SEATED POSTURAL CONTROL MEASURE DEVELOPMENT

Brigitte Gagnon^1,2,3, Claude Vincent^1,2, Luc Noreau^1,2

¹ CIRRIS, Quebec, Canada; ² Université Laval, Quebec, Canada;

³ IRDPQ, Quebec, Canada.

BACKGROUND AND GOALS

In 2000, the Quebec Health Insurance Board spent more than 28,5 million dollars on the purchasing, the replacement and the repair of wheelchairs and postural aids for nearly 20 000 individuals [1]. In 1997, more than 2 million Americans over the age of 15 used a wheelchair and showed a need for assistance in seated posture [2]. It follows that the volume of interventions in mobility and posture as well as the associated cost would justify a valid, quick and affordable assessment of the seated postural control of clients. This being said, there is currently no French-language tool for the evaluation of seated postural control of adults who use a wheelchair. In recent years, such a tool was finally developed to measure seated postural control with a paediatric clientele: the Seated Postural Control Measure [3]. It consists of an instrument in which seated postural control is assessed according to the postural alignment of the individual and to the impact which this alignment has on his/her functional tasks. The scoring is based on an ordinal scale. In the framework of a Master’s project, the Seated Postural Control Measure was translated and adapted to the evaluation of an adult clientele. Subsequently, the inter-evaluator and test-retest reliabilities of the new instrument were evaluated, which is the object of this presentation.

DESCRIPTION OF THE TOOL

The new instrument evaluates the client’s postural alignment in his/her wheelchair as well as the impact of a functional task (moving his/her wheelchair) on postural control. It contains three very distinct sections. The first consists of background information on the individual (diagnosis, age, date of first deficit manifestation, birth date, description of current seating system and date of its last modification, etc.) and a scale of the level of seating ability, adapted from the Level of Sitting Scale [4]. This 7 point ordinal scale provides a global index of the sitting ability of the person to be evaluated. With this tool, it can determined whether the individual can autonomously adopt a seated position, maintain it without support and move his/her upper body around and beyond the centre of gravity. The second section evaluates seated static postural alignment (22 items, see table 1). This alignment is scored on an ordinal scale ranging from 1 to 4 according to the degree of deviation from neutral base posture. In this manner, normal, light, moderate and severe degrees of deviation receive scores of 4, 3, 2, and 1 respectively. Each item to be evaluated (ex. : head, pelvis, trunk, etc.) is illustrated with sketches in order to precisely identify the angle or the segment (see figure 1). Only palpation, observation and the use of simple instruments such as a goniometer or an inclinometer are used to help the evaluator score the postural alignment. The third section evaluates postural alignment following a dynamic activity (moving his/her wheelchair). The person being evaluated must first move on a flat surface and on an incline with the mobility assistive device (can be moved by another person if unable alone). Next, a second evaluation of postural alignment is performed in order to observe the impact of this dynamic activity on the person’s posture. The same items and evaluation conditions found in the second section are repeated in the third one.

Table 1 Items in section 2 and section 3, Seated Postural Control Measure for Adults

Anterior view	Right lateral view		Superior view
1. Pelvic obliquity	7. Pelvic tilt	11. Head anterior/posterior tilt	18. Pelvic rotation
2. Trunk lateral shift	8. Lumbar curve	12./13. Right and left hip flexion/extension	19. Upper trunk rotation
3. Shoulder height	9. Thoracic curve	14./15. Right and left knee flexion/extension	20. Head rotation
4. Head lateral tilt	10. Spinal curve in the frontal plane	16./17. Right and left ankle dorsi/plantar flexion	21./22. Right and left hip add/abduction
5./6. Right and left hip rotation

Adapted from the Seated Postural Control Measure [4]

Figure 1 Examples of items, Seated Postural Control Measure for Adults

Score Descriptive Numeric	Severe 1	Moderate 2	Light 3	Normal 4	Light 3		Moderate 2	Severe 1	Score
Anterior view 1. Pelvic obliquity Line joining ASIS’s relative to horizontal	> 25°	15°- 24°	5°- 14°	0°± 4°	5°- 14°		15°- 24°	> 25°	A) B)
	Right side high (left obliquity)					Left side high (right obliquity)
2. Trunk lateral shift Line joining sternal notch to midpoint between ASIS’s relative to vertical	> 25°	15°- 24°	5°- 14°	0°± 4°	5°- 14°		15°- 24°	> 25°	A) B)
	Shift to right					Shift to left
Right lateral view 8. Lumbar curve L1-L5									A) B)
	Flexed					Extended
Superior view 19. Upper trunk rotation Line joining shoulders relative to frontal plane of pelvis	> 35°	20° - 34°	5° -19°	0° ± 4°	5° - 19°		20° - 34°	> 35°	A) B)
	Right side forward (left rotation WRT pelvis)					Left side forward (right rotation WRT pelvis)

21-22. Hip add/abduction R (21) and L (22) Angle of femur in relation to line joining ASIS’s	> 35°	20° - 34°	5° - 19°	0° ± 4°	5° - 19°		20° - 34°	> 35°	21. A) B) 22. A) B)
	R L	R L	R L	R L	R L		R L	R L
	Hip adduction					Hip abduction

Adapted from the Seated Postural Control Measure [4]

METHODS

A study to assess test-retest and inter-evaluator reliability was undertaken with thirty-three adults (n=33) who use a wheelchair. They were aged between 23 and 81 years old and presented a variety of diagnoses encountered in a sitting and mobility department. They were evaluated twice, within an interval of 3 weeks, at the Quebec City Rehabilitation Institute.

RESULTS

Preliminary results indicate that evaluated items allow the establishment of an objective standardised measure appropriate for the postural control of adults, which is easily applicable in a clinical setting.

DISCUSSION

This research project contains some inherent limits concerning the representativity of the subjects with respect to the clinical clientele of mobility and posture (diagnosis, severity of deficits) and concerning the inability of the tool to detect minor changes in body alignment. However, through the course of clinical use, the new instrument will improve the recommendation of postural and mobility assistive devices which are appropriate to clients, will foster more effective communication between clinical staff working with the same client and will ensure better tracking of the evolution of seated posture among evaluated clients. Be that as it may, further research must be conducted to determine the construct and criterion validity of this newly developed instrument.

REFERENCES

1. Régie de l'assurance maladie du Québec. Les aides techniques, Statistiques annuelles 2000 (pp. 201-222). Québec, 2000.

2. Housing and Household Economic Statistics Division's St. Americans with Disabilities: 1997-Table 2. Available at: www.census.gov/hhes/www/disable/sipp/disab97/ds97t2.html Accessed April 6, 2001.

3. Fife, S. E., Roxborough, L. A., Armstrong, R. W., Harris, S. R., Gregson, J. L., & Field, D. Development of a clinical measure of postural control for assessment of adaptive seating in children with neuromotor disabilities. Phys Ther, 1991, 71 (12), 981-993.

4. Roxborough, L., Fife, S. E., Story, M., & Armstrong, R. Seated Postural Control Measure, Research Version, Administration and Scoring Manual. Vancouver, British Columbia: Sunny Hill Centre for Children, 1994.