Sitting position - Posture and performance in C5-C6 tetraplegia

Objectives: To investigate how sitting position and seating affect posture and performance (balance, transfers, wheelchair skills, physical strain during wheelchair propulsion, spasticity and respiration) in persons with C5 and C6 tetraplegia. Setting: Outpatient clinic 'Spinalhalsan', Goteborg, Sweden. Method: Baseline measurements of sitting position and performance were performed followed by an intervention period. The intervention was individually adapted to each person with emphasis on reduction of kyphotic posture and pelvic obliquity. Furthermore, a functional requirement was that the new sitting position was used in everyday life and did not impair balance, transfers, wheelchair skills, physical strain during wheelchair propulsion, spasticity and respiration. Results: Four persons with complete C5-C6 tetraplegia who reported dissatisfaction with posture and seating took part in the study. A comparison of photographs before and after the intervention showed a reduction of kyphotic posture and pelvic obliquity. Balance, transfers, wheelchair skills, physical strain during wheelchair propulsion, spasticity and respiration were affected by the sitting position in an individual manner. Conclusion: Solution of problems concerning sitting and posture for persons with C5-C6 tetraplegia requires good knowledge of the physical impairment, wheelchair adaptation, seating systems and cushions as well as an understanding of the individual's demands and wishes. Due to the complexity of the issue, standard solutions are not applicable. Thus, an analytical working method is required and co-operation between professionals - occupational therapists and physiotherapists - is important. Sponsorship: This study was supported by the Swedish Association for the Neurologically Disabled (NHR) and the Greta and Einar Asker Foundation.