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.”“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 Vol. 48 (4); p 244Tina Gericke. Developmental Medicine and Child Neurology. London: Apr 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.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 bone density. Improved access and participation.Improved access and participation.

Why Is it so Important ? Improved comfort and reduction of pain.Improved comfort and reduction of pain. Musculo-tendinous contractures can be reduced by stretching for hours daily. This may require the use of day and/or night positioning equipment.Musculo-tendinous contractures can be reduced by stretching for hours daily. This may require the use of day and/or night positioning equipment. Facilitation of communication, cognitive & functional skills.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 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.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 Standing FramesStanding Frames Sleep systemSleep system WheelchairWheelchair Static ChairsStatic Chairs OrthoticsOrthotics

Standing Frames

Sleep Systems

On average we spend 3,640 hours in bed out of a potential 8,760 in a year.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.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 Positioning –Active, sustained –More robust evidence (Tardieu,Lespargota,Taba ryc, Bret 1998) –Easily incorporated into their day Stretching Stretching –Passive –Evidence poor (Pin,Dyke,Chan 2006) –Takes time out of the day

So Over to You! Check to see if the young person has a 24 hour postural management programme in place.Check to see if the young person has a 24 hour postural management programme in place. Check if they have recent surgery or botox.Check if they have recent surgery or botox. Get familiar with their equipmentGet familiar with their equipment Ensure they are positioned correctly over night.Ensure they are positioned correctly over night.

Any Questions ?