Postural assessment, Part Two: Deviation for sense of and actual alignment

Abstract

Introduction: Accurate sensing of the body position in space is important for safe and mechanically effective interaction with 
the environment. Clinical evidence however suggests that a client's sense of postural alignment differs from their actual 
alignment, which may influence the accuracy of postural repositioning during participation in activities of daily life.
Objectives: The aim of this quantitative descriptive study was to investigate the difference between sense and actual postural
alignment during sitting and standing positions, with the anatomical landmarks as reference points for measurement from anterior and lateral views.
Methods: Ten health care clinics in the Free State towns of Botshabelo and Thaba N'chu, were randomly selected and 95 
patients participated in the study. Measurements consisted of (a) a biographical questionnaire, (b) assessment of actual 
postural alignment, and (c) assessment of sensed postural alignment. Assessment of actual postural alignment was done by 
using the Photographic Method of Postural Assessment (P-MPA), during which the actual (real) distance on photos was 
established by calculating the ratio of measures/real distance x distance from plumb line for each photo. A clinical significant 
difference from the reference point as measured on the photo was set at 10mm. The sense and actual deviation, for sitting and standing were compared by means of 95% confidence intervals for median differences.
Results: Results show statistical and clinically significant differences for sense and actual deviations from the plumb line for 
lateral views for all anatomical landmarks, in both sitting and standing positions. With the exception of a clinical significant 
difference at the nose landmark in anterior view, results show no other statistical or clinical significant differences for anterior sitting or standing.
Recommendations: The authors recommend that follow up studies investigate postural repositioning during motion and in 
addition to speed and direction, also test the degree to which discrepancy between sense and actual values occurs.
Conclusion: Increased awareness by health care professionals and educators of the discrepancy between sensed and actual 
postural alignment, in anterior and lateral views, may benefit the planning of intervention programmes aimed to enhance safe and meaningful occupational performance.

Keywords:  Postural alignment, sense of posture and actual posture