POSITIONING STRATEGIES. POSITIONING “Positioning refers to the use of appropriate body positions...
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THE PHYSICAL MANAGEMENT OF STUDENTS WITH DISABILITIES POSITIONING STRATEGIES
POSITIONING STRATEGIES. POSITIONING “Positioning refers to the use of appropriate body positions to insure that the child is in the optimal position for
POSITIONING Positioning refers to the use of appropriate body
positions to insure that the child is in the optimal position for
learning and participating in classroom activities. The best
practice is a transdisciplinary approach that bring together
therapists and other service providers that fully integrates
services within the educational environment.
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HAZARDS OF IMMOBILITY MUSCULOSKELETAL DIGESTIVE RESPIRATORY
CARDIOVASCULAR URINARY SKIN PSYCHOLOGICAL
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MUSCULOSKELETAL Skeletal Deformities Muscle Tone Muscle
Strength Integration of Reflexes Osteoporosis
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DIGESTIVE Ability to safely swallow GERD Shift in internal
organs Constipation
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RESPIRATORY Position of the jaw and other oral structures
Coordination of breathing and swallowing Pooling of secretions
(congestion) Quality and effectiveness of breathing
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CARDIOVASCULAR Weak Heart Heart Rate Blood Return Increase Work
Load on the Heart Blood Pressure Changes Pooling in the Veins
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URINARY Urinary Pooling Potential for Kidney Stones Potential
for Infection Loss or Lack of Bladder Control
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SKIN Skin Breakdown Skin Irritation
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Psychological Changes in Perception of and Responses to the
Environment
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THERAPEUTIC POSITIONING PRINCIPLES Provide Firm Base of Support
The resting surface of the body in any position should distribute
the persons body weight across the broadest area possible.
Facilitate Optimal Positioning Alignment The head and trunk need to
be as symmetrical as possible so that the front of the head, trunk,
and legs are facing in the same direction. The shoulders should be
squared over his hips. Start at the pelvis and work up and
down.
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ELEVATED SUPINE
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PURPOSE: Good for resting and sleeping. ADVANTAGES: Low energy
position except when manual or visual work is expected Breathing is
easier Useful for students with poor neck and trunk control
POTENTIAL PROBLEMS: Poor position for cognition and awareness
Encourages skeletal deformities especially in the legs Poor
positioning of the jaw and oral structures Pooling of secretions in
the back of the mouth increases risk of aspiration Mucous build-up
in the lungs and difficulty with coughing to clear secretions
increase the risk for pneumonia. More difficult for the kidneys to
drain in this position. If the student is active, they may roll off
the edge or release straps.
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SUPINE
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CUSTOM ELEVATED SUPINE
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SIDELYING ELEVATED SIDELYING
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SIDELYING PURPOSE: Can be used as a resting position or as a
work position where the pull of gravity is balanced between muscle
groups ADVANTAGES: Allows the body to relax and, therefore, allows
more flexibility in the joints Decreases the influence of immature
reflexes Promotes a midline head position Promotes a more
symmetrical body alignment Brings both hands to midline Allows
gravity to affect deformities in the legs Better alignment of oral
structures Postural drainage Increased ease of productive cough
Elevated right sidelying promotes gastric emptying Different visual
orientation
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SIDELYING (CONT.) POTENTIAL PROBLEMS: There is a risk for
increased pressure on bony parts of the body Modifications may need
to be made for musculoskeletal deformities Monitor the color and
temperature on weightbearing extremities especially if there are
documented circulation problems
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ELEVATED SIDELYING
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CUSTOM ELEVATED SIDELYING
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PRONE ON FOREARMS (POF)
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PURPOSE: Provides an alternative to sitting Can be used for
rest or work ADVANTAGES: Helps improve flexibility of shoulders,
elbows, hips, knees, and spine Helps improve muscle strength of the
neck and trunk extensors Improved weightbearing through the
shoulder joints Helps trunk alignment for improved breathing and
digestion Helps clear congestion for those with trachs, URI, and
chronic congestion Brings the jaw forward Aids kidney and bladder
drainage Inhibits/integrates abnormal reflexes/movement patterns
Pressure relief on the skin
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POF (CONT.) P OTENTIAL PROBLEMS Muscle tightness at the
shoulders or hips may not allow proper positioning Safety risk for
students that are able to move Frequent repositioning may be
required
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PRONE ON FOREARMS (POF)
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POF (CONT.)
