{"id":55397,"date":"2024-06-25T15:02:54","date_gmt":"2024-06-25T13:02:54","guid":{"rendered":"https:\/\/www.rehagirona.com\/?p=55397"},"modified":"2024-06-25T15:03:35","modified_gmt":"2024-06-25T13:03:35","slug":"alternatives-per-tenir-la-pelvis-sota-control-amb-bodypoint","status":"publish","type":"post","link":"https:\/\/www.rehagirona.com\/ca\/alternatives-per-tenir-la-pelvis-sota-control-amb-bodypoint\/","title":{"rendered":"Alternatives per tenir la pelvis sota control, amb Bodypoint"},"content":{"rendered":"

Foto destacada de l’article: Punts de suport ossis \u00fatils al voltant de la pelvis.<\/em><\/p>\n

 <\/p>\n

Article del Dr Barend ter Haar<\/strong><\/p>\n

 <\/p>\n

Quan estem asseguts, confiem en la posici\u00f3 i estabilitat de la nostra pelvis per permetre’ns gestionar la posici\u00f3 i la funcionalitat de la resta del nostre cos, en particular la part superior. Asseure’s \u00e9s una activitat i, per tant, l’ideal \u00e9s trobar mitjans per controlar la pelvis que permetin una activitat din\u00e0mica. En aquest article revisem els diferents enfocaments que s’adopten per assolir aquest control i els pros i contres dels diferents m\u00e8todes<\/strong>.<\/p>\n

Si considerem que controlar la pelvis \u00e9s similar a controlar una pilota de b\u00e0squet, tenim alguna cosa que es pot moure potencialment en tres dimensions. Podem balancejar-nos cap endavant i cap enrere en un pla, podem balancejar-nos de banda a banda en un segon pla i podem rotar al voltant de l’eix vertical en un tercer pla.<\/p>\n

Alguns d’aquests moviments s\u00f3n funcionalment \u00fatils i cal fomentar-los per proporcionar aspectes beneficiosos de la sedestaci\u00f3 com a activitat, mentre que altres s\u00f3n contraproduents per al control funcional d’altres parts del cos. Aleshores, com podem facilitar els bons moviments i restringir els no desitjats?<\/strong><\/p>\n

 <\/p>\n

Usant palanques \u00f2ssies<\/h2>\n

La majoria dels llocs on apliquem forces per controlar la posici\u00f3 d’una part del cos estan vinculats a les parts \u00f2ssies. A m\u00e9s d’aix\u00f2, en la majoria dels casos, per tenir un control total necessitem tres punts de control.<\/p>\n

\"Figura<\/p>\n

Figura 2. Posicionament de suports posturals primaris per posicionar la pelvis (ISO\/TS 16840-151).<\/em><\/p>\n

Si continuem amb l’analogia de la pilota, si tenim un bloqueig en forma de “V” des del darrere controlant l’esquerra i la dreta, la pilota encara pot rodar cap endavant. Si tenim un bloc al davant i al darrere, encara pot rodar cap als costats. En cada cas, necessitar\u00edem un tercer punt de control.<\/p>\n

Aleshores, qu\u00e8 podem fer amb la pelvis?<\/strong> Encara que la nostra pelvis pot estar envoltada de teixits tous, podem arribar a moltes de les parts \u00f2ssies amb for\u00e7a facilitat. Els punts ossis clau s\u00f3n a la part superior de la pelvis on tenim, al capdavant, les espines il\u00edaques anterosuperiors (EIAS); a la part posterior, les espines il\u00edaques posterosuperiors (PSIS); i al costat, les crestes il\u00edaques.<\/p>\n

A la part inferior de la pelvis tenim les nostres tuberositats isqui\u00e0tiques (Figura 1). A m\u00e9s, a mig cam\u00ed, tenim les articulacions del maluc, on els ossos de la cuixa (f\u00e8mur) s’uneixen amb la pelvis, i s\u00f3n els f\u00e8murs els que s’utilitzen per proporcionar la major influ\u00e8ncia al moviment cap endavant de la pelvis.<\/p>\n

 <\/p>\n

Controlar la rotaci\u00f3 posterior\/anterior<\/h2>\n

La majoria de nosaltres necessitem la rotaci\u00f3 cap endavant de la pelvis per permetre un abast \u00f2ptim cap endavant i, per tant, no l’hem de restringir, si \u00e9s possible.<\/p>\n

