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Guide for Finding the Best Head Position for Your Client

Before Ordering of Equipment
WHAT TO DO:• Before ordering, a thorough mat evaluation is key.
Not only parameters and measurements, but all
the subjective information will be extremely helpful (head position, excessive drooling, diﬃculty
breathing, headaches, etc.).
• Always start with the pelvis, then trunk, and thenthe lower and upper extremities. Follow thisorder in supine or seated position.
• Determine if client needs an accommodation or
correction of posture. You may find they need amix of both approaches.
• Simulate head position with your hands. This will
help you to determine active movement, amountof support, location, and size of lateral or anterior
supports if needed.
• Once you determine the best head position withyour hands, review the equipment options withother members of the complex rehabilitation technology (CRT) provision team. Identify the headsupport and components that best duplicate yourhand simulation and meet the other needs
identified by the team.
• Establish realistic goals. It might not be possible tocorrect a specific posture, but improvement inswallowing, breathing, or the visual field are great
results that will increase function and quality of life.

WHAT TO CONSIDER:• Visual problems are frequently misinterpreted ormisdiagnosed. Refer to a specialist if necessary.
• For clients with or without flexible asymmetries,
look for corrective postures that allow for alignmentof trunk and head.
• For clients with non-reducible asymmetries, look fora personal posture that respects the asymmetries.
• Consider aesthetics. If the head support is too bulky,
uses too many accessories, or is simply unattractive,
chances are the client or caregiver will not use themas intended.
• Look for the cause, not the symptom. Common
symptoms include: head down, hyperextension of
the neck, excessive drooling. Dig deeper and findout what is causing these symptoms. Poor neckstrength, deviated postures in pelvis or trunk, andvisual impairments are examples of causes we wantto address.
• Clients with progressive conditions might need additional support over time. Make sure to choose asystem with compatible hardware to be able tomount components like lateral facial pads, anterior
supports, etc. when needed.

(Continued)(Page 1 of 3)

Guide for Finding the Best Head Position for Your Client

During Delivery of Equipment
WHAT TO DO:

WHAT TO CONSIDER:• In wheelchairs with power or manual tilt, tilt thewheelchair as much as possible, and swing away
lateral trunk supports and armrests. Transfer theuser and position the pelvis in the most neutral
position, as close to the back support as possible.

• Check the thigh-to-trunk angle and increase trunk
extension as needed to find the position where
the client’s head is most stable. This will facilitate
breathing, swallowing, the visual field, etc.

• As recommended in the previous “Before Ordering”
section, position the pelvis first, then the trunkand lower/upper extremities before positioning
the head.
• Use the tilt and recline as needed. Each wheelchair will oﬀer diﬀerent mechanisms to do this:power actuators or mechanical tilt/recline inmanual tilt wheelchairs. Get familiar with theequipment and take advantage of these functions.
• On a sagittal plane, determine the most beneficial
thigh-to-trunk angle and head angle.
• Overall, look for the most functional position,even if that means a deviation from a perfectalignment.

• Go from less to more. Try to use the minimum
amount of components needed. Make sure eachcomponent has a function.
• When placing the head support and its components, avoid direct pressure on the temporal areaand eyes, ears, mastoid process, and mandible.
• It is paramount to receive input from the clientand make adjustments as needed. Depending on
the client's ability to communicate you may gather
this information in both verbal and nonverbal
forms. Paying close attention to nonverbal cues,
such as increased work of breathing or a decreasein the presence of muscular tone.

• Review the goals established by the team at thebeginning of the process and look not only for
progress in position but also in areas like breathing,alertness, communication, learning, comfort,
and seating tolerance.
(Continued)(Page 2 of 3)

Guide for Finding the Best Head Position for Your Client

After Delivery of Equipment
WHAT TO DO:

WHAT TO CONSIDER:• During a follow-up visit, always reassess overallposition. Look for changes in other areas that may
aﬀect the position of the head.

• Sometimes improvements in position are imperceptible,
but they have improved levels of fatigue, breathing,pain, etc. All of this is improvement, too.

• Take pictures, if permitted, and track the client’sprogress.

• Maintaining the most functional position of the headis a dynamic process that needs periodic evaluations.
Don’t be afraid to make changes and try new strategies
if your client needs them.

• Review the goals established by the team at thebeginning of the process and look not only for
progress in position but also in areas like breathing,alertness, communication, learning, comfort, andseating tolerance.
• Reassess goals, make necessary changes, andestablish new goals if needed.

(Page 3 of 3)

References:
1. Lange, M.L. & Minkel, J.L. (2018). Seating and Wheeled Mobility. A Clinical Resource Guide. Thorofare, NJ. Slack Incorporated.
2. Watanabe, L. (2020, June 07) The Critical role of head positioning & support for kids. Mobility Management. Retrieved from:https://mobilitymgmt.com/articles/2020/06/07/head-positioning-for-children.aspx
3. Lange, M.L. (2017) Positioning the head. Proceedings of the 33rd International Seating Symposium: Be Empowered. 02-04 March 2017. Nashville, TN.
4. Caneiro JP, O'Sullivan P, Burnett A, Barach A, O'Neil D, Tveit O, et al. The influence of diﬀerent sitting postures on head/neck posture and muscle activity.
Manual therapy. 2010; 15: 54–60.
5. Sisto, S.A., Druin, E. & Sliwinski, M.M. (2009) Spinal Cord Injury. Management and Rehabilitation. St Louis, MO. Mosby ELSEVIER.
6. Watanabe, L. (2013, June 01) Using your head. Mobility Management, ATP Series.

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