Head Positioning: matching product to client need, part 1 Posterior Supports

Michelle L. Lange, OTR/L, ABDA, ATP/SMS

Quite a variety of head supports are available to meet individual needs. These head supports have unique features designed to match specific requirements. Posterior head supports are by far the most common and may include lateral support. Collars provide support under the jaw and the suboccipital shelf. Forehead supports or straps provide support anterior to the forehead. One product provides support superior to the head, allowing for rotation and some limited flexion and extension while supporting/suspending the head in an upright position.

Head supports are commonly referred to as head rests as many clients use this seating component to rest against. A simple posterior head support provides a surface for the occipital area to rest against but offers little postural support and cannot prevent neck hyperextension unless placed at an angle to cup the suboccipital shelf. Some posterior head supports do include a generic contour designed to contact this suboccipital shelf but may not match the client’s unique contours. Other supports include a separate suboccipital pad designed to be placed inferior to this shelf to provide some actual head support and to limit neck hyperextension in combination with a separate occipital pad.

Lateral supports can be used to limit lateral neck flexion and rotation. When this head position is difficult to correct, 3-point contact may be required: lateral support at either side of the head, as well as lateral support along one jaw, often provided by the suboccipital pad. This force and counterforce help achieve neck alignment.

A critical part of wheelchair seating is achieving and maintaining an upright and aligned head position. Positioning the head involves far more than choosing a head support. Using a combination of seating strategies as well as matching product features to an individual’s needs will improve the final outcome for the client.