This presentation by Wendy Hendrie, Specialist physiotherapist in MS at the Norwich MS Centre, looks at why posture is important and provides information about assessment as well as case studies. It was presented at the MS Trust Annual Conference in November 2014.

1. POSTURAL
MANAGEMENT FOR
PEOPLE WITH MS
Wendy Hendrie
Specialist physiotherapist in MS
Norwich MS Centre

2. Aims
•Why bother about posture?
•Assessment
•Case studies

3. Aims
•Why bother about posture?
•Assessment
•Case studies

4. Posture is not usually something we
have to think about

6. Posture…
•is the shape and position our body adopts
and is constantly changing
•provides balance and stability which is
vital before we can function
•is a learned skill

7. Posture is complex
•Adapting to the surface your body is resting
on
•Organising body segments when sitting,
lying and standing
•Being able to adjust quickly e.g. to the
disturbance of moving a limb
•Being able to position the body for
movement

8. Posture is complex
•Changing position
•Taking the weight off limbs in order to
move them – e.g. walking
•Allowing muscles to act by providing a
fixed point to act against
•Keeping stable in order to function -
balance

9. Many systems contribute to posture
SENSORY
VESTIBULAR CEREBELLAR
POSTURE
MOTOR VISUAL

10. What is ‘good’ posture?
•Stable base - supported and balanced
•A position from which we function
effectively
•Uses as little energy as possible
•Causes the least damage to the body

11. ‘Good’ Posture
Sitting Standing

12. Good posture?

13. What is ‘bad’ posture?
•Any position that causes damage to the
body
•Asymmetrical postures can often cause
the most damage
•Damage often occurs when bad postures
are held for a long time

14. ‘Normal’ Posture!
Sitting
Standing

15. Keeping upright in standing or sitting
involves a constant struggle against
the force of gravity

16. Posture changes with
weakness
in standing…

17. …and in sitting

18. In people with MS…
•Things go wrong when automatic and
voluntary postural control is lost
•Compensatory strategies maximise balance,
stability and function
•Secondary complications inevitably arise

20. Secondary complications
•Pain
•Pressure
•Contractures
•Breathing difficulties
•Speech and swallowing difficulties
•Digestion problems
•Inability to function effectively
•Decreased quality of life

21. Why manage posture?
•Improve function
•Increase quality of life for pwMS and
family/carers
•To minimise or avoid secondary complications

22. Aims
•Why bother about posture?
•Assessment
•Case studies

23. Assessment
•Subjective (rarely about posture!)
•Pain
•Pressure ulcer
•Spasms
•Speech or swallowing problems
•Breathing difficulties
•Handling or positioning problems
•ADL problems

24. Assessment
•Objective
•ROM
•Active movement
•Functional independence
•Tissue damage
•Infections – urinary/respiratory
•Pain
•Preferred posture

25. The ‘preferred’ posture
•The posture which the body customarily
adopts when placed in any position.
•On release of passive correction the posture
reverts to the original attitude indicating the
existence of tissue adaptation.

26. Preferred posture

27. Pelvis position – the key
stone
Pelvic rotation
– right ASIS
forward
Posterior pelvic tilt
Pelvic obliquity – higher
on left

28. Measure between the
coracoid process and
the ASIS – less useful
if double curvature
present in spine

29. Assessing sitting posture
•Lay the person on a flat bed
•Look at the preferred posture
•If the body is able to lay completely
straight, a symmetrical posture can be
achieved in sitting

30. Fixed postures
•The aim is to adapt the surface so that no
further deformity can take place
•Referral to wheelchair service
•Consider Botox, antispasticity medication
change

31. Goals
•Emphasis on function
•Aim for dynamic and/or static success
•Patient/family/carer led and agreed

32. Aims
•Why bother about posture?
•Assessment
•Case studies

33. Early intervention is vital
•Stretch hip flexors
•Work hip extensors
•Upright standing

34. Standing fully upright

35. Sitting postures
Easier to
control posture
in sitting

37. Foam blocks – 1” and 2”

42. Using head support to push back
in the chair.

44. Postures for function

45. Normal eating posture

46. Using the toilet/commode

49. Ataxia

51. Hoisting

54. Posture in lying
•Most damage done in this position
•Keep body as straight and in-line as possible,
hips in line with knees and shoulders and avoid
twisting in the middle
•Keep knees apart and supported
•Support arms and move them away from the
sides of the body if possible

55. Preferred posture

61. ‘Windswept’ posture in bed

66. Head support

67. Headmaster
collar

72. Good posture = function

73. Standing
and good
posture is
great!!

74. Summary
•Often a compromise between posture and
function
•Try to make people feel stable and balanced
•Change position regularly if possible
•Most damage done in lying position

75. Summary
•Pelvis is the keystone – correct pelvis first
•Dynamic and static success is good
•‘Sell’ the concept of good posture and
ensure that people know what to do

76. 24/7 management
•Meeting of experts
•Care Plans that describe the correct
positions
•Use digital cameras
•Family /carer awareness and training

77. What’s the point?
•Function and independence
•Prevention of unnecessary secondary
complications which increase disability
•To improve quality of life for pwMS their
family and carers

79. Thanks for listening