Posicionamiento y Movilidad 2024

Key wellness & self-care / care-planning strategies (positioning & mobility)

1) Use a structured, whole-person framework (person-centered care)

The session is grounded in the ICF (International Classification of Functioning, Disability and Health), organizing health around:

• Body structures & function
• Activities & participation
• Environment & personal factors

Wheelchair seating devices are part of the “environment,” and the whole healthcare team plus the user/family are involved.

2) Build the wheelchair team around the user (shared decision-making)

Key roles mentioned:

• Patient (and family/caregivers when the patient can’t fully communicate)
• Physiatrist/doctor (typically) + kinesiologists + occupational therapist
• Technology provider (supports equipment options and testing)

A major emphasis is that the person is always at the center—their age, functional abilities, lifestyle, gender, sensory/cognitive/behavioral skills, and the environment they’ll use the chair in.

3) Apply “wheelchair objectives” as care priorities

Seated mobility is discussed with multiple wellness goals:

• Adequate positioning (core focus of the talk)
• Stability for safety and effective daily functioning
• Muscle tone management (positioning helps posture organization and prepares for function)
• Pressure ulcer prevention via pressure redistribution + risk-aware equipment choices
• Participation in social/cognitive/psychosocial development (especially important for children)
• Prevent/correct deformities
  • Prevent or correct flexible deformities
  • Compensate for rigid deformities
• Comfort & tolerance to reduce secondary issues

4) Pediatric-specific care: plan for growth

For children:

• Choose chairs that accommodate growth (example: expandable axle for seat width, back depth, and height)
• Expect periodic equipment changes as the child develops

5) Follow a standardized wheelchair service workflow (WHO “8 steps”)

The talk references WHO’s 8-step process to unify selection and prescription:

1. Referral & appointments (self-referral or via health networks)
2. Assessment
   • Interview: user condition, lifestyle, environment, current wheelchair use
   • Physical assessment: pressure ulcer risk/history, posture support needs, pushing method, measurements/observation (pelvis/hip screening)
3. Prescription with user & caregivers: wheelchair type/model + postural support device characteristics + financing plan
4. Financing & ordering via local suppliers
5. Preparation by trained personnel for an initial test
6. Fit test: user tries chair; finalize adaptations and add/modify postural supports
7. User training: safe use and maintenance for user + caregivers
8. Maintenance/follow-up/repairs
   • Ideal first follow-up: 6 weeks after delivery
   • Pediatric follow-up: every 6 months
   • If chair no longer fits: return to Step 1

6) Positioning fundamentals: pelvis first (to protect skin, posture, and function)

The talk emphasizes that the basis of seated positioning is pelvic alignment and symmetry at the ischial tuberosities.

Common pelvic alignment issues described:

• Posterior pelvic tilt / retroversion (sitting more on the sacrum)
• Anterior pelvic tilt / anteversion
• Pelvic obliquity
• Pelvic rotation (like “steering wheel” movement)

Proper wheelchair fit criteria given:

• Matches user needs and environmental conditions
• Provides adequate postural support
• Safe, durable, locally available
• Maintainable/repairable locally (important for long-term care access)

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Practical positioning & equipment tips highlighted

A) Pressure injury prevention (skin integrity strategy)

• Use seating systems that maximize surface area to facilitate pressure redistribution
• Cushion/key high-risk sites mentioned:
  • Ischial tuberosities (receive ~80% of body weight)
  • Coccyx/sacrum region, and areas below trochanters depending on pelvic posture

B) Cushion selection: match contour, immersion depth, and maintenance needs

Core cushion principles:

• Respect patient contours
• Appropriate immersion depth: ~7–8 cm to reduce spine retroversion

Cushion types discussed (with tradeoffs):

• Foam rubber
  • Pros: economical, can be molded
  • Cons: moisture/heat trapping; not ideal long-term durability; limited “wrap/inversion”
• Elastic / memory foam
  • Pros: stable base and comfort
  • Cons: slip resistance and cushioning depend on material; may affect transfers
• Air-filled cushions (single or multiple compartments)
  • Pros: durable, allows inversion/wrap-up, larger contact area
  • Cons: requires maintenance (inflation control), hygiene/cleaning to prevent puncture/tears
• Viscoelastic fluid cushions
  • Pros: stable postural support
  • Cons: temperature sensitive (freezes in cold; loosens in heat); needs gel redistribution each time
• Hybrid (foam + air + gel)
  • Pros: stable support and postural help
  • Cons: maintenance depends on component materials

C) Postural support devices: use them to improve balance and prevent deformities

Examples of supports listed:

