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24 Hour Postural
management
Sarah Clements
June 2016
What is 24 Hour Postural
Management !
• “A postural management programme is a planned
approach encompassing all activities and interventions
which impact on an individual's posture and function.
Programmes are tailored specifically for each child and
may include special seating, night-time support,
standing supports, active exercise, orthotics, surgical
interventions, and individual therapy sessions.”
• Tina Gericke. Developmental Medicine and Child
Neurology. London: Apr 2006. Vol. 48 (4); p 244
Why Is it so Important ?
• Introduction of a postural management programme
before the development of hip subluxation with
positioning in lying, sitting and standing can reduce hip
subluxation.
• Improved bone density.
• Improved access and participation.
Why Is it so Important ?
• Improved comfort and reduction of pain.
• Musculo-tendinous contractures can be reduced
by stretching for 5 - 7 hours daily. This may
require the use of day and/or night positioning
equipment.
• Facilitation of communication, cognitive &
functional skills.
Why Is it so Important ?
• Weight-bearing programmes for children in GMFCS levels IV
and V utilise a range of equipment to facilitate more upright
posture in a variety of positions; some of these provide limited
weight-bearing but encourage activity and experience in postures
other than lying and sitting.
• Weight bearing programmes may delay progression of lower
limb deformities and scoliosis, also possibly improving
respiratory function (preventing aspiration) and bowel/bladder
function (urinary drainage and reducing constipation). There are
also potential social and behavioural benefits if the experience is
enjoyed, and if the posture facilitates improved social interaction.
Equipment
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Standing Frames
Sleep system
Wheelchair
Static Chairs
Orthotics
Standing Frames
Sleep Systems
• On average we spend 3,640 hours in bed out of
a potential 8,760 in a year.
• When we sleep we are able to change position
throughout the night but the children we look
after have a movement disorder. Therefore this
is not an option and they spend their whole time
in bed in limited positions and are at risk of
developing deformities.
Wheelchair
Static Seating
Orthotics
Positioning Vs Passive Stretching
• Stretching
• Positioning
– Active, sustained
– Passive
– More robust evidence
– Evidence poor (Pin,Dyke,Chan 2006)
(Tardieu,Lespargota,Taba
– Takes time out of the day
ryc, Bret 1998)
– Easily incorporated into
their day
So Over to You!
• Check to see if the young person has a 24 hour
postural management programme in place.
• Check if they have recent surgery or botox.
• Get familiar with their equipment
• Ensure they are positioned correctly over night.
Any Questions ?