Capati, Claire Julianne T.

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Search an article or journal on the latest update on the use of body mechanics, transferring and positioning
patients, and assistive devices

- Body Mechanics
A Head's Up on Posture: Don't Be a Slouch!
Proper posture can help reduce the risk for neck and back pain
Most people are completely unaware they slouch when sitting, standing or walking.
Slouching is a sign of poor posture, and if not corrected can cause neck and back pain.
Poor posture is easy, whereas adapting habits of good posture often requires conscious
effort. Most people do not think about their posture until someone brings it to their
attention. The benefits of good posture far outweigh poor posture.
You could say that poor posture habits have followed trends in society. Children carry
heavy backpacks, adults lug briefcases and bags to work, and many people spend
hours hunched over a computer screen at work or at home. Poor posture is not only a
bad habit, but it can lead to back pain and neck pain.

Change takes willpower. However, the rewards of good posture are well worth the
effort. You will feel great, and you will look taller and appear more confident!

What Does Good Posture Look Like?

The body is straight, but not robotic. Good posture looks something like this: The ears,
shoulders, hips, knees and ankles align in a straight line. If you hung an imaginary
plumb line from the earlobe, the line would hang straight through the middle of the
anklebone.

Good posture means there is musculoskeletal balance. This balance helps to protect
the joints in the spine from excessive stress. Good posture also guards against injury
and possible deformity, and it can even help prevent back pain and neck pain.
Stand up and stretch your arms above your head! The American Chiropractic
Association (ACA) suggests, "Do the 'hug your best friend.' Wrap your arms around
your body and twist to the left, then to the right."

 Exercise regularly to keep the abdominal muscles strong—strong abs help

support the spine.
 Avoid wearing high heels. Choose shoes that are comfrtable and that offer good
foot support. 
 Look at yourself in the mirror. Is your posture good? Think about your posture
and how to maintain it throughout your everyday activities.

Purses, Backpacks, and Briefcases

Carry only the essential items that are required for your day.

Avoid wearing a heavy purse or bag over one shoulder. This can place too much weight
on one side of the body and can cause neck, shoulder, and back pain. Instead, use a
bag or briefcase with a single strap, make sure the strap is padded and wide. The ACA
suggests wearing a strap that is long enough to place over the head resting on the
opposite side of the bag or briefcase. This can help to distribute the weight more evenly.

Some children carry almost as much weight in their backpack as they weigh! A heavy
backpack should not exceed 15% of your body's weight and certainly never more than
25 pounds!
Here are some backpack tips:

 Choose a backpack made of a lightweight material.

 Make sure the shoulder straps are adjustable, wide, and padded. A backpack
with a waist/hip strap is preferable. Wear the backpack with both shoulder straps
and hip strap.
 Pack the heavier items close to the back. Backpacks with many compartments
will help you equalize and distribute the weight. Pointy objects should be packed
away from your spine.
 Parents can talk to their child's teacher and arrange for a separate set of books
to be kept at home, eliminating the need to haul books back and forth.
Posture-friendly Tips for Working at Your Desk

 Choose office furniture that is ergonomically designed and that fits your body.
 Sit with your back against the back of the chair with knees at hip level. Consider
using a foot rest. A small pillow or rolled towel placed at the lower back can offer
needed support.
 Your workstation or desk should be at elbow height. Adjust chair height to meet
this need.
 Sit with your shoulders straight and parallel to the hips.
 Don't slouch or lean over your computer monitor. Either move closer to the work
or move the work closer to you. Tilt the monitor so the center of the screen is at
eye level for easy viewing.
 Don't cradle the phone between your head and shoulder! It is much better to use
the speaker phone or hold the phone in your hand.
 Get up, walk tall, and stretch often!

A firm mattress will help keep your spine aligned! However, a few other tips to maintain
great posture during sleep include:

 Don't sleep on your stomach. Sleep on your side or back.

 When lying on your back, place a pillow under your knees. This will ease low
back tension.
 When lying on your side, place a pillow between slightly bent knees. This will
help keep the spine straight.
 Although oversize cushy pillows are inviting, they do not benefit your spine.
Instead, use a pillow that allows your head to align with the rest of your body.

What Else Can You Do to Maintain Good Posture?

Of course there are other things you can do to help establish a lifestyle that supports
good posture. Your doctor and your chiropractor can give you many personalized tips to
help you gain the benefits of good posture.
In this article by Dr. Maurer, there is a specific emphasis upon the need for good
posture. Posture implies strength and self-confidence, but it also implies the concept of
musculoskeletal or sagittal balance. Since gravity and time are two unavoidable forces,
we must use good posture to resist them. An individual with good posture will balance
the forces on the spine more equally, thereby hopefully limiting degeneration. This
article is not only informative in terms of basic information, but it also gives specific tips
as to lifestyle changes to obtain better posture.

