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Seating and Positioning: Common Clinical Considerations

Seating and Positioning: Common Clinical Considerations
Michelle Hediger, M.S., OTR/L
January 30, 2012



Thank you.  I would like to welcome you to seating, positioning and common clinical considerations.  I have been doing seating and positioning for 15 years as an occupational therapist.  I have worked mostly with a geriatric population, but also a little bit in pediatrics. 

Learning Objectives

I hope that you will be able to identify common impairments that influence posture and positioning.  We are also going to focus on identifying the common environmental influences on seating in a wheelchair.  By the end of this presentation, you should be able to demonstrate an understanding of some restorative and compensatory treatment models for seating and positioning.  Lastly, you should be able to define some various common treatment approaches to positioning, and, hopefully, you will go back into your clinic and be able to implement these.  Our goal with seating and positioning is to find the right functional posture for an individual.  We need to always be mindful that we do not sacrifice function by trying to correct position. 

Optimal Seated Position

I am going to discuss what optimal seated position is, but it is important to remember that even though we want to maintain joints in a specific position, we need to keep function in mind.  We want to have the head in a neutral position with the gaze going forward, shoulders in a neutral position of equal height, elbows at 90 degrees flexion on armrests and natural spinal curves maintained.   A neutral pelvis is very critical with hips at 90 degrees flexion with some slight abduction and alignment in the shoulders and head.  There should be equal weight bearing through both ischial tuberosities.   The knees should be comfortably flexed, approximately 90 to 100 degrees and in line with the hips, with the back of the knees two inches away from the edge of the seat.  The ankles should maintain a neutral position whenever possible with feet having a solid base of support on the ground or on foot pedals. 

michelle hediger

Michelle Hediger, M.S., OTR/L

Michelle is an Occupational Therapist who currently is responsible for clinical program development and special projects for a large contract rehab provider. Prior to this role, she has held regional operations positions providing management oversight for post-acute rehab and assisted living settings. She has nearly 15 years experience as an Occupational Therapist across a variety of settings including skilled nursing, assisted and independent living, mental health and school based therapy. Her clinical areas of expertise include management and leadership, long term care programming and wellness program design and implementation. She spent four years as an Assistant Professor and Academic Fieldwork Coordinator at Suffolk County Community College, New York. She is an experienced program developer who has produced and presented training courses for healthcare professionals with a variety of backgrounds, including therapists, nurses, social work and long term care administrators. Her expertise in Geriatric management and education has led her to expand rehab teams and build innovative therapy programs across the geriatric care continuum.

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