This document discusses positioning techniques for rehabilitation patients. It covers the goals of positioning which include comfort, safety, independence, range of motion, and skin integrity. Theory around neuromuscular development and spasticity is explained. Specific positioning techniques are outlined for supine, side lying, special needs like hemiplegia, prone, and pain control. References are provided.

1. POSITIONING IN REHAB
PATIENTS
BY
RIFFAT KALSOOM
(AFNS)AFIRM RWP

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

8. Relieving of pressure areas

9. Cont….

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.

12. Cont…

13. For tetra plegic pt

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

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

19. Cont….

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).

22. Cont…

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.

24. Cont…

25. Cont…

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