…is a feeling! (like or not like)
…your senses inform you!
THE SPINAL COLUMN IN SITTING
SYMMETRY OF THE SPINAL COLUMN
The core for freedom to move the trunk.
ASYMMETRY OF THE SPINAL COLUMN
When the trunk moves and for trunk stability
SPINAL COLUMN MOVEMENTS
Forward Bending, Rotation, Side Bending
(Scoliotic...), Extension and - Combinations!
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DESIGNING IT or RE-DESIGNING IT!
Never forget!
If this is your work, YOU are a designer!
We dictate how the user’s body is influenced when
changing Softness, Contours, Angles and Measures.
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The Center of Mass of the Head
Active
and
passive
stabilize
Upright and well
balanced position
Tendency in a
balance position
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THE BASE POSTURE
Task A Reach for a glas on the table.
Task B Scratch your left lower leg.
Task C Take an apple on a plate just behind you.
Task D Bend forwards and ush the wheelchair with your arms.
Move to
Return
SEATING ADAPTATION GOAL
STABILITY
FREEDOM
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CONTOUR
FOLLOW BODY CONTOUR
PRESSURE DISTRIBUTION
AND LATERAL STABILITY
CONTOUR
PREVENTION OF
FORWARD SLIDING AND
POSTERIOR ROTATION
PELVIS and HIP AREA
IMPORTANT SEAT CUSHION FEATURES
PELVIC STABILITY
Pressure
from seat
surface
Pressure
from
back
support
CONTOUR
Pressure Distribution
Pelvic Stability
CONTOUR
Functional Leg Support -
for Trunk Stability
Slide Prevention
CONTOUR
Comfortable Leg
Support - stabilizing
Pelvis and Trunk
PELVIS & HIPS LEGS / THIGHS
Basic Shape of a Seat Cushion / Surface
Slide Prevention
PELVIS & LEGS
s
Slide Prevention
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SEAT-ON-BACK INFLUENCE
Functional thigh contact against the front area of
the seat stabilizes (presses) the trunk/chest
against the middle to upper area of the backrest.
A functionally stabilized pelvis
stabilizes the thorax (downwards).
Comfortable and safe pressure in the buttock area is a must to
prevent sliding and shifting of the pelvis (due to discomfort or pain).
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GOAL: Pelvic stability and trunk freedom.The seat lower under the pelvis combined with
forward angle, frees the trunk in direction forward
and makes it also easier to extend the trunk.
GOAL: Pressure distrubution and trunk stability.Lower under the pelvis (knees higher than hips) increases
the collapse of the trunk. A sacral support stabilizes!
COMBINATION SEAT CONTOUR and SEAT ANGLE
GOAL: Creating more trunk stability.Knees still higher than the hips means a stronger
trunk collapse and sacral support is highly
necessary to stabilize the (weak) trunk!
NEUTRAL
1-2 POSITION OF THE PELVIS / THE SACRUM
By allowing room behind the pelvis for placing it and the Sacrum in space, the base for L5 is decided for an optimal alignment of the rest of the vertebras of the Spinal Column.
With a stable pelvis it is easier to maintain the trunk in an upright position - the vertical collapse of the spine is more or less blocked.
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This is the first and second KEY-ADAPTATION!
3 EXTENSION OF THE THORACIC SPINE
Make room for a personal extension of the trunk and support comfortably against the Thorax, behind and sides.
This balances the weight of the upper trunk and, when assisted by gravity, its contact against the back support is maintained. It stabilizes the pelvis and prevent a negative, posterior rotation.
Placing the chest places the neck, head and shoulders in space.
This is the third KEY-ADAPTATION!
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4 CONTOURING FOR THE LOW BACK
The size of the Lumbar Lordosis is dictated by the position of the sacrum in space AND the extension of the thoracic spine (the position of the chest in the sagital plane).
Follow the Curve of the Lumbar Lordosis.
Observe, not too much pressure!
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The fourth KEY-ADAPTATION!
Supporting in the midline and
from the sides against
the Pelvis and Thorax
stabilizes the chest and spinal
column, making it easier to
keep the trunk symmetrically
upright.
SYMMETRIC STABILITY OF THE TRUNK
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= Key support areas
Contact Contact
Supporting in the midline, just
below* the scapulas,
the”Scapula Triangle”, stabilizes
the trunk while allowing the upper
trunk and the shoulders more
funtional freedom**.
This adaptation also improves the
head’s overall freedom for easier
movement and control. Even better
when the head is well balanced!
* For users who need a high back support.
** The top of the back should be arched, higher in
the middle and lower on the sides.
TRUNK STABILITY / SHOULDER & HEAD FREEDOM
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!!
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CONCLUSION OF THE PRINCIPLES
BACK SUPPORT
SEAT
Copyright 2001
Pressure Distribution
for Pelvis Positioning
and Stability
Comfortable Leg
Support for
Pelvis Positioning and
Trunk Extension
Pelvic Stability
Preventing
Forward Sliding
on the Seat
Stabilizing Pelvis and Sacrum
Placing Pelvis and Sacrum
Extension of the Spine and
Thorax-Support
Contouring for the Low Back
SEATSEAT
BACKRESTBACKREST