What Does a Can of Coke Have to Do with Seating and Positioning? - GTK

When was the last time you considered the pelvic floor in seating and positioning? What is its relationship with the diaphragm and the abdominal muscles?

With the International Seating Symposium 2020 coming up soon, at GTK we’ve been reflecting on some of the great sessions we’ve attended in the past at previous symposiums. Some years ago, we attended the International Seating Symposium in Nashville. With many great sessions to select from, George decided to attend sessions that challenged his way of thinking. One such session was titled, ‘Enhancing Pelvic Floor Function through Seating and Positioning’ (presented by Physiotherapist Carina Siracusa Majzun, Ohio Health Wheelchair Clinic).

The beginning of the talk called for the audience to consider a can of Coke...

Let’s imagine the top of the can (core) is the diaphragm. The sides of the can are your transverse abdominals and the base is the pelvic floor. A hole in the can, and you have a leak. A kink in the can and core stability is compromised resulting in possible functional limitations. Paying attention to the strength and functioning of all areas should be considered during seating and positioning.

The abdominals (particularly transverse abdominals) are important to a functional performing pelvic floor. When the abdominals contract, the pelvic floor is elevated.

The pelvic floor is an important part of the core in posture and physiological functioning. Correct positioning of the pelvic floor will help with bladder and bowel function as well as functioning of the GI tract. This position is generally a ‘neutral to slightly anterior’ pelvis. However, the best position is one that allows the pelvic floor to be relaxed.

The deep pelvic floor muscles (levator ani muscles, coccygeus and pubo-rectalis) support postural tone, assist in core stability and are vital for sphincteric function. If your deep pelvic floor muscles are in a good position, they facilitate bowel function. Good seating will aid normal digestive processes, thus reducing constipation.

The following should be considered for enhancing pelvic floor function:

1. Tilt in Space – tilt aids postural stability. Anterior tilt helps with tone management and can improve postural balance. 30 degrees of tilt assists with relaxing the pelvic floor muscles.
2. Recline – assists with catheterisation and sitting balance for long periods.
3. Tilt and Recline – working together, tilt and recline improve bladder function and are a practical way for toileting practices in the wheelchair. Ability to alter the tilt and recline positon throughout the day will also allow clients to manage tone, pain and upper limb function. It also improves respiratory function by reducing the gravitational pull on the abdominal muscles.
4. Standing – great for digestion and facilitates bowel management. Standing also aids voluntary sphincter control and creates abdominal tone. There is evidence to support a reduction in urinary tract infections.
5. Leg elevation – this should be considered for daytime practice and to be avoided in the evening. Oedema management at night encourages the fluid to enter the lymph system. As this then drains into the bladder, our clients are most likely have urges to relieve themselves at night, thus disturbing sleep.
6. Finally, consider what medical treatment your client is receiving. For example, baclofen and botox relax the pelvic floor reducing function and potentially increasing incontinence.

References

Faubion SS, Shuster LT, Bharucha AE. ‘Recognition and management of nonrelaxing pelvic floor dysfunction’. Mayo Clin Proc. 2012 Feb; 87(2):187-93

Lombardi G1, Nelli F, Mencarini M, Del Popolo G. ‘Clinical concomitant benefits on pelvic floor dysfunctions after sacral neuromodulation in patients with incomplete spinal cord injury’. Spinal Cord. 2011 May;49(5):629-36

De Looze DA, De Muynck MC, Van Laere M, De Vos MM, ELewaut AG. ‘Pelvic floor function in patients with clinically complete spinal cord injury and its relation to constipation’. Dis Colon Rectum. 1998 Jun:41(6):778-86.

Barks L, Haw P. ‘Wheelchair positioning and breathing in children with Cerebral Palsy: Study methods and lessons learned’. Rehabil Nurs. 2011 Jul-Aug;36(4):146-52, 174.