1. Departement of Physical Medicine and Rehabilitation Faculty of Medicine Universitas Padjadjaran Hasan Sadikin General Hospital

2. THE AIM PREVENTION AND TREATMENT OF CONTRACTURES AND DECUBITI TO ACHIEVE THE AIM PROPER EQUIPMENT, A WELL TRAINED AND WELL MOTIVATED NURSING STAFF, AND APPROPRIATE PHYSICIAN’S ORDERS ARE NEEDED

3. THE POSITIONING PRESCRIPTION SHOULD IDENTIFY THE EQUIPMENT SPECIFICALLY NEEDED POSITION TO BE USED MOTION AND POSITION TO BE AVOIDED FREQUENCY OF TURNING PATIENT SHOULD ASSUME INCREASING RESPONSIBILITY FOR THE POSITIONING PROGRAM THE STAFF ASSUME FULL RESPONSIBILITY IN ASSISTS CHANGING POSITION WHEN PATIENT NEED TO BE TURNED, KNOW WHERE THE EQUIPMENT IS KEPT

4. THE EQUIPMENTS FOR EFFECTIVE BED POSITIONING HIGH-LOW BED,ADJUSTABLE TO HIGH 30 INCHES AND LOW 20 INCHES POSITION IS RECOMMENDED BED BOARDS

5. - FIRM MATTRESSES FOOTBOARD,PROVIDES SENSORY INPUT TO THE PLANTAR SURFACE OF THE FEET SO THAT EXTENSOR REFLEX DOMINANCE IS MAINTAINED. THE BOARD IS BLOCKED 4 INCHES AWAY FROM THE END OF THE MATTRESS

6. STANDING BED SHORT SIDE RAILS, ARE USED FOR SAFETY MOVING TO SITTING POSITION AND TRANSFERRING IN AND OUT OF BED HAND ROLLS AND TROCHANTER ROLLS PILLOWS

7. THE POSITIONING PROGRAM BASED ON INDIVIDUAL PATIENT NEEDS GENERALIZATION CAN BE MADE ABOUT MOST DISABILITIES THAT ARE ASSOCIATED WITH MUSCLE WEAKNESS AND JOINT DEFORMITY IT HAS BEEN FOUND DESIRABLE TO ESTABLISH A SET OF POSITIONING PROCEDURES FOR HEMIPLEGIA, QUADRIPLEGIA AND PARAPLEGIA

8. THE POSITION ARE PRESCRIBE TO OVERCOME CERTAIN NATURAL AND PATHOLOGICAL FORCES PROVIDE A VARIETY OF JOINTS POSITION FOR MAINTAINING JOINT RANGE PLACE THE EXTRIMITY IN A MORE FUNCTIONAL POSITION

9. SUPINE POSITION LOWER EXTRIMITIES THE ENTIRE PLANTAR SURFACE FIRMLY AGAINST THE FOOTBOARD CONTACT WITH THE POSTERIOR HEEL IS AVOIDED THE LEG ARE PLACED IN NETRAL POSITION WITH THE TOES POINTED TOWARD THE CEILING THE POSITION IS MAINTAINED BY USING THE FOOTBOARD AND TROCHANTER ROLL THE KNEE AND HIP ARE POSITIONED IN EXTENSION TO PREVENT HIP AND KNEE FLEXION CONTRACTURES

10. - UPPER EXTRIMITIES SHOULD BE CAUTIONED TO POSITION ONLY WITHIN THE PAINLESS OR NON RESISTIVE RANGE OF MOTION POSITION 1 SHOULDER IS ABDUCTED TO 90 DEGREES AND SLIGHTLY INTERNALLY ROTATED THE ELBOW IS AT 90 DEGREES THE FOREARM IS PARTIALLY PRONATED

11. - POSITION 2 SHOULDER IS ABDUCTED TO 90 DEGREES AND EXTERNALLY ROTATED TO THE DEGREE COMPATIBLE WITH COMFORT THE ELBOW IS FLEXED 90 DEGREES THE FOREARM IS PRONATED

12. - POSTION 3 THE SHOULDER IS IN SLIGHT ABDUCTION THE ELBOW IS EXTENDED THE FOREARM SUPINATED

13. - WRIST AND HAND POSITION 1 THE WRIST IS EXTENDED THE FINGER ARE PARTIALLY FLEXED AT THE INTERPHALANGEAL AND METACARPOPHALANGEAL JOINTS THE THUMB IS ABDUCTED, OPPOSED, AND SLIGHTLY FLEXED AT THE INTERPHALANGEAL JOINT USE A HAND ROLL

14. - POSITION 2 SIMILAR TO THE POSITION 1 EXCEPT THAT THE FINGERS ARE EXTENDED AT THE INTERPHALANGEAL AND METACARPOPHALANGEAL JOINTS USE A PALMAR POSITIONING SPLINT

15. SIDE-LYING POSITION THE TOP LEG IS PLACED IN A POSITION OF FLEXION AT THE HIP AND KNEE CONTACT WITH THE UNDER LEG IS AVOIDED THE INNER (BOTTOM) ARM IS EXTERNALLY ROTATED AND PARTIALLY EXTENDED THE OUTER (TOP) ARM IS KEPT AWAY FROM THE PATIENT’S CHEST

16. - THE PRONE POSITION THIS POSITION IS ORDERED WHEN PULMONARY, CARDIAC, AND SKELETAL STATUS PERMIT MANY PATIENT DO NOT TOLERATE IT WELL FIRST HIPS AND KNEES EXTENDED, TOES SHOULD NOT BE ALLOWEDTO TOUCH THE FOOTBOARD THE FEET CAN BE ELEVATED SLIGHTLY USING A TROCHANTER ROLL UNDER THE ANTERIOR ANKLE THE ARM IS ABDUCTED SLIGHTLY, EXTENDED AT THE ELBOW, AND EXTENDED AND SUPPINATED AT THE WRIST FINGER AND HAND USES HAND ROLL

17. FREQUENCY OF TURNING TURNING THE PATIENT EVERY TWO HOURS USUALLY A SAFE ROUTINE TO FOLLOW UNTIL THE PATIENT’S SKIN SENSITIVITY AND TOLERANCE OF THE POSITION HAVE BEEN DETERMINED IT IS BEST TO ORDER THE MORE PROLONGED POSITIONING PERIODS FOR THE NIGHT HOURS THE PHYSICIAN SHOULD FREQUENTLY CHECK THE SKIN IN VULNERABLE AREAS TO MAKE CERTAIN THAT NO DECUBITI ARE DEVELOPING AND TO EMPHASIZE TO THE ATTENDING STAFF THE IMPORTANCE OF THE PROPER TURNING SCHEDULE

18. THANK YOU