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QUADRUPED ON FOREARMS
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QUADRUPED ON FOREARMS (QOF) PURPOSE: Same as other prone
positioning with additional benefits ADVANTAGES: Prone position
available for those with severe hip flexion contractures Helps
improve flexibility in shoulders, elbows, hips, knees, and trunk
Improves muscle strength of neck and trunk extensors Increased
weightbearing through the shoulders and hip Brings the jaw forward
Aids kidney and bladder drainage Pressure relief on the skin
Inhibit/integrate primitive reflexes
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QOF (CONT.) POTENTIAL PROBLEMS: Modifications may need to be
made for those with shoulder and hip tightness Safety risk for
those students that are able to move Frequent repositioning may be
required
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QUADRUPED ON FOREARMS (QOF)
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QOF (CONT.)
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CUSTOM QOF
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CUSTOM QOF (CONT.)
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STANDING
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PURPOSE: To allow students to bear weight through their
extremities while in an upright posture ADVANTAGE: SUPINE Provides
full length support which is better for those with limited head
control Promotes weight bearing through the heels Allows students
with limited head and trunk control to be in a more vertical
position with their peers Promotes improved physiological
function
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STANDING (CONT.) ADVANTAGES: PRONE: Promotes strengthening of
the neck and trunk muscles to facilitate a more upright posture
Provides support while allowing arms and hands to be free to engage
in an activity Provides for weight bearing through the arms and
legs Provides maintained passive stretch to hip and knee flexors
and calf muscles Pressure relief for the skin Allows students to be
in a more vertical position with their peers
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STANDING (CONT.) POTENTIAL PROBLEMS: Elevation should be
gradual if the student is not used to upright. Can be done in times
increments during a session. Students may experience circulatory
changes if they are not used to being upright. Watch for changes in
color and temperature Students may experience hypotension if they
are not used to being upright. Watch for pallor, sweating, changes
in breathing.
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SUPINE STANDER
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SUPINE STANDER (CONT.)
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PRONE STANDER
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STANDER-OTHER
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KNEELING
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TALL KNEELER PURPOSE: To provide an alternative upright posture
when limitations prevent a standing position ADVANTAGES: Same as
for standing but with a shortened lever arm POTENTIAL PROBLEMS:
Availability is limited as this is a custom piece of equipment. Not
available commercially. Hip flexor tightness may not be able to be
accommodated if moderately severe. May not be recommended for
students with little to no head and trunk control
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TALL KNEELER
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SITTING
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PROPER SITTING POSTURE Pelvis is neutral or slightly forward
Weight is evenly distributed on both buttocks Hips and knees are
bent to 90 degrees Feet are supported Shoulders are squared over
the hips and even Head is midline
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PROPER SITTING POSTURE
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PROPER SITTING POSTURE (CONT.)
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ADAPTIVE SEATING PURPOSE: To provide needed support to allow
the student to be in a seated position for work ADVANTAGES: Allows
students to sit at a work surface with their peers Provides head
and/or trunk support for visual orientations, trunk control, and
balance while concentrating on tasks Allows arms to be available
for function Breaks up undesired patterns and positions Allows
adjustments as the student changes Better positioning for feeding
Visual orientation for tracking and eye hand coordination
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ADAPTIVE SEATING (CONT.) POTENTIAL PROBLEMS: Provides too much
support Skin breakdown Circulatory impairments Range of motion or
presence of contractures may not allow positioning in adaptive
seating Positioning in seated positions for too long may encourage
formation or worsening of contractures Work surface heights may
need to be adjusted