What is 24/7 Postural Support?

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During a 24 hour period, there are generally three core postural orientations for all of us. They are lying, sitting and standing. Individuals with no movement limitations are able to move freely between these three postures.  However, for those who have movement differences this is not always the case.

If your child uses a customised and supportive wheelchair, they may spend all day in a wheelchair, and can tolerate short periods in a standing frame. After 16 hours in a wheelchair your child might spend 8 hours in lying posture, which makes them susceptible to the impacts of gravity.

Identifying the need for a supportive wheelchair and seating system, is often high priority for parents and carers of children with disability. In contrast, sometimes the significance of overnight positioning and positioning in lying posture is not always given as much attention.

What happens if we don’t consider 24 hour postural care?

Asymmetries and body distortions (such as pelvic rotation and distortion of the chest) are common in children with reduced mobility and disability largely due to the effects of gravity and muscle tone (Hill & Goldsmith, 2010).  Longer periods spent in static positions - such as lying - will increase the chance of this occurring due to the sustained forces of gravity.

The result of these body distortions correlate with an increase in issues relating to:

  • Breathing issues (compromised respiration)
  • Body deformities (contractures, scoliosis, pelvic rotation)
  • Pressure injuries
  • Swallowing and digestive difficulties
  • Pain and discomfort
  • Increased levels of fatigue
  • Reduced quality of life

Providing the right postural care 24/7 will aid in protecting or improving body shape and physical ability allowing for improved functioning.

What can I do?

Consider your child’s positioning over the full 24 hours of the day, a supportive seating system/wheelchair and standing frame alone is not enough.

No piece of equipment or intervention in isolation will be effective. 24-hour postural management requires consideration of all postural orientations available to your child across their day. The earlier the intervention, the better – however it is never too late to start protecting, restoring and improving someone’s body shape. (Mencap, 2011).

24/7 Postural Care Toolkit:

  • A trusted allied health team to provide information, therapeutic intervention, assessment and applications for equipment
  • Allied health exercise, ranging and activity at home programs
  • A positive medical alliance for regular orthopaedic and respiratory surveillance and review
  • A range of positioning and handling techniques (preferably compiled in a 24/7 positioning document available for all caregivers)
  • A range of equipment to aid in promoting positive postural positioning
  • Standing frames (if applicable and possible)
  • Wheelchairs with supportive seating
  • Specialised seating
  • Sleep systems and positioning supports in the lying position
  • Wedges and other ways of positioning for play
  • Classroom positioning systems

A discussion with your therapy team regarding 24-hour postural care will allow you to explore what options are available to you to improve positioning across the day.

Further information

Check out this fabulous video “A simple story: therapy for children with complex needs

Our Occupational Therapy team are here to help and can provide advise on 24/7 postural support.

References

MENCAP Postural Care Action Group, (2011), Postural Care: protecting and restoring body shape, London, Menca

Hill, S. & Goldsmith, J., 2010. Biomechanics and Body Shape Distrotion. Tizard Learning Disability Review, 15(2), pp. 15-32.