Scoliosis Seating Challenges
Scoliosis or curvature of the spine is due to a muscle imbalance or is the result of weakness or paralysis. Most scoliosis is found during childhood screenings at school, by your pediatrician or family doctor.
Approximately two to three percent of Americans are afflicted at the age of 16. It is more common in girls than boys and idiopathic in nature occuring during the growth spurt of adolescents between 10 and 16 years of age. Changes in appearance and body functions can result from this condition. With proper treatment many symptoms or issues can be alleviated.
Sometimes surgery is successful. If the curve is 25-40 degrees bracing is considered. If the curve is beyond 40-50 degrees surgery may be recommended. Regardless of the type of scoliosis, staying active and fit should be a part of your routine.
Types of Scoliosis
There are many types.
Congenital is caused from a bone abnormality present at birth.
Neuromuscular is a result of abnormal muscles or nerves. It is frequently seen in people with spina bifida or cerebral palsy or in those with conditions that are accompanied by paralysis.
Degenerative may result from traumatic (from an injury or illness) bone collapse, previous major back surgery, or osteoporosis (thinning of the bones).
Idiopathic is the most common type and has no specific identifiable cause. There are no conclusive theories. There is, however, strong evidence that idiopathic scoliosis is inherited.
Pain Is The Common Problem
The most common problem associated with scoliosis is pain, usually more in the lumbar (lower spine) than in the thoracic (upper spine). Severe curves in the upper spine can compromise the ability for the individual to expand their lungs. Being able to eat and drink safely can cause the person to aspirate or choke on food or liquids (swallowing in to their lungs instead of the stomach). Added pressure from the ribs can affect the stomach and intestines to not work properly.
Because it affects the musculoskeletal alignment, long term wheelchair users are at a high risk for orthopedic injuries, and increased pain in the spine and shoulders. Arm use becomes less efficient with the decreased trunk strength.
One solution is to provide proper trunk support either with braces, surgical structures such as a rod placed in the spinal column, or wheelchair backs and cushions.
To assess the scoliosis using a wheelchair seating system the first step is to look at the individual’s sitting posture and current ability to function. By changing the pelvic position, the trunk, head, arms and legs are all affected.
Pelvic obliquity is when a person’s pelvis sits higher on one side than the other. If the obliquity is flexible you may be able to place a pelvic cushion or small pad under the wheelchair cushion on the side that is lower. For a fixed obliquity you would do just the opposite by placing a small pad under the higher side. By doing this pressure is more evenly distributed.
Check The Spine
The next area you will evaluate is the curvature and rotation of the spine, and the movement of the shoulder blades. Lateral supports attached to the wheelchair back can support the curvatures. By using a three point system you are providing a balance between maximum force and pressure relief.
For a “C” shaped curve (one that causes the person to lean to one side), place the first support at the top of the curve, allowing room at the armpit. The second support should be on the other side at the apex of the curve or directly below it.
The third support will be the seat cushion to prevent shifting. This can be accomplished by using a contour cushion, one with hip guides or by using the armrest of the wheelchair.
For an individual with an “S” curve lateral supports should be positioned at the apex of each curve.
Tilt Or Recline
Standard wheelchair backs do not conform as needed for pressure relief or comfort for people with severe spinal curvatures. The best solution is a custom contoured wheelchair back.
Gravity can cause flexible scoliosis when a person sits upright in the wheelchair. Tilting or reclining the chair’s back a few degrees counteracts this and allows the lateral supports to be more effective. Tilting the wheelchair occurs when the back and seat of the chair move; a recline occurs when only the back moves and the seat does not move.
A reclining back allows the person to stretch their hips and can provide a more comfortable resting position with the legs elevated. The complex seating system can be combined with the tilted seat position and keeps the person in the same position at the hips to help maintain proper positioning.
For someone using a custom contoured back, a tilt is preferred, because reclining would change the position of the contoured back relative to the person.
Scoliosis is a curvature of the spine. There are various types with different recommendations for different degrees of curvature. Severe scoliosis interferes with many daily activities, including getting around in your wheelchair, breathing and eating.
You want to start with a good seating system and add the proper back support depending upon the type of curvature. This may be as simple as a reclining back wheelchair with lateral supports and a contour cushion to a more complex seating system that has a specially molded back support. A therapist who specializes in seating can evaluate positioning and recommend the appropriate equipment.
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