SPINALCORD: Posture Changes after SCI: "Getting Straight"

This article is from the Pushin' On Newsletter, Vol 17[2], Summer, 1999.

By Gayle Benson, PT
It is important for persons with spinal cord injury (SCI) to maintain good posture. Many individuals with SCI come into the clinic with a pressure sore or red spot. They say, "I've been sitting on this cushion for 20 years, and it's never given me a problem. I can't understand why, all of a sudden, I'm having a problem." There are two reasons for this. First, your skin changes elasticity and thickness as you age; it is simply not as sturdy as you get older. Second, changes in muscle bulk can cause problems. There is atrophy, or shrinking, of the muscle after SCI. It essentially leaves you without all those muscles padding the pelvis. Another physical change that may cause problems with posture is scoliosis, or curvature of the spine. This can cause you to put more weight on one side of your pelvis.

With these types of physical changes, you may not have adequate muscle strength or balance. You probably need some type of external support to make up for your loss of muscle strength. But how do you really know whether or not you have a problem with your posture? Ask yourself?

Do I have problems with pressure areas or red spots?

Do I look crooked or look like I am sitting sideways in my chair?

Do I loose my balance and fall over when I raise my arms?

Do I have pain in my neck or shoulders?

If you say "yes" to one of these questions, you need to talk with your doctor about a referral to consult a physical or occupational therapist about your seating and posture. There are some steps that you can take to improve your posture, but you need a professional that can help you find the right method for you.

The first step is often making adjustments to your wheelchair. If you have a chair that is easily adjustable, there are a few things that can be done to improve posture. The proper height of your backrest depends on your level of injury and how much trunk musculature you have to assist you with your balance and posture. If the back of your chair is too high, sometimes it can feel as if you are being pushed forward. If the back is too low, you may tend to slump down in your chair because you do not have enough support.

People with a higher level of SCI may want to adjust the tilt of the chair. Moving the axles up in relation to the frame can actually tilt the whole chair back. This tilt allows gravity to help push you back in the chair rather than pushing you over forward. A lot of times, a little bit of tilt can really help in terms of balance and positioning. Otherwise, you may try to compensate for the feeling that you are falling forward by sliding your bottom forward, slumping down, and essentially lowering your center of gravity to help with balance. Although slumping down may help with balance, it does terrible things to your posture. Another adjustable part of some chairs is the armrest height. If the height is too low, you are going to end up leaning forward in order to rest on the armrest. This can also lead to poor posture.

The second step in improving posture is choosing the right seat cushion for you. There is lot of variety on the market, but it is an individual choice on which you prefer. Some companies will now allow you to try a cushion out before you buy it. Two cushions that are commonly used are the Roho and the Jay cushions.

If you have skin and pressure problems, you might need a cushion that gives you more pressure relief. An air cushion like the Roho does a very good job of pressure relief. The adjustment is critical for this type of cushion. To be effective it must be adjusted so that you sink down into the cushion to within about 1/2 inch of the bottom. It should not be as hard as a rock.

With the Jay cushion there is a "flolite" material that feels like a gel, but it is a gel-type material that offers pressure relief as it forms around your body. This cushion has a lot of little extra pads that you can add underneath one side of the gel pack to help with your position.

Above all, the one thing to remember with a cushion is pressure distribution. Do not create high-pressure areas! Eliminate them! The pressure distribution can be checked with a pressure mapping system like the Force Sensing Array, a system of 144 sensors that determine pressure points while you are sitting on your cushion.

In addition to wheelchair adjustments and seat cushions, there is one more suggestion to help you maintain good posture. Some problems may be prevented with exercise. It is important to stretch and maintain your flexibility. If you are sitting all day, you need to try to get out of your chair at the end of the day, lie on your stomach, and stretch your hips and knees. Find a way to stretch your ankles daily. If you need bed rest for any reason, try to maintain your stretching exercises.

Pushin' On is supported by grants #H133B980016 and #H133N50009 from the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education, Washington, D.C. Opinions expressed in Pushin' On are not necessarily those of the granting agency.