- Transferring and Positioning Patient

Improving the Safety of Patient Turning and Repositioning Tasks for Caregivers
Turning and positioning in bed is essential for immobilized patients to increase com-
fort, maintain skin integrity, enhance healing, and achieve care outcomes. When
patients are immobilized for any reason and spend extended pe- riods of the day in bed,
frequent and proper position changes are beneficial to healing (Fletcher, 2005; Metzler
& Harr, 1996). Clinical experience and research have demonstrated that immobility can
adversely affect all body systems. For example, immo- bility decreases gastrointestinal
and genitourinary activity, increasing risk of constipation, urinary stasis, and fluid
retention. Lack of mobility and extended periods in bed also result in diminished muscle
tone, general weakness, fatigue, and venous stasis, which may lead to thrombophlebitis,
pulmonary embolism, and reduced peripheral perfusion. Reduced periph- eral
perfusion, in turn, contributes to loss of skin integrity, particularly over bony
prominences (Metzler & Harr, 1996; Vollman, 2010).
Recognizing the need for and value of turning and positioning im- mobilized patients,
the protocol for progressive mobility is an essential part of care plans for patients in in-
tensive care units. Progressive mobil- ity is defined as a series of planned sequential
movements beginning at the patient’s current mobility with the goal of returning to
baseline (Voll- man, 2010). With more than 5 million individuals experiencing intensive
care unit admissions each year, the short- and long-term complications of immobility
and bed rest significantly affect morbidity, mortality, health care costs, and quality of life
(Graf, Koch, Dujardin, Kersten, & Janssens, 2003; Vollman, 2010).
To achieve the care objectives for progressive mobility and en- hance care quality,
patients require frequent repositioning; however, this necessary repositioning activity
can increase both the patients’ and care- givers’ risk for injury. For example, when
patients are grasped under the axillae and then pulled toward the head of the bed,
caregivers can com- press patients’ arteries and damage the brachial plexus (Metzler &
Harr, 1996). Similarly, caregivers are often in awkward postures and at risk for
overexertion when moving patients in bed, which can contribute to work- related
musculoskeletal disorders. Research and clinical experiences have demonstrated that
patient re- positioning is one nursing task that exposes caregivers to a high risk of
occupational injury.

Results from this pilot study indicate that through the applica- tion of the TAP, frequent turning and
positioning of patients in bed can be made safer and easier for caregivers to perform. Caregivers
 reported sig- nificantly lower perceived physical exertion during turning and position- ing tasks with
the TAP. Caregivers’ greater perceived physical exertion equates to greater stress on musculo-
skeletal structures and increased risk for injury (Fragala & Fragala, 2013; Owen et al., 1992;
Winkelmolen et al., 1994). This reduction in per- ceived physical exertion translates into less force
exerted on musculo- skeletal structures and a lower risk of injury to the caregiver.
As a result of facilitating turning and positioning patients in bed, care- givers may be more likely to
comply with turning protocols as specified in care plans. This change in care qual- ity may translate to
more positive out- comes for patients, including less risk of developing pressure wounds and other
adverse consequences of immo- bility. This study demonstrates how implementation of simple and
effec- tive safe patient handling and mobil- ity solutions can yield better outcomes for both patients
and caregivers.

- Assistive Devices
Recent trends in assistive technology for mobility
Mobility encompasses an individual’s ability to move his or her body within an
environment or between environments and the ability to manipulate objects.
Collectively, these activities enable the individual to pursue life activities of their
choosing. An individual’s ability to perform any mobility task can be compromised by
impaired body functions or structures. Impairments can onset gradually, as occurs with
multiple sclerosis, or they can begin instantly, as occurs with traumatic spinal cord
injury, cerebral vascular accidents, and limb amputations. The link between impairment
and restricted mobility is evident for amputations and spinal cord injury. However,
mobility is also affected by less obvious impairments. For example, the pain associated
with knee osteoarthritis can significantly affect walking ability. Persons with reduced
heat tolerance, such as those with multiple sclerosis, experience decreased endurance
and increased fatigue as ambient temperature increases [1]. Regardless of which body
structure or function is impaired, technology can improve mobility. Wheelchairs, walking
aids, and prosthetic limbs are examples of technologies that have provided widespread
benefit.