\"Figura<\/p>\n

Figura 3. Posicionament del cintur\u00f3 de 4 punts per controlar la inclinaci\u00f3 p\u00e8lvica anterior.<\/em><\/p>\n

Quan volem relaxar-nos, adoptem una “inclinaci\u00f3 posterior” de la pelvis, per\u00f2 en exc\u00e9s aix\u00f2 significa que ho compensem inclinant la columna cap endavant; fer-ho durant massa temps seguit comporta el risc de desenvolupar una curvatura cif\u00f2tica permanent de la columna amb la necessitat compensat\u00f2ria d’hiperestendre el coll per poder continuar veient endavant.<\/p>\n

A mesura que la part superior i posterior de la pelvis llisquen cap enrere, les tuberositats isqui\u00e0tiques comencen a lliscar cap endavant sota nosaltres, cosa que agreuja el problema. La millor manera de manejar aix\u00f2 \u00e9s tenir alguna cosa (com la base del suport de l’esquena) que aturi la rotaci\u00f3 de la pelvis cap enrere (apliqui-ho als PSIS i no a la regi\u00f3 lumbar inferior) i una cresta preisqui\u00e0tica prima (5-10 mm) al coix\u00ed just davant de les tuberositats isqui\u00e0tiques, per evitar que llisquin cap endavant (Figura 2).<\/p>\n

Per controlar la rotaci\u00f3 anterior, per exemple, en nens amb distr\u00f2fia muscular de Duchenne (DMD), on la indicaci\u00f3 \u00e9s tirar enrere la part frontal de la pelvis, es requereix un cintur\u00f3 de posicionament p\u00e8lvic de quatre punts, com el Cintur\u00f3 p\u00e8lvic 4 punts Bodypoint<\/strong><\/span><\/a>: la secci\u00f3 encoixinada del cintur\u00f3 (de vegades amb coixinets ASIS afegides) s’aplica als ASIS i les corretges es fixen als pals del darrere de la cadira.<\/p>\n

La cinta secund\u00e0ria s’ha de subjectar als rails del seient per ajudar a evitar que el cintur\u00f3 primari pugi fins als teixits tous de l’abdomen (Figura 3).<\/p>\n

\"Figura<\/p>\n

Figura 4. Opcions per al posicionament correcte d’un cintur\u00f3 de posicionament pelvi\u00e0 (ISO\/TS 16840-15 1)<\/em><\/p>\n

 <\/p>\n

Usant els f\u00e8murs<\/h2>\n

Per a un maneig m\u00e9s refinat de la posici\u00f3 de la pelvis utilitzem l’efecte d’ancoratge que tenen els f\u00e8murs a trav\u00e9s de la seva inserci\u00f3 a l’articulaci\u00f3 acetabular (maluc) (Figura 1). No obstant aix\u00f2, tingueu en compte que aix\u00f2 nom\u00e9s \u00e9s apropiat amb una articulaci\u00f3 acetabular ben formada, ja que no desitgem c\u00f3rrer el risc de subluxaci\u00f3\/dislocaci\u00f3 de l’articulaci\u00f3. Les forces que s’exerceixen sobre l’articulaci\u00f3 a causa de l’\u00fas regular de bipedestar, especialment per als infants en creixement, s\u00f3n essencials per a la formaci\u00f3 adequada d’aquesta articulaci\u00f3.<\/p>\n

L’eina m\u00e9s utilitzada \u00e9s un cintur\u00f3 de<\/strong> posicionament p\u00e8lvic<\/span><\/strong><\/a>, com el Cintur\u00f3 p\u00e8lvic 2 punts Bodypoint<\/strong> <\/span><\/a>o el Cintur\u00f3 p\u00e8lvic 4 punts Bodypoint<\/span><\/strong><\/a>. La col\u00b7locaci\u00f3 daquest cintur\u00f3 \u00e9s important tant per a la seguretat de l’usuari com per a una funcionalitat \u00f2ptima<\/strong>. Amb freq\u00fc\u00e8ncia aquests cinturons de posicionament es col\u00b7loquen err\u00f2niament en una posici\u00f3 de subjecci\u00f3 de 45\u00ba a la uni\u00f3 entre el respatller i la carcassa del seient1.<\/p>\n

