It's Time to Consider All-Day, All-Night Posture Management
- By Laurie Watanabe
- Apr 01, 2019
WAKING DAUGHTER: ISTOCKPHOTO.COM/EVGENYATAMANENKO
If you use a wheelchair with positioning features or postural supports — or if you have a family member who does — you know how those systems can improve functional abilities and outcomes. For instance, optimally fit wheelchair seat cushions and backrests can improve a wheelchair user’s stability while seated. Tilt and recline can re-distribute weight to relieve pressure on the weight-bearing parts of the body and can help to prevent pressure injuries. Standing in a wheelchair or standing frame can help to prevent contractures that eventually inhibit range of motion, and standing can also help to manage or lessen a progressive curvature of the spine (scoliosis).
An optimally fit wheelchair can provide postural support that helps wheelchair users to be as active and independent as possible, while also helping to manage chronic conditions or preventing others from occurring.
But what happens when a wheelchair user leaves his or her wheelchair, and all that postural support disappears? Even full-time wheelchair users also spend many hours every day out of their wheelchairs… especially while sleeping.
What Happens Without Support?
The concept of 24-hour postural support or posture management is relatively new to North America, but it’s a more familiar idea in Europe and Australia.
This all-day/all-night postural support strategy starts by examining a wheelchair user’s entire day and night to determine and provide the best possible support in all environments and during all activities.
Posture 24/7, a postural support organization, says, “24-hour positioning is a non-invasive way to support the health and wellbeing of persons who have difficulty changing their positions easily and frequently throughout the day and night.”1
When people lie down in unsupported positions and are
unable to frequently and substantially change position on their own, such as during sleep, gravity changes their bodies over time2. For instance, their chests can rotate and become distorted, which can impact breathing and make respiratory functioning more difficult.
Contractures — when muscles, ligaments or tendons shorten and tighten — can reduce range of motion and cause limitations to movement.3 Spinal curvatures (scoliosis) can also occur, which can lead to asymmetrical posture, when the two halves of the body are imbalanced. Wheelchair users can experience difficulty with swallowing, and can experience discomfort and pain.
Mobility users are often well supported while seated in their wheelchairs, and they are also well supported if they use standing frames or standing wheelchairs. But what is often missing is optimal support while lying down. That lack of support while sleeping can, over time, cause loss of function that can’t easily be reversed.
Since we spend about a third of our lives asleep, postural support while sleeping is a trending topic even for people without disabilities. Body pillows, wedge pillows and orthopaedic cushions meant to support people as they sleep can be found in big box stores, department stores and through online retailers. But people with disabilities should ask their occupational or physical therapists for recommendations before changing their sleep positioning regimens, so that new nighttime strategies mesh well with the daytime postural support that custom-fitted wheelchairs provide.
The seating and wheeled mobility industry, also called the Complex Rehab Technology (CRT) industry, designs and manufactures modular positioning systems that can be specifically tailored to give each wheelchair user customized support as he or she sleeps.
Postural Support in Other Environments
Of course, there are plenty of other environments that people experience throughout their days while not in their wheelchairs. That’s especially true for kids, who often spend less time in their wheelchairs every day versus their adult counterparts.
Fortunately, there are plenty of options to keep kids optimally supported during the day.
For riding to school, to Grandma’s house, to visit friends and to run errands with Mom and Dad, look for car seats that offer more targeted support for the child’s head, chest, trunk, arms and legs. Positioning car seats offer modular options to provide extra support just where it’s needed.
When it’s time to eat or do schoolwork, consider an activity chair with postural support that can be dialed in to each child’s needs. Some activity seating systems can be combined with a high-low base to lift a child up to reach the dinner table, then lower the child afterward so he or she is at eye level with siblings for playtime. In fact, some activity seating can also be placed on a mobility base to form a posturally supportive stroller — how’s that for multi-tasking?
CRT manufacturers now offer hygiene chairs that optimally support a child or adult during bathing and toileting/catheterization activities. Since hygiene tasks can be time consuming, postural support in the bathroom is important, too.
And when it’s time to relax and watch a movie or play a board game, positioning products can keep a child or adult comfortable and well supported either while sitting or lying/lounging on the floor. These positioning systems can help their users maintain good eye contact with family members for better social engagement… with far better postural support than a standard beanbag chair can offer.
Proper positioning can contribute to a wide range of positive outcomes. Ask your assistive technology provider and your occupational or physical therapist how you can make postural support a round-the-clock success story.
Sources & Resources:
- 1 Posture 24/7 and the Montana Postural Care Project, https://posture24-7.org
- 2 24-Hour Posture Management, an Introduction, by Lee Ann Hoffman, Mobility Management, Aug. 2016, https://tinyurl.com/yxcgo6ym
- 3 24-Hour Posture Management: Challenges to Implementation, by Lee Ann Hoffman, Mobility Management, Sept. 2016, https://tinyurl.com/y62xkebs
- The 24-Hour Postural Support Goal, by Lee Ann Hoffman, Mobility Management, Sept. 2017, https://tinyurl.com/y3c7h5ar
- OT Equip, The Importance of 24-Hour Postural Care, by Amy Hilaire, Sept. 2017, https://tinyurl.com/y6euya4g
Laurie Watanabe is the editor of Mobility Management. She can be reached at firstname.lastname@example.org.