To identify new opportunities for improving assistive technologies for persons with a
mobility impairment, the National Science Foundation initiated a study using the World
Technology Evaluation Center. A scientific panel of national experts was formed and
charged with gathering information about research trends in technology that could
transform mobility for people with mobility disabilities. Information gathering involved a
5-day visit by two teams to several of the leading European laboratories working in this
area. Given the many pathways by which disability can impact mobility, and given the
large number of possible technological solutions, the panel focused on seven mobility-
based tasks: posture, balance and transfers, manipulation, walking, stair climbing, other
locomotion tasks, and using transportation. Even within this limited scope, the
technologies reviewed were not exhaustive, but they did provide insight into some
important themes in assistive technology research.
Before describing these trends, we briefly discuss a framework for understanding
different types of assistive technology. Although there are several frameworks that
conceptualize disability [2], the international standard is the World Health Organization’s
International Classification of Functioning, Disability and Health (ICF) framework
(Figure 1). Like other frameworks, the ICF framework acknowledges that ’disability’
results from the dynamic interaction of the user, technology, and the environment.
When environmental demands exceed an individual’s mobility resources, participation
may be restricted. Technology can facilitate participation by indirectly (via treatment or
therapy) or directly (via physical assistance) enhancing and individual’s mobility such
that their mobility capacity meets or exceeds the demand of the environment (Figure 2).

Figure 1
ICF Framework: Body functions are physiological functions of body systems
(including psychological functions). Body structures are anatomical parts of the body
such as organs, limbs, and their components. Impairments are significant deviations
from normal or loss of body function or structures. An activity is the execution of a task
or action by an individual. Participation is involvement in a life situation. Activity
limitations are difficulties an individual has in executing activities. Participation
restrictions are problems an individual experiences in involvement in life situations.
Environmental factors make up the physical, social, and attitudinal environment in which
people live and conduct their lives.

Figure 2
Simplified ICF framework demonstrating indirect (therapeutic) pathways (black
arrows) and direct (assistive) pathways (light arrow) by which technology can
improve mobility. (Modified from World Health Organization model)
Indirect, or therapeutic, technologies enhance mobility by reducing impairments at the
body structure/function level by helping the body in repairing or redressing the body
structure impairment, or by supporting rehabilitation of the impaired body function
(Figure 2, black arrows). Baclofen pumps are an example of an indirect approach
because they facilitate mobility by allowing a person to control his or her spasticity.
Robotic therapy devices are another example of an indirect approach because they
allow people to reduce impairment through repetitive movement training. Therapeutic
technologies typically require clinical oversight to be set-up and operated, are one
modality in an overall rehabilitation plan, and are typically not designed to be used to
execute daily activities outside the clinic. A companion article reviews recent advances
in therapeutic technologies [4].

On the other hand, direct, or assistive, technologies (AT) enhance mobility without
altering the impaired body structure/function (Figure 2, grey arrow). Wheelchairs and
walkers are prime examples; they enhance mobility, but they do not alter the impairment
underlying the mobility loss. Direct technological approaches can augment or support
impaired body structure or function, as in the case of a cane or walker, or they can
replace the missing or impaired body structure or function, as in the case of a prosthetic
limb. In contrast to therapeutic technologies, assistive technologies are operated by the
user rather than a clinician and they are designed to be used to execute functional
activities in the home and community. The focus of this article is on recent trends in
direct technology or AT approaches to enhancing mobility.

Recent trends in assistive technology for mobility: improved user-technology integration

As stated in the abstract, the unifying theme or trend of the research we observed is a
more seamless integration of the capabilities of the user and the assistive technologies.
The observed approaches to enhance integration can be broadly classed into three
non-mutually exclusive areas; 1) improvements to the assistive technology mechanics;
2) improvements to the user-technology physical interface; and 3) improved shared
control between the user and the technology. Improvements in the technology
mechanics include hardware and software advances. Improvements to the physical
interface typically focused on better leveraging the capabilities of user to operate the
technology and providing more intuitive device control.

The panel observed a trend toward better user-technology integration in four key
technologies: powered wheelchairs, prosthetics, functional electrical stimulation, and
robotic exoskeletons.

The panel saw no fundamentally new assistive technologies on its trip; rather the primary
theme in assistive technology development observed was refinement of existing assistive
technology in clever ways so that its capabilities integrated better with the user’s
capabilities. These refinements are being done on an application-by-application basis
through development of improved technology mechanics (e.g., knee-ankle-foot orthosis,
kinetic control of a prosthetic limb); improved user interfaces (e.g., tongue or whole-body
controllers, electrodes implanted in central and peripheral nervous system) and by
automating target control functions in a way that blends the machine’s assistance with the
natural abilities of the user. Better integrated control systems decrease user burden,
enabling more refined control of highly sophisticated prosthetics or enabling persons with
the most severe physical disabilities autonomous mobility in power wheelchairs.

REFERENCE:
https://www.spineuniverse.com/wellness/body-mechanics/heads-posture-dont-slouch
https://journals.sagepub.com/doi/pdf/10.1177/216507991406200701
https://jneuroengrehab.biomedcentral.com/articles/10.1186/1743-0003-9-20