To improve sitting posture and lower-extremity dressing ability for a patient with tetraplegia, which intervention is MOST appropriate?

• A. Stretch the lower trunk muscles and the hamstrings.
• B. Allow the hamstrings and the lower trunk muscles to tighten.
• C. Allow the hamstrings to tighten and stretch the lower trunk muscles.
• D. Allow the lower trunk muscles to tighten and stretch the hamstrings.

Answer: (D)

In this scenario, posture in a seated position depends largely on tone in the trunk and the ability to position the lower limbs for dressing. Allowing the lower trunk muscles to tighten uses the body's existing postural support to keep the spine erect and the pelvis stable, which creates a solid base for reaching and manipulating clothing. At the same time, stretching the hamstrings reduces resistance to knee extension and leg movement, making it easier to position the legs for dressing and to achieve better overall leg alignment when seated.

Stretching the lower trunk muscles would tend to lessen that postural support, making it harder to maintain an upright, stable sitting position. Allowing hamstrings to tighten would hinder knee extension and leg positioning, complicating dressing. Conversely, the chosen approach of preserving trunk tightness while lengthening the hamstrings best supports both a stable sitting posture and smoother dressing movements.