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Video: Proper Posture Reduces Sacral Sitting and Improves Independence

Download a printable poster here.

Traditional wheelchair cushions used on uneven or sagging wheelchair seats can often buckle or tilt, losing their intended effectiveness and causing weakened or frail residents to slide forward or slouch. And poor posture as a result of an unstable seating surface can produce dangerous shear forces, leaving residents susceptible to pressure injuries while limiting their sitting tolerance and ability to fully participate in functional tasks.

The Dangers of Sacral Sitting

Weakened, frail, or immobile wheelchair users often do not have the physical ability to sit properly in their chairs or the wheelchair itself offers insufficient support from hammocking sling seats or are oversized for the resident.¹ These issues can cause the pelvis to rest in a neutral or posterior pelvic tilt and, after a short time, the user's buttocks slide forward on the seat, resulting in sacral sitting—a dangerous position that places contact pressure on the sacrum and ischial region and can lead to skin breakdown, falls from the wheelchair, poor sitting tolerance, and loss of functional abilities.

Good Support Starts with a Stable Base

As most positioning or therapeutic cushions require a flat seating surface for optimal function and comfort, a supportive and level base is a key component in helping to reverse poor posture and the dangers of sacral sitting, which in turn can reduce the risk of pressure injuries.

But a level base alone doesn’t solve seating problems.

Adding a wedge-shaped cushion top can help limit forward sliding by keeping the hips positioned slightly lower than the knees, promoting an anterior pelvic tilt and subsequent upright sitting posture. This minimizes the effects of sacral sitting by decreasing pressure on the sacrum and coccyx while allowing the resident to achieve a proper postural position and improved sitting tolerance.

Useful Solutions from AliMed: Sit-Straight™ Cushions

Sit-Straight Cushions are a simple and effective, all-in-one positioning solution that combines a stable seating surface with a wedge-shaped cushion. Sit-Straight’s convex base design counteracts the negative effects of a sagging sling seat by filling the sag area without modifying the wheelchair in any way or raising the height of the surface while the wedge top limits forward sliding and maintains hips at 90° for optimal postural support. This allows residents to participate more fully in self-feeding, self-care, and recreational activities. Sit-Straight Cushions are also beneficial for caregivers as it frees them from continuous repositioning of residents or using restraints to keep them from falling out of wheelchairs. See our printable poster for more on how the Sit-Straight works.

AliMed offers a full line of Sit-Straight styles to meet the unique positioning needs of your residents:

• Sit-Straight Basic Cushions are economical and offer basic support for those who do not need specialized care for pressure relief or shear reduction.
• Sit-Straight Coccyx Cushions with T-Foam™ feature a soft top layer of “slow recovery” T-Foam with a rear cutout for pressure relief at the base of the spine.
• Sit-Straight Cushions with T-Gel™ have a top layer of checkerboard T-Gel for maximum shear reduction and pressure redistribution.
• Sit-Straight Cushions with Pommel assist with hip abduction and forward sliding as the pommel helps keep hips and femurs aligned.
• Sit-Straight Cushions with Release Pommel feature a pommel that conveniently drops out of the way for unhindered transfers.
• Sit-Straight Stay-Put™ Coccyx Cushions have a rear cutout to reduce pressure on the buttocks, promoting increased sitting tolerance, and feature a hinged center and fastening straps that attach under the sling seat so cushions “stay put” when the wheelchair is folded.

References

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088135/