Let’s get it clear: Pommels, what they are and what they aren’t

Let’s get it clear: Pommels, what they are and what they aren’t

A pommel was initially the name offered to the rounded knob at the top of a sword, dagger, or old-fashioned gun. Later it ended up being the name for a protuberance on the front of a horses saddle, and was there as something to clinch If needed and to increase the range of safe movement to enable combating. In seating, this has been the typical name credited to a product at the front of the seat, between the legs. But why do we issue these? As we talk about in this short article, there is one thing that a pommel is not, and that is a legitimate ways to stop somebody slipping forward in their seat.

Pommels come in all sizes and shapes: round ones, triangular ones, oval ones. Often they are fixed, often they are flip down, and sometimes they fast release. Despite their type and how they are mounted, this post takes a look at what they should and need to not be utilized for.

Labeling convention for seating assistances:

To find out what a pommel should truly be used for, lets offer it its appropriate name– right or left median knee support. This comes from ISO 16840-11 and the related Clinical Guidelines document2 (which cover seating terminology), in which it states that supports are named by the body sector planned to be contacted (here the knee), and the side of the segment (using the terms inferior/superior, anterior/posterior, or medial/lateral to suggest which side of the body segment the support is positioned– here right or left, and median). Pommel itself is a deprecated term within the wheelchair terminology basic ISO 7176-263.

In the case of the medial knee assistance it might simply be restricting adduction, rather than actively developing kidnapping. The problem with identifying a support based on its desired purpose is that it restricts possible usages, it can be misleading, and it risks changing excellent client specific issue fixing.

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Figure 1. The Stealth Products MTD-42 provides for apart left and right median knee support that can be changed for the requirements of each leg

Why is it bad practice to use a pommel as means to stop somebody slipping forward? The primary factor is that the groin is not created to be load-bearing: if the individual is sliding forward into the pommel they are probably slipping into posterior pelvic tilt and a kyphotic back curvature, which is not a perfect seated posture.

Great practice

What is the best practice then for managing the position of the hips for a client with a propensity towards posterior tilt at the pelvis? The response is: follow the guidelines to be discovered in BS 86254, and put a pelvic positioning belt over the thighs and connect it to the seat frame anterior to the greater trochanters. This combined with a block at the PSISs at the top of the rear of the hips, need to help to keep the hips in a fairly neutral position, however still permit the customer to reach forward.

Why is it important/useful to keep the knees apart?

There may likewise be a requirement for a lateral knee or lateral thigh support, to control the amount of outward rotation of the thigh. A lot of median knee assistances are single things that act as both right and left median knee supports at the very same time. Stealth Products provide a cool service (Figure 1) where the left and ideal medial support pads can be changed individually to fulfill differing requirements of the left and ideal leg, but placed under a single cover to make the two parts appear aesthetically as a single item.

Is a medial knee support the only way to do this?

A beneficial gadget that can cover both the needs of keeping the hips from slipping into a posterior tilt, while managing the amount of hip kidnapping at the very same time, are leg harnesses (Figure 2). These curve around the thighs, and depending on the fixation points selected, can provide higher or lower aggressive leg and pelvic positional management.

Figure 2. Leg harnesses provide individual leg and pelvic placing management– away from the groin

Do no harm

Dr Barend ter Haar has actually been included in seating and movement for over 30 years, including lecturing globally and establishing global seating standards.

This concept in information is really appropriate to the positioning and function of medial knee supports. We have an obligation not simply to do no harm by what we offer, however likewise promote a possibly less hazardous posture.

Referrals

Further items can be found at www.beshealthcare.net. Please contact barend@beshealthcare.net if you are interested in getting more details on the subject.

ISO 16840-1:2006 Wheelchair seating– Part 1: Vocabulary, reference axis convention and measures for body sectors, posture and postural assistance surfaces
Waugh, K & & Crane, B (2013) A Clinical Application Guide to Standardized Wheelchair Seating Measures of the Body and Seating Support Surfaces Available from: https://www.pmguk.co.uk/resources/best-practice-guidelines archived products
ISO 7176-26:2007 Wheelchairs– Part 26: Vocabulary
BS 8625:2019 Selection, placement and fixation of flexible postural assistance gadgets in seating. Specification

Click to learn more from the Lets get it clear series from Dr Barend ter Haar

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To discover out what a pommel needs to actually be utilized for, lets offer it its appropriate name– right or left medial knee assistance. This stems from ISO 16840-11 and the related Clinical Guidelines document2 (which cover seating terminology), in which it says that supports are named by the body section meant to be contacted (here the knee), and the side of the segment (using the terms inferior/superior, anterior/posterior, or medial/lateral to indicate which side of the body segment the assistance is put– here right or left, and medial). In the case of the median knee support it might simply be limiting adduction, rather than actively developing abduction. There may also be a requirement for a lateral knee or lateral thigh assistance, to control the quantity of outside rotation of the thigh. The majority of median knee supports are single items that act as both right and left median knee supports at the exact same time.