2. LEARNING OBJECTIVES
Goals of Positioning
Theory about positioning
Positioning techniques
Positioning needs
Positioning and pain
3. Goals of Positioning
The client should be as comfortable as
possible.
Excellent care
The client should have access to his
environment.
Safety and independence
Decrease source of frustration
Maintain and promote normal joint
range of motion.
Encourage normal joint range
Prevent contractures
4. Cont…
Promote healthy and intact skin.
prevention of pressure sores
Help to control edema.
Edema limit range of motion
5. Theory
Neuromuscular Developmental
Treatment (NDT) is a theory formulated
in movement science that explains
normal movement and effective
interventions.
Weight-bearing encourages normal
muscle
tone
Weight-bearing also increases sensory
input
Facilitate improved proprioception and
awareness of that body part.
6. Spasticity and high tone
Lengthening the side or extremity
with increased tone
Emphasized throughout In side lying,
flexing the top leg while keeping the
bottom leg extended may also assist
in breaking up spastic patterns.
7. Positioning Techniques
A. Supine
The head, neck, shoulders, and hips
should be as symmetrical as possible.
Pillows may be required
Care should be taken when placing a
pillow under the client’s knees for
comfort.
Allowable for brief periods,
Extremities with edema should be
elevated
10. B. Side lying
Pressure on the extremities against
the bed must be minimized while the
extremities away from the bed are
supported by pillows.
The head and neck should be supported
symmetrically by a pillow.
The trunk can be rotated back or forward,
supported by a pillow placed posteriorly or
anteriorly to the trunk if needed.
11. Cont……
To avoid pressure on the
glenohumeral joint on the body’s side
against the bed, the shoulder should
be protracted (brought forward).
A pillow should also be placed under
the entire length of the client’s leg
away from the bed to align the leg with
the hips and trunk while reducing
pressure between bony areas and the
bed.
14. C. Special Positioning
Needs
1. The Hemiplegic Client
When positioning the client with
hemiplegia in sidelying on either
side, the hemiplegic shoulder should
always be protracted with 90 degrees
of shoulder flexion.
15. Heamiplegic pt cont….
When lying on the hemiplegic side,
have the affected forearm flexed and
supinated (palm up) with the elbow
flexed.
You can place the hand under the
pillow supporting the head and neck to
stabilize the hemiplegic arm in this
position.
16. Cont…..
The nonaffected leg can be supported
in a flexed position by a pillow. The
affected leg’s hip should be extended
with the knee slightly flexed.
When lying on the nonhemiplegic side,
the hemiplegic extremities should be
fully supported by pillows with the leg
flexed at the hip and knee
17.
18. Cont……
In supine, the client’s hemiplegic shoulder will
require the support of a pillow or folded towel to
maintain symmetry with the opposing shoulder.
If elevated above a symmetrical position, the
client will be a greater risk for anterior luxation
(dislocation) of the glenohumeral joint.
The rest of the arm will require support through
its entire length by a pillow to provide elevation
with the elbow extended and the forearm
supinated.
A thin pillow may also be used to keep the hips
symmetrical and reduce a retracted (drawn back)
pelvis
21. Prone lying
In prone, pillows should be used to
elevate heels off of the bed if splints
are not used.
Towel rolls placed on the outside of
the person’s hip will also keep their
legs from rolling outward (a position
that will place excessive pressure on
their hip bones and outer ankle
bones).
23. Pain control
Use of one to two pillows placed
horizontally under their ribcage (see
photo) will un-weight the shoulder joint
and greatly improve their comfort
Flexing the top leg and arm forward
and resting them on pillows will also
improve comfort, spasticity, edema
and pressure relief.
26. References
Davis, J.Z. (2001). Neurodevelopment treatment of adult
hemiplegia: The
Bobath Approach. In Pedretti, L.W., & Early, M.B. (Eds.).
Occupational
therapy practice skills for physical dysfunction (5th ed.).
(pp 624-640). St.
Louis, MO: Mosby.
Minor, M.A.D., & Minor, S.D. (1995). Patient care skills
(3rd ed.). Norwalk, CT:
Appleton & Lange.
Umphred, D.A. (Ed.). (1995). Neurological rehabilitation
(3rd ed.). St. Louis,
MD: Mosby.
27. The best way to find yourself is to
lose yourself in the service of others
Editor's Notes
Taking an extra moment to fluff and align a pillow or providing an extra blanket can impact someone’s perception of his or her experience at our facility. increased tone cause joints to flex (bend). If allowed to remain in extended periods of time,shortening of the muscles that lead to loss of motion or tissue contracture.joints with high tone are extended and the associated muscle groups are lengthened will assist in inhibition of high tone and the prevention of loss of motion
preventing edema
Edema is an abnormal build up of excess tissue fluid that can limit range of motion and decrease skin integrity. Because water flows downhill, the “at risk of swelling” or swollen extremity should be positioned above the heart. This allows gravity to have an effect on the excess fluids and return the fluids to the client’s trunk and therefore aid in the prevention or reduction of edema
hemiplegic
client, positioning him or her on the affected side is the most effective position to aid
in the client’s recovery.
can cause a client to repeatedly move himself into
abnormal positions, leading to shortening of muscles, pain and more spasticity.
To support the desired alignment,lead to shortening of the knee and hip flexor muscles if used for a prolonged period of time. It can also create increased pressure on the client’s heels above the level of the client’s heart with pillows
The client’s bed should be situated so that the majority of the room is on their
hemiplegic side to improve attention and awareness of that side.
Many patients with tetra paresis experience severe shoulder pain and are unable to tolerate side lying positions
This technique will allow the patient
to be placed more fully on their side therefore eliminating the need for multiple
pillows behind their back
