How to position your patient

Side view

• Bottom right back in chair – Spasticity can be increased if Dave is in a slouched position.
• Correct seat depth – Too deep a chair can prevent Dave’s lower legs from being positioned straight down allowing his feet to be flat on the floor. Too shallow a chair puts excessive pressure on Dave’s bottom and upper thighs.
• Correct seat height – Too high, and Dave’s feet will not be fully on the floor, too low, will put excessive pressure on his coccyx.
• Correct arm height – Too high will cause Dave to hunch his shoulders and too low will provide inadequate support for his arms and shoulders.
• Correct back height – If the back of the chair is too low, Dave will not have enough support to maintain his position
• Good feet support to enable 90° ankles – If the floor or foot plates are not at the right angle or uneven, increased spasticity may cause him to pull further out of position

Front view

• Centralise the pelvis – This is always an important first step as it sets up the position for all other adjustments to be made
• Correct seat width – To keep Dave’s pelvis central, the width of the chair must support him from both sides or cushions should be used if the chair is not adjustable or a chair of appropriate width is not available
• Abduct – If Dave’s legs are held tightly together, it is necessary to use a cushion to position them slightly apart
• Midline trunk position – Keeping Dave’s trunk in midline is essential for maintaining a base from which to move his arms and from which to maintain head position.
• Midline head position – Good head position can help to control spasticity in the other parts of Dave’s body as well as helping him to concentrate and process information more easily.
• Shoulders in external rotation – Maintaining a position with Dave’s forearms pointing forwards helps to keep his muscles at the front and his shoulders from being shortened for long periods.