What’s Posture Got to Do with It?

Posted on October 5th, 2012 by Denise | No Comments

What’s Posture Got to Do with It?


Denise Koonce OTR

I learn so much from my own daughter it is incredible!  For example, we were sitting at the table doing homework and I was constantly reminding her to sit still and concentrate.  No amount of reminding was working and homework was dragging on and my patience was running out.  Then in her brilliance she said “Mom I can’t be still. I need to be up higher so I can do my work!”  It took me a moment but I realized the problem.  She was sitting at our dining room table, feet dangling, chair too big, and her trunk was not at the right height in relation to the table surface for function.  Oops!  OT 101 and I had missed it. 

When I have my therapy hat on, I think like a clinician, when I have my mommy hat on I think more like a mom.  The challenge is when I need to wear both hats because of her needs.  Needless to say I dusted off the foot stool, found the yellow pages (I am not sure what I am going to use when they stop printing these.), located the non-slip shelving paper, cut out some foam and we corrected the situation.  I am now happy to report that homework time and meal time run much smoother.

A child’s body position in relation to the environment impacts how successful the child is with a given task.  The child’s posture can either be supported by their environment or diminished.  If they are using all of their energy to try and sit correctly in an incorrect environment they will not have the organization or energy to engage higher executive functions for learning.  It is therefore very important that the furniture a child is using fit properly.  When sitting, the table height should come to the child’s lower rib cage and their elbow should rest on the table surface comfortably at a 90 degree angle without raising their shoulder.  Their feet should rest on the floor or be in contact with a flat surface with their ankles, knees, and hips at 90 degree angles.  

The three main environments which require a child to sit for functional activities are home, school and for our population, the clinic.  Therefore, we as therapists can impact the success of a child by educating parents, being a resource for their teachers and providing appropriate seating surfaces during therapy. Therapists can make parents aware of the importance in providing a properly fitted seating area for homework and mealtime by giving them with some tips on how to adapt the home environment to make it more suitable.  It is best to begin by adjusting the chair in accordance to the table surface first.  Pillows, yellow pages, or layers of foam can be used to build up a chair surface so the child’s ribcage meets the table height.  Next is to provide a flat supported surface for their feet allowing a 90/90/90 position with their legs.  A foot stool placed under the table works great and layers can be added for height adjustability.   In order to prevent the foot stool from moving and making noise, use a slip resistant material on the foot stool feet.  Parents can then attach a small pillow to the back of the dinning room chair to lessen the hip to knee depth and provide some back support.   By making these small changes I believe our parents will be pleased with the results.

We as therapists also need to be conscious in clinic to make sure the child is positioned correctly in regards to the furniture.  Because of the variety of children that are treated in a clinic there should be a variety of chairs and surfaces.  Clinics invest in adjustable tables and adjustable supported chairs but sometimes there is not enough to go around.  That is when I turn to adaptations which involve little to no cost and are readily available in the clinic.  You can use a bench or folded up accordion mat in lieu of a chair.  If their feet do not touch the floor, use stacking exercise steps, folded accordion mats or varying thicknesses of duct tape covered yellow pages.    It’s good to keep extra foam pieces available and use them to build up the sitting or back surfaces of furniture.  No matter what task you are engaging your patient in; if their posture is appropriately supported by their surrounding environment their chance for success will be heightened.

So, “What does posture got to do with it?” A lot!  Make a concerted effort over the next week to check your patients seated posture and make sure it is optimized.  Please share with us any experiences you have or your creative ideas of how you adapt the environment.

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