How Seating & Positioning Can Impact Efficient Breathing

Seating systems impact several aspects of life, it can determine whether you primarily use your arms to keep your trunk up or freely use your hands to pick up a coffee. A properly set up seating system will reduce the likelihood of pressure wounds or take away that pain in your shoulder from pushing. But your seating and positioning set up is not just about supporting movement, it can directly impact the rhythm of each breath.

Let’s explore the connection between wheelchair positioning and respiration, highlighting how subtle positioning can improve overall respiratory efficiency and quality of life.

What to Consider

First, understanding the bread and butter of what helps you breathe: your diaphragm, lungs (intrathoracic pressure), ribs, and accessory breathing muscles like neck, chest, and upper back muscles.

There are 4 Key postural components that impact your diaphragm and accessory muscles from making something as simple as a breath become a struggle. These postural components can be impacted by several things including muscle weakness or paralysis, spasticity, inattention, or genetics.

1.     Pelvic obliquity

Just like the importance of having a good foundation to a house, if your foundation is collapsing on one side, you will see the house tilt. The pelvis is like the foundation of our body. If the pelvis is tilted, also known as pelvic obliquity, it will directly impact how your trunk or head is positioned.  Below you will see terms that can originate from a pelvic obliquity but are not required to have to occur. For example, a pelvis that is slouched can cause your trunk to come forward causing compression on your lungs (Kyphosis); if your pelvis is higher on one side, this typically leads to a type of scoliosis.

2.     Kyphosis

Kyphosis is a condition where the upper spine curves excessively forward. This abnormal curvature can compress the chest cavity, restricting the space available for the lungs and diaphragm to expand fully. As a result, the diaphragm and rib cage have less room to move,which can make it harder to take deep breaths. Over time, this can lead to shallow breathing, reduced lung capacity, and potentially lower oxygen levels in the body.

3.     Spinal Asymmetries or Scoliosis

Scoliosis is a term used to identify a “C” or “S” shape of your spine which can occur with or without a pelvic obliquity. When your spine curves to one side, this can compress that side of your chest cavity, again making it difficult for those muscles such as your ribs, lungs,and diaphragm to activate to help you breathe.  Having a collapsed side can also lead to serious issues of atelectasis, a collapsed lung, or air trapping. Overall, any type of asymmetry can put you at a disadvantage for your muscles to activate.

4.     Head/neck rotation and or forward Flexion

Zafar et al (2018) did studies showing that when your head hangs forward or forward and rotated you have decreased respiratory function because those accessory breathing muscles are already shortened and have difficulty activating to help you breathe.

The OTHER Considerations:

Other areas of change that can alter your positioning in your wheelchair therefore indirectly impact your respiratory efficiency:

1.     Weight changes or weight fluctuations, specifically weight gain

2.     Skin changes

3.     Change in medical condition or a new medical event

4.     Changes in activity level or overall strength.

These are just a few simple concepts that impact your body’s ability to breath from seated positioning, there are other components not discussed that also impact you- including underlining medical conditions, use of a ventilator, and genetics that generate unique breathing needs of a person.

Check it Yourself

You can monitor your own breathing efficiency by using a portable oximeter, looking at your oxygen percentage and comparing it indifferent positioning in or out of your chair. Remember, if you have difficulty breathing always seek out the appropriate counsel to discuss causes and how to address.

What can be done?

When you and a medical professional have deemed that your seating and positioning are a contributing cause of your respiratory needs, reach out to your ATP. There are several wheelchair products that can assist with your respiratory rate, all of which require special assessment and collaboration with your Assistive Technology Professional (ATP), therapist, and physician. Here are some examples of how your seating can be addressed:

·        Chest Straps

·        Lateral trunk supports

·        Customized seated molding

·        Wheelchair adjustment

·        Body Re-assessment - maybe your body has changed!

FINAL THOUGHT

Wheelchair and customized seating systems can significantly improve your breathing capacity while thinking of 3 main components:

1)     How does your body stack- pelvic, trunk, neck and head?

2)     There are external factors that can be added to your wheelchair OR have a re-evaluation to best configure your wheelchair to your body’s changing needs.  

3)     Team Effort: These issues benefit from collaboration from your physician, your physical therapist, and/or occupational therapist who should reach out to Westpeak’s ATP to discuss how to address your respiratory concerns and get your fix.  

At Westpeak Mobility, we always aim for the best functional fit for your body’s evolving needs.  

**NOTE: This blog is for an educational purpose only and is not intended as a medical advice. Please see seek out a physician for medical concerns.**

Check out our references below for more information.

https://www.physio-pedia.com/Muscles_of_Respiration

Koumbourlis A. C. (2006). Scoliosis and the respiratory system. Paediatric respiratory reviews, 7(2), 152–160. https://doi.org/10.1016/j.prrv.2006.04.009

Zafar, H., Albarrati, A., Alghadir, A. H., & Iqbal, Z.A. (2018). Effect of Different Head-Neck Postures on the Respiratory Function in Healthy Males. BioMed research international, 2018,4518269. https://doi.org/10.1155/2018/4518269

‍