Posture and Postural Ability Scale

Original Editor - Lauren Heydenrych

Top Contributors - Lauren Heydenrych, Lucinda hampton and Carina Therese Magtibay  

Objective

The Posture and Postural Ability Scale (PPAS) is an assessment tool that allows for posture and postural ability to be assessed independently.It is specifically designed to assess both the qualitative and quantitative aspects of posture.

'Quality' of posture is addressed by observing the shape of the body, considering the alignment of specific structures relative to adjoining structures and the support surface.

'Quantity' of posture is related to the ability to stabilize in relation to adjoining structures and the support surface, looking specifically at the ability to hold the centre of gravity within the base of support.

Intended Population

The PPAS is intended for individuals with severe physical disabilities. This tool is not age or diagnosis-specific.

Method of Use

Materials needed

1. Copy of the PPAS scoring sheet.
2. Pen/ pencil

Time required

When performed by experienced therapists, the PPAS can take less than 10 minutes.

Equipment needed

• Plinth/ table for supine and prone lying, as well as for sitting, where feet need to rest on a support surface.
• Firm support surface for standing.

Scoring

The PPAS assesses 4 positions:

• Standing
• Sitting
• Supine
• Prone

Each position is assessed according to:

1. Postural Ability
2. Quality of Posture

Within Postural Ability seven levels are designated, ranging from Level 1 = 'Unplaceable in an aligned posture' to 7 = 'Able to move into and out of position.'

Quality of Posture comprises of six items, each looking at a specific body region. These items are observed in the frontal view and then in the sagittal view. Scoring of the Quality of Posture is given either as a 1 or 0. The value 1 = postural symmetry and alignment, while 0 = asymmetry and deviation from the midline. The total score is calculated separately for each position in the frontal plane and the sagittal plane. Within the assessment of the quality of posture, a space for comments is also made available.

Evidence

Reliability

When tested on an adult cerebral palsy (CP) population, interrater reliability was scored as excellent (three independent raters were used). In addition, there was a high internal consistency for all items scored.These results were reproduced in a study performed with children diagnosed with cerebral palsy.

When tested with children (aged between 6 and 16 years) diagnosed with cerebral palsy, no difference in scoring was related to the children's ages.

Validity

Construct validity was also demonstrated when using the Gross Motor Function Classification System (GMFCS). Lower scores on the PPAS were correlated with higher levels of the GMFCS. It must be noted that the PPAS was not able to identify differences in postural abilities in individuals between the levels I and II.

While these are promising results, further research needs to be done to ascertain if the same reliability and validity can be obtained from other populations and age groups.

Relevance

The PPAS is a tool that aids in equipment prescription, providing insight into where support is needed.

Furthermore, the PPAS is a tool that can be used in active surveillance of posture and developing deformities. Thus providing a way for early identification and management of asymmetries and deficits which would otherwise lead to contractures and boney or joint deformities.

Links

• SeekFreeks is a website specifically for therapists. On their page relating to adaptive equipment selection and implementation are additional resources around the PPAS and other tools.
• A comprehensive guide to the use of the PPAS (in PowerPoint) can be found here.