Have you ever ordered a slice of your favorite cake and then only eaten the icing? And then just left the rest? Seems crazy, right?
Well – 24-hour posture management is very similar to the scenario above.
By only addressing the postural orientations of sitting and standing, and not postures in lying, a crucial part of posture management is being completely ignored.
Again to the cake analogy: just try to imagine baking your favorite cake without a key ingredient. Each and every part of any cake recipe is important — as are all three of the major postural orientations in postural management.
Here is how it works: Posture management aims to maintain and protect body shape by providing support over the whole 24-hour period where three predominant postural orientations are present: Lying, Sitting and Standing.
When appraising a day in the life of a person with complex rehabilitation needs, I am always intrigued and humbled to see the dedication and commitment from therapy teams, support networks, families, and the individual themselves. Numerous therapy sessions per week, time spent in standers, seating systems and various positioning assistive devices. All the focus and emphasis is usually placed on corrective positioning in sitting and standing postures.
However, it saddens me that often this hard work can so easily be undone, usually due to lack of positioning support in lying. Out of the estimated 8760 annual hours, it can be roughly calculated that approximately 3600 hours are spent in lying. Therefore, potentially 3600 hours of unsupported lying.
Enter Gravity into the equation: The distortion of the body in unsupported lying is further influenced by the effect of gravity on the body structures such as the hips, pelvis and the chest wall. Studies on newborns lying in asymmetrical postures have been well-documented noting the negative effect which gravity has on the immobile growing child.
So what does Lying have to do with sitting? There is mounting evidence highlighting the link between habitual postures assumed in lying and their influence, along with a ‘dash’ of gravity, on seated postures. Changes in body shape occur in lying, when the person no longer has the ability to self-correct, or is placed in unsupported postures. Damage occurs to the individual’s body as a result of prolonged and sustained lying postures. It is clearly evident that asymmetrical postures result in unequal tissue loading. If this is left unchecked, the individual is likely to develop postural changes, such as asymmetry, through contractures and deformity, which often makes positioning the individual in any standard equipment challenging and sometimes impossible.
Further evidence highlights the correlation between asymmetrical lying postures and postural deformity, when exploring chest wall deformities, windswept lower limbs, and joint dislocation. Sadly, the net effect of poor unsupported positioning in lying, has a far reaching impact resulting in serious health problems related to pain, breathing, swallowing, digestion and an increased risk of pressure areas. The consequences of failure to prevent the distortion of the individual’s body shape are both serious and potentially life-threatening.
Good supportive positioning in Lying is absolutely essential.
Sometimes it is the smallest changes that can have the biggest impact.
Where to start? I would encourage you to start small. Implement small changes in lying to the night-time positioning of an individual with posture management needs. Gradual changes and a gentle start are so important — as good quality sleep is essential. Respecting the individual, their comfort and their sleep – as well as those of the family and the support network, is an effective way to begin this process. Remember – the poor posture did not occur in one week, so it won’t be remedied in one week…but changes will literally happen ‘overnight’.
So I remind you, that by only addressing the individual’s postures in standing and sitting and not those in lying, it is truly like eating only the icing on the cake — and consequently missing out on the whole cake.
With 24-hour Posture Management, you can now have your cake and eat it too!
Lee Ann Hoffman, MSc. Rehabilitation: Posture Management