Uploaded by User1129

24 hour posture management for children with disabilities

advertisement
24 hour posture management
for children with disabilities
BY: CAROLINE ADRIAANSE
WISHESLANDER
SENIOR PHYSIOTHERAPIST/OCCUPATIONAL THERAPIST
CERTIFIED PAEDIATRIC MASSAGE THERAPIST (US)
EMMETT THERAPY PRACTITIONER & AQUATIC REHAB THERAPIST
introduction
Children with movement
limitations are at risk for body
distortions (contractures). The
more severe the limitations the
higher the risk.
We often assume that body
shape distortions are inevitable
for children with disabilities, but it
should not be the case…..
PROBLEM
SOLVING

MOST PEOPLE WITH MOTOR DISABILITIES ARE BORN
SYMMETRICAL

WHY DO THEY BECOME ASYMMETRICAL?

CAN WE HELP THEM STAY SYMMETRICAL?

CAN WE IMPROVE HEALTH AND FUNCTION WITH AN
SYMMETRICAL BODY?
Defining
postural
care
Postural care is very gentle; it is not about doing
exercises and stretching to change your child’s
shape but instead using equipment to protect the
shape they have from birth.
Postural care is a program of controlled posture
which manages a child’s shape using different
pieces of equipment ( it can also be achieved
using rolled up towels, soft toys and pillows). It
needs to occur throughout the day and night,
wherever your child is. It enables your child to be
comfortable in sitting, lying standing or when
moving position.
“
Posture management is a
planned approach
encompassing all activities and
interventions which impact on an
individual posture and function
”
POSTURAL CARE IS ABOUT USING THE RIGHT EQUIPMENT
AND POSITIONING TECHNIQUES
CURRENT SITUATION

Some of us have not really thought (or
heard)about importance

Provision of postural care advice/services is still
emerging in Sarawak. Wishesland therapists aim
to develop this further..and create awareness.

Some children have their body shape protected
when sitting in their wheelchair but not in other
positions/situations…
“
“Many people like us, are
unaware of how important
posture is for those we are caring
for. We are allowing problems to
arise through ignorance”
”
PARENT OF CP TEENAGER (KUCHING)
WHY IS
POSTURAL
CARE
IMPORTANT?
Failure to protect body
shape can result in lots
of health complications:
• Contractures
• Pressure sores
• Scoliosis
• Difficulty breathing
• Poor digestion
• Constipation
• Pressure on internal organs
Promotes health and well being, prevention
of disabling positions
BENEFITS OF
POSTURAL
CARE
Will help to make eating, drinking, playing
and communicating easier for the child
Makes it easier for the parents to care for
their child
Reduces need for invasive and expensive
interventions, including surgical procedures.
It is time for some postural exercises!
Exercise 1: slump in your
chair, another person resist
your lifted arms….now
compare with sitting
straight…………….what do
you notice?
Exercise 1: notice your
breathing depth…..
Exercise 3: dangle your
legs and imagine your
have poor sitting balance,
what do you notice?
Exercise 2: sit sideways ,
what do you notice about
your neck ? Your back?
Imagine lying in your bed
whole night in same
position……..
The link between lying and sitting
Lying/sleeping position
There are 8,760 hours in a year:

on average a child will spend approximately
1,140 hours at school

7,620 hours at home, of which 3,600 of those
hours are spent in bed. Night time positioning can
be an extremely effective way of protecting
body shape.

BE AWARE THAT GOOD POSITIONING AT DAYTIME
CAN BE UNDONE AT NIGHT…..
Lying/sleeping position
o
This is a poor position because:
Head and body
o
Make sure the head is in the middle and
comfortable
o
Body (spine) must be straight – support on the side if
needed with a rolled up towel to keep the body
straight
o
Head pushing back and turned to one side
o
Hips turning in causing legs to cross (scissor)
o
o
Feet are pointing down, which means the feet
cannot get flat if the child is standing
Bend the hips – this helps to release tension in lower
back
o
Place support under knees to keep hips bent – help
to relax stiffness in legs
o
Keep legs open and uncrossed
o
Feet should be as close to a standing position as
possible
o
Shoulders and arms: Should be forward and
supported – ca helps to relax upper back and allows
hands to open more easily.
o
Hands and arms away from body
o
Hands fisted and closed
Side lying
Head and body:
o
Head supported on a pillow so the chin is level(in the
middle, with head and spine in a straight line)
Legs and feet:
o
Keeps bottom leg straight
o
Support top leg bent at knee with pillows or blankets
so knee is level with hip – this is important to help
prevent injury to hip (dislocation)
o
Bending one leg and keeping the other straight
helps to relax the stiffness in their legs
Shoulders and arms:
o
Lower shoulder and arm must be brought forward so
they are not trapped underneath
o
Keep both arm forward to bring hands together –
encourage the child to use their hands by playing a
game or putting a toy for them to touch or reach
Prone lying
o
Body is not even, because head is turned
Head and body:
o
Difficult for the child to breathe
o
In a straight line
o
Legs may be crossed (scissoring)
o
o
Hands are in a fist
Encourage the child to lift his head and look
something on the floor
Legs and feet:
o
Straight – push down on his bottom from side to
side in a rocking motion to help to straighten the
hips
Shoulders and arms:
o
Arm should be in line with or slightly in front of
shoulders
o
Encourage them to open the hands and push
down on them
Sitting on a chair, or on a couch
Head and body:
o
o
o
o
o
Head is pushing back, and the child tends to
slide out of the chair
Hips are too straight and stiff
Shoulders are not supported, and are either
pulling back, or pushed too far forward
Body leans sideways and is not stable
Leg problems can develop from twisting of leg
bones
o
Sit upright with back straight and head upright
o
Buttocks are all the way to the back
o
If there is a lap strap, make sure it is tightened
firmly enough to stop them from sliding down
the chair
Legs and feet:
o
Legs and feet must be supported
Shoulders and arms:
o
Should be supported slightly forward and in
front of the body
Principle of
HoSoPoA

