Postural control is an integral part of motor control, providing stability and a substrate for movement. Posture is defined as the alignment of the segments with each other and their position in space.
Postural control is the ability to obtain and maintain postures during quasi-static and dynamic activities. It includes the ability to straighten the head, trunk and limbs and to maintain and regain balance. We cannot approach it from a single point of view, since good control is essential for each and every moment, activity and task of the day.
From personal hygiene activities, dressing, eating, transportation, sitting... all will need some degree of postural assessment, so that the tasks are as functional and rewarding as possible. Sitting, sitting, is undoubtedly the most used posture and to which we have to pay greater attention in school.
Based on the fact that wheelchairs are technical aids, considered in our case technical aids for transport, transferring to another seat is a priority, so a good sitting position, adapted school furniture, positioning aids and other appropriate materials will provide children with better postural control, as well as better interaction with their environment, in the school environment.
However, there are more and more wheelchairs that, with different positioning systems, ensure good general postural control, so in many of these cases other seats will be omitted, although other postural changes in standing or recumbent will be maintained.
Seated goals or objectives are considered:
• - Enhance functional capacity.
• - Normalize muscle tone/decrease abnormal reflex movements.
• - Prevent the development of skeletal and muscular deformities.
• - Promote proximal stability.
• - Achievement of maximum comfort and safety.
• - Enhance visual/perceptive abilities.
• - Improves swallowing and digestive functions.
• - Increase lung hygiene.
• - Increase self-esteem.
For sitting in general, it is necessary to consider giving support to the pelvis, without there being an obliquity; give the lower extremities support and stability; restore physiological curves and scapulo-thoracic orientation in the trunk and upper extremities; and finally, alignment of the head and neck.
To meet the sitting needs of wheelchair users, we must provide a level of balance in the seat to help prevent pelvic obliquity, reduce the risk of pressure and friction by placing the hips deep in the seat, providing a functional base of support, maintaining proper alignment of the lower extremities and reducing pressure on the ischisal area. Keeping the knees as close as possible to 90°, respecting the limitations of knee movement, we must also stabilize the pelvis in an optimal position, provide support in the lower dorsal part to correct or accommodate kyphosis.
The spine must be aligned to obtain adequate alignment of the head and neck, lateral supports and headboard, if necessary, tilting seats with trays and straps on the trunk.
For all this, the conclusion is reached that the aid, modifications and adaptations in the furniture are personal, since they aim to respond to individual needs. Furniture adaptations tend to be as simple as possible and aesthetically pleasing.
It is important as a general rule to maintain the same working height as the rest of your group. And it is necessary to provide sufficient furniture adaptations for the rooms of the center in which the student carries out their activities.
The adapted furniture must undergo subsequent reviews for better adaptation, the intervention of the teaching team being essential, in this case, to detect possible deficiencies or modification needs. It is the teachers who, being with the children in all situations, will be able to better assess the adaptation needs of the furniture.
In short, providing comfort, facilitating balance, stabilizing the trunk, arms and lower limbs, avoiding incorrect postures, providing security to the student, promoting control and reach of school materials, and therefore improving the self-esteem of students, are the main objectives of adaptations to school furniture.
To adapt school chairs, we must consider several points before getting down to work:
• - What level of postural control do we start from.
• - What the student's wheelchair gives us and what we can improve.
• - Use of some type of orthosis for the trunk or lower limbs.
• - What the rehabilitation doctor or physiotherapist who treats the child thinks, what the teachers and the educator think, and also what they suggest and what expectations the family and the student themselves have.
For all this and as general criteria, what is intended with the adaptations of the furniture is:.
• - A comfortable posture.
• - Provide security.
• - Facilitate balance.
• - Avoid incorrect postures.
• - Guarantee foot support.
• - Better control of school materials.
• - Be able to use magnetic materials.
The bases of correct posture would be:.
• - Symmetry.
• - Equal support in both hemibodies.
• - Head in the midline.
• - Tilt the pelvis until you achieve balance.
• - Correct support of the feet.
The basic principle of correct sitting posture in a wheelchair is the same as that pursued with school furniture. The choice and adaptation of a wheelchair will be essential for the development of all activities in the school environment.
The following are the objectives of good sitting in a wheelchair:
• - Postural objectives: Alignment and symmetry, trying to inhibit primitive reflexes, normalize muscle tone or compensate for inadequate tone, prevent the development and progression of the deformity, distribute pressures evenly.
• - Functional objectives: Improve head control, adequately supporting the pelvis, feet and trunk if necessary, to improve head control. Improve the function of the upper limb, stabilizing other ends and segments, to free the hands from the support function.
• - Practical objectives: Increase the mobility and autonomy of the user.