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For those of us who work with children with disabilities, we seem to intuitively know that if the child stays in one position too long, then the body will take the "shape" of that position, and if the position is not in good alignment, the child will begin to develop postural asymmetries. So, we try to create a program that offers alternative positioning throughout the day while supporting the child to prevent asymmetries.
Our goal is to break this cycle of asymmetries by using 24-hour postural management.
24-hour postural management is a planned program that considers all relevant positions a child uses throughout the day and intervenes to improve or maintain a body shape while promoting the child's function and development. It should then be incorporated into the child's everyday life at home, at school, and during social activities. The three core postural orientations are lying, sitting, and standing. However, postural management strategies should be applied across all activities from bathing to floor play to upright movement.
Healthy individuals can move freely in and out of lying, sitting, and standing for functional activities. When an individual has complex rehab needs, they are often unable to assume these positions, and therefore their functional ability is compromised. Many times, an individual with complex rehab needs may be in a standing position for one hour, seated for 15 minutes, and lying down for seven hours in a given day. Because we know the effects of sitting for long periods of time, great attention has been given to seating systems. We know that good supportive seating provides an individual with a stable posture in sitting, creating a good foundation for function and promoting active participation in daily living.
Orientations for Positions
Lying
- Head in middle and comfortable
- Spine straight, support on sides if needed
- Hip and knees bent with lower back in neutral, support under knees if needed
- Legs open and uncrossed, padding between knees if needed
- Ankle in neutral, night resting splints if needed
- Shoulders forward and supported
Sitting
- Head in middle and comfortable
- Spine straight, lateral support if needed
- Hip and knees bent with lower back in neutral, support under knees if needed
- Legs opened and uncrossed, padding between knees if needed
- Ankle in neutral, night resting splints if needed
- Shoulders neutral and supported
Standing
- Spine is straight
- Hips facing the front
- Neutral pelvis
- Feet firmly on floor
- Hips and knees aligned under pelvis
- Upper extremities at sides or engaged in activity
Goal in all orientations is always the body segments aligned/neutral
When the body is in an unsupported position, we know that gravity will negatively influence this position. These positions become habitual and eventually lead to obligatory positions and ultimately create permanent asymmetries. As the child ages, these harmful postures change the child's body shape. This often leads to the need for custom positioning equipment.
Let's also consider the amount of time someone with complex rehab needs may be in a standing position. Most times, it is inadequate, and therefore they spend the majority of their day in positions that result in loss of joint range of motion, shortened muscles, and muscle weakness. This ultimately causes changes to the spine and hips. It can also result in difficulties with respiration, digestion, and elimination, as well as reduced function and pain.
The goal is products which support the child's clinical needs to: maintain posture, maximise the child's abilities to function on everyday tasks, and promote comfort while using the equipment, for example, the Leckey BeMe. This special needs equipment must support the child from early days, through childhood right up to adulthood and beyond.
A typical 24 hour schedule may look like:
MORNING - Activity Chair >> SCHOOL - Standing Frame >> POST LUNCH - Upright Mobility >> AFTERNOON - Seating System >> EVENING - Floor Time Activities >> BEDTIME >> Bathing Support >> NIGHT TIME >> Sleep System
When we evaluate our children with special needs, it is important that we not only look at their positioning for the time they are with us, we need to consider all aspects of their daily life: family/home, school, and entertainment. When we provide options for their positioning, we are not only improving their positioning, but also their social and communication opportunities. 24-hour positioning equipment is critical for a child's quality of life.