Aix\u00f2 pot causar importants problemes de seguretat en permetre que la persona es “submarini” o llisqui sota el cintur\u00f3, i tamb\u00e9 llen\u00e7a la persona cap avall sobre les seves tuberositats isqui\u00e0tiques.<\/p>\n

Al front funcional, aix\u00f2 restringeix severament la capacitat de la persona per avan\u00e7ar. En col\u00b7locar el cintur\u00f3 davant dels troc\u00e0nters majors (\u00e9s a dir, davant de l’articulaci\u00f3 del maluc), les forces de posicionament es transmeten a trav\u00e9s del f\u00e8mur (consulteu la Figura 4).<\/p>\n

\"Figura<\/p>\n

Figura 5. Un parell d’arnesos per a les cames en posici\u00f3.<\/em><\/p>\n

Algunes persones han utilitzat poms com a mitj\u00e0 per evitar que l’usuari de la cadira llisqui cap endavant. L’entrecuix, compost de teixit tou i sensible, \u00e9s completament inadequat per suportar c\u00e0rregues, i el coixinet del pom nom\u00e9s s’ha d’usar per ajudar a l’abducci\u00f3 del f\u00e8mur.<\/p>\n

Aix\u00ed mateix, els bloquejos de genoll tamb\u00e9 s’han utilitzat com a mitj\u00e0 per controlar la pelvis. Els desavantatges d’aix\u00f2 s\u00f3n que aquests blocs poden generar forces excessives a l’articulaci\u00f3 del maluc, restringeixen el moviment lateral\/medial de la cama i col\u00b7loquen una barrera visual addicional entre l’ocupant de la cadira i el m\u00f3n exterior.<\/p>\n

 <\/p>\n

Arn\u00e8s de cama<\/h2>\n

Una alternativa al cintur\u00f3 de posicionament p\u00e8lvic, i una soluci\u00f3 que ofereix una varietat molt m\u00e9s \u00e0mplia d’aplicacions, \u00e9s un o un parell d’arnesos per a les cames (Figura 5)<\/strong>, \u200b\u200bcom l’Arn\u00e8s de cames Bodypoint<\/strong><\/span><\/a>.<\/p>\n

Un arn\u00e8s per a les cames s’embolcalla al voltant d’una cuixa i es fixa al rail del seient a cada extrem. L’avantatge de manejar cada costat del cos per separat \u00e9s que permet el control independent de la rotaci\u00f3 p\u00e8lvica i les obliq\u00fcitats p\u00e8lviques, alhora que es controla la inclinaci\u00f3 posterior de la pelvis.<\/p>\n

Alhora, hi ha la possibilitat de controlar el grau d’adducci\u00f3 o abducci\u00f3 de la cuixa mitjan\u00e7ant la col\u00b7locaci\u00f3 selectiva dels punts de fixaci\u00f3 de l’arn\u00e8s<\/strong>. Les contraindicacions s\u00f3n si la persona t\u00e9 una articulaci\u00f3 del maluc feble i, clarament, un arn\u00e8s per a les cames nom\u00e9s es pot utilitzar si la persona fa servir roba adequada, com texans.<\/p>\n

 <\/p>\n

Refer\u00e8ncies<\/h2>\n

ISO\/TS 16840-15:2023 Seients per a cadires de rodes – Part 15: Selecci\u00f3, col\u00b7locaci\u00f3 i fixaci\u00f3 de dispositius flexibles de suport postural als seients<\/p>\n","protected":false},"excerpt":{"rendered":"

Foto destacada de l’article: Punts de suport ossis \u00fatils al voltant de la pelvis.   Article del Dr Barend ter […]<\/p>\n","protected":false},"author":4,"featured_media":55386,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[1050],"tags":[1172,6251,6252,6254,6253,6255,1633],"class_list":["post-55397","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-novedades-ca","tag-bodypoint-ca","tag-cinturo-pelvic","tag-cinturo-pelvic-bodypoint","tag-cinturo-pelvic-cadira-rodes","tag-cinturo-pelvic-per-a-nens","tag-pelvis-sota-control","tag-rehagirona-2-ca"],"acf":[],"yoast_head":"\nAlternatives per tenir la pelvis sota control, amb Bodypoint - Rehagirona<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.rehagirona.com\/ca\/alternatives-per-tenir-la-pelvis-sota-control-amb-bodypoint\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Alternatives per tenir la pelvis sota control, amb Bodypoint - 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