Head over Shoulders over
Pelvis over Ankle
Proper seating for function
Tilt in space wheelchair

A wheelchair with a tilt-in-space feature allows the whole chair to
tilt up to 30 or 60 degrees, depending on the model, while
maintaining the hip and knee angles at 90 degrees. Traditionally
been used by special need persons who require pressure relief.
However, they are beneficial in many other ways as well.

Here are some physiological benefits of a tilt-in-space wheelchair:
reduce pressure, shear, improves stability and balance, improves
endurance (child less tired), stimulate vestibular function, improves
independence and promotes participation.
Reclining wheelchair

Like a reclining easy chair, the seat back
of a reclining wheelchair tilts back. The
reclining feature allows to change
position in the chair without having to get
up. ... The reclining feature and leg lift
feature on some chair models means
that a person can lie completely flat in
the chair (easy for sleeping and transfers)
Seating =
Extension of therapeutic treatment

Tilt and recline affect pressure and perfusion at the skin
and muscle tissue at the ischial tuberosities, and to a
minimum extent, at the sacrum.

Tilt, when used alone, must be greater than about 25° to
achieve pressure relief and/or tissue perfusion at the
ischial tuberosities (4)

Recline, when used alone, can increase shear but may
provide reduction in pressure at the ischial tuberosities
at angles greater than 95-100°(4)

The greatest reductions in pressure are seen when tilt
and recline are used together, either at tilt of 35° with
recline 100° or tilt of 15-25° with recline of 120°(4)
STAND UP!
When to start a standing program?
Children at risk of hip subluxation/dislocation
should begin a standing program between 8 -12
months of age. There is no “cut off” age for
implementing a standing program and it is just
as important for a teenager/adult to stand daily
as a child.
Children with a GMFCS of IV or V are most at risk
of hip subluxation/dislocation with a prevalence
of between 68 – 90% of this population

Types of standers: posterior and anterior
and combination of both

Standing in abduction

Most published clinical research is based
on standing with legs in 30º to 45º
abduction and for levels IV and V on
GMFCS

Standing in abduction increases the
opportunity for the head of the femur to
locate into the acetabulum groove
TOMMY’S STORY https:youtu.be/fbmNt4uNeGw
Tommy’s story…..
Use Gross Motor Function Classification system as
a clinical guide
Earlier is
better but it
is never too
late…..
For GMFCS type IV and V use:
Good sleeping posture as soon as appropriate
after birth
Sitting from 6 months
Standing from 12 months
It is vital to include family, paediatrician,
therapists, teachers
SUMMARY
1
Promote
awareness of 24
hour posture
management
2
Introduce the basic
3-S postures
Sitting
Standing
Sleeping
3
Introduce the basic #-S
strategies
Support
Stable
Symmetrical
Thanks for attending
BRING HOME MESSAGE: EFFECTIVE POSTURAL CARE-----IT IS NEVER TOO
LATE
REFERENCES
1.
Fulford, G.E. and Brown, J.K. (1976) “Position as a cause of deformity in cerebral palsy”.
Developmental Medicine and Child Neurology, Vol. 18, pages 305-14.
2.
Hill [Clayton] S., Goldsmith J. (2010) “Biomechanics and Prevention of Body Shape Distortion”.
Tizard Learning Disability Review, Vol. 15, No. 2, pages 15-29
3.
Pope, P. (2014) “Conception, Birth and Development of Management of the Physical Condition
in People with Significant Posture/Motor Deficit”.
4.
RESNAPPonTiltRecline_2015.pdf
5.
https:www.physio-pedia.com/Module_3:Positioning_Your_Child
Some Malaysian companies

Sleep positioning systems are suggested to address a range of issues. In the
absence of research evidence, it is important that families do not feel
pressured to use sleep positioning systems, especially if it disrupts their lives.
Equally, it is important to support families in persevering, if it is something they
wish to pursue.

As sleep positioning systems are expensive and frequently abandoned,
occupational therapists and physiotherapists need further, specific clinical
guidance about how to assess who might be appropriate and which system to
recommend over another, if at all. As the children typically prescribed sleep
positioning systems (GMFCS Level IV or V) are often unable to express feelings
of discomfort or pain (Gough 2009), careful consideration should be given to
how to assess the effects for individual children. Routine audit of provision of
sleep positioning systems may help identify which children benefit from, and
why children and families abandon using this equipment.
Download
Random flashcards
mij droom land

4 Cards Lisandro Kurasaki DLuffy

Test

2 Cards oauth2_google_0682e24b-4e3a-44be-9bca-59ad7a2e66a4

Create flashcards