um here I just want uh I just want to give you a a brief int introduction of the posture and then um when you get to learn more in detail or more Advance um you know um basic stuff um so um first of all the position of um of our but on the wheelchair so make sure that this person sit as far back back in the seat as possible so we want this person to going to be fully supported and then um we want to consider if the back rest uh can be required or no okay and then again of course you want to check the pressure you see uh the our butt going to put on the seat and then the trunk over here the back over here okay so uh this is the basic um sitting position that we uh want to uh for our client sitting on the wheelchair so again that's 909090 okay so if you look at a cushion U this is a cushion mapping you see uh because of the AR posture we apply uh different degrees or um uh yeah different degrees of of stress on our city the ideal one is we want it to be even right you can kind of see if it's uneven or more asymmetrical asymmetric then this person may have some kind of posture problem or develop pressure sore on one side than the other and then see here you see this person's kind of sitting kind of uh rotate to the front on this side and you see the uh the bottom kind of give a lot of pressure to the seat so it is very likely that this person will develop a pressure sord right here and once this person develop personal store it's going to be like month that um for B written and you don't want that to that to happen and we we don't want that to happen so a lot of time you need to be careful on the design or choosing the right cushion for our client and then you need to do a lot of uh education okay okay and these are some types of uh cushion that available right now in a on the market and depending on um um the need of the patient and then uh uh their financial um status of course okay so that's the cush so now let's look at the uh body part uh the most important uh body part uh for wheelchair is the pelvic um symmetry um we learned a lot of um posture problem kind of originated from the pelvis or the pelvic movement or uh positions so the first uh factor that uh we typically look for look at is a pelvic symmetry so if you pic the S Asis and then you can you can determine if um this person's pelvic a symmetry or not right and and then you see if it's an uh asymmetric um or non symmetric uh you can kind of expect that the the pressure is not even on both sides right and then uh also uh when this person sitting in the wheelchair we want to see if there's um pressure appli to the side of um the chanter so we want to make sure that the size of the wheelchair or all the uh seat is um appropriate okay so this is uh a quick examples for uh the pelvic uh symmetry so if the pelvic uh as posterior til the person may have difficulty doing you know swallowing breathing because the posture is more like a kyotic posture right and then uh if the pelvic is more like anterior T that would just cause more like a spinal muscle fatigue because the the the back muscle is uh is Contracting at all times and uh the person may have some kind of uh bladder control problem because the pelvic is um ched anteriorly and um other U posture related to this is the foot the neck all those and if the pelvic teal to one side um it kind of shows the instability of the person and the person may have um limited range of motion because of that tilt on one side you can try that if you sit on one side you can see uh um the other side is more like a free uh but the way bearing side you kind of have limited um ability to do things and as it in a long run um people you know tend not to use it and then they range of motion limitation all of it okay so this is the pelvic that we want to see uh first and then uh related to it is the foot position so uh we want the we want to put the feet uh in uh so that we have that 909090 position for the P for the client so um the key is we want to allow um as much hamstring lens as possible because if the hamstring is tight the the pelvic will be like posteriorly tiled and uh you know all all other posture problem will be uh developed okay and then so we may need to adjust the height and the depth of the support for uh the calf P okay and then the thigh yeah um if we if we look at the picture right here so if we look at from the side we may not see uh the thigh position so that's that's let's turn our eyes uh to the front looking so you see that this lady uh her thigh is going to tilot to One Direction like this that will uh create some pressure uh you know in the medial side of uh her legs and then that will put the weight on the we bearing side U here and you can see the spine kind of go in uh more like scoliosis um kind of tendency so we don't want to see that um happen so the leg should be as straight as possible so if it's if it's okay we can put a wedge in between to to facilitate that um Symmetry and straight thigh and um and you uh you can um add something to adjust the width of the leg um rest to avoid a pressure on the KNE like like I said um put something right there and um um yeah and then that let's keep it as straight as possible and um so it may be uh the seed is not um deep enough for this person so in other term the size of the wheelchair May be too small for for the person or too large for the for the person so you want you may want to check the size of the wheelchair or the seat as well okay and now uh the seat angle or cushion so again the seat angle um should allow a large counter area for the person to sit on so you know the person sit on the on the chair there's a large contact area between the seat and then the the back rest so we want to make sure that the cushion on the seat um allows enough space um for um the EC tuberosity so we don't put pressure from the side okay and one indication for that um size is the eyes and the ear should be level so once this person sit in a wheelchair um we should maintain that balance that to keep the eyes and ear parallel to the floor so that's the seat anle and then um so looking at the back ankle um again the ear and the eyes should parallel U to the floor and then the back rest should support the client's trunk or spine right so the back racks uh should be as upright as possible um so that we don't uh create that sheer force that the person may to slide um down or out of the chair okay and then um the height of the back support So typically is you know one or two Ines below um the scab or shoulder blade so that the the the shoulder movement is uh preserved and it really depends on the person's need uh for example if if a person's using a sports wheelchair typically uh Sports uh require a little bit more uh trunk movement so in that sense you can see that uh you know um a lot of um uh Sports wheelchair they have really low uh back support Port because that would allow them to do um some rotation of the trunk but but notice that if the back support is lower that means you know the person needs to be um um to have some control over the uh trunk otherwise uh this person will fall okay and then the back shape it's important so uh uh should be supported um and if not we can add some kind of uh wedge or some kind of support to it so that this person uh spank is uh being uh supported and unless it's necessary okay so typically we don't uh add lateral or trunk L trunk support um to the wheelchair unless it's it it's necessary what I meant by that is um people um argue that if we add support a letter support like this the the user won't need to you know use their own body um Force to to you know that's that person will lose the opportunity to use their own body ability to for trunk control so but you know some people may have difficulty like spinal injury a high T level they kind of have really really poor um back trunks um control right so in this sense um sometimes uh um people may choose um to have um adding um the lateral trunk support for the person okay and then armrest uh the the quick concept is uh the armrest should you know afford this person to rest right so the shoulder should be relaxed the elbow should be relaxed however the height of the armrest should allow this person to push thems up like this so um they may need this technique to uh release the pressure under um the butt so yeah it should be um low enough to have um a shoulder and elbow relaxed but it should be high enough to allow this person to to do some push up for pressure relief okay so for head support um if um it's it's needed if the uh neck um if the body or the sck angle is greater than 105 degrees so this is 90 degrees and then you if it's greater than uh 105 you see the person's head tend to be like you know over or hyper um Extended because of that ankle so in that sense we would add a head support to the wheelchair and depending on the purpose um so if this person U mainly use the wheelchair for transportation then the dors of the Hat should be supported if it's more like normal use you don't need that um support you you don't need that much support So U put the head support kind of a little bit down like at the cical spine will be good enough