• Lower pelvic supports: wedges for tilt, lower back support, abductor/lateral supports
• Feet/ankles: footrests and ankle supports
• Trunk supports: chest supports
• Thigh supports/wedges for pelvic alignment and stability

Caution about lateral supports:

• Should be not too thick (avoid restricting mobility or creating pressure points)
• If supportive, use size/shape to redistribute pressure

D) Backrest design: specific alignment rules to prevent pelvic retroversion

Common backrest “error patterns” and what to do instead:

• Avoid a flat backrest that presses the pelvis forward and causes pelvic retroversion
• Backrest should:
  • Leave clearance in key pelvic area
  • Support over posterior superior iliac spines (not lumbar-only support)
  • Add thoracic extension contouring for individualized comfort and balance
  • Avoid excessive lumbar contouring (can overstress spine and encourage forward sliding)
  • Support neck/head balance so the head can stay upright with less muscle effort

Backrest types and pros/cons mentioned:

• Canvas backrests
  • Pros: lighter, cheaper
  • Cons: limited postural support; can lose tension; less comfortable
• Postural contoured backrests
  • Pros: better stability/comfort/tolerance
  • Cons: heavier; more difficult for folding
• Air anti-decubitus backrests
  • Pros: improve weight distribution
  • Cons: heavier, more maintenance, less stable, higher cost
• Molded contoured backrests (noted especially for asymmetry/scoliosis)
  • Pros: controlled contact; comfortable; anti-decubitus
  • Cons: heavy; needs replacement as patients (especially pediatric) grow

E) Pelvic belt positioning: optimize stability without causing discomfort

Pelvic belt guidance included:

• Purpose: prevent slippage and stabilize pelvis
• Angle options described:
  • 0°: used in geriatrics to prevent forward falling, but may be uncomfortable/dangerous if not functioning appropriately
  • ~45°: common due to chair design; caution with soft tissues; may limit pelvic movement
  • ~60–70°: belt in front of pelvis rotation axis; provides downward force without compressing stomach/bladder; better comfort while controlling anterior sliding
  • ~90°: comfortable and allows pelvic movement to occur; suggests using a four-point belt for keeping the belt firm in place

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Productivity / functional independence strategies (mobility & assistive technology)

1) Choose wheelchair type according to propulsion and postural needs

Wheelchair categories discussed:

• Manual wheelchairs
• Motorized wheelchairs
• In-between self-propelled wheelchairs (discussed later)

Manual types described with functional intent:

• Standard (non-adjustable, heavy, temporary/hospital)
• Transfer chairs (short-term; limited/no postural adjustment)
• Transfer & posture chairs (more positioning options; can add supports)
• Postural chairs (recline; posture maintenance throughout day)
• Respiratory chairs (recline + elevating legs; temporary for specific medical stages)

2) Self-propulsion “fit” considerations

• Lightweight chairs with adjustability (center of gravity, seat height, backrest, etc.) were highlighted for self-propelled users.

3) Frame/transport: match folding & chassis to the person’s real environment

Folding/transport tips:

• Rigid frames: lighter, less maintenance, more stable
• Side folding: more moving parts, heavier, needs more maintenance

Choice depends on:

• Transportation mode (public transport, taxi, private car, trunk size)
• User abilities (some functional users prefer rigid frames for transfer into a car seat)
• Terrain (rural gravel: rigid frames recommended due to fewer moving parts)

4) Cushion + positioning reduces caregiver load and secondary problems

The closing message ties the right wheelchair adaptation to:

• Reduced consequences of deterioration
• Less caregiver burden
• Prevention of secondary impairments
• Lower social and healthcare costs
• Reduced exclusion

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Motorized mobility: how to enable independence (not just “transport”)

Eligibility considerations mentioned

• Users who can’t self-propel with needed speed, tolerance, and comfort
• Children/adults with inefficient mobility or cardiorespiratory complications
• Wheelchair users unable to achieve manual self-propulsion
• Temporary use or regained mobility after losing independence

Cognitive/access requirements emphasized

• Understanding cause/effect, directionality concepts
• Perception and sensorimotor development
• Motor planning + coping strategies (attention, motivation, persistence)

Motorized mobility benefits described (especially for children)

• Independence and timely development of mobility
• Improved emotional confidence/self-esteem
• Better self-initiated curiosity and participation
• Support for language development via social inclusion

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Sources / presenters

• Fabiana Pinto (kinesiologist)
• Elisabeth Soo (kinesiologist)
• World Health Organization (WHO) (referenced for the manual wheelchair guide and the 8-step provision process)