Postural Management: A Clinical Priority

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Here at Jiraffe we understand the difference a robust postural management plan can make to a child’s comfort, function and health. It can allow a child to access education, interact with their peers and enables as much independence as possible.

Not managing someone’s posture, when they cannot do it for themselves, can have detrimental effect on their health. The formation of contractures can occur, which can cause a loss of range of motion in their joints. If a person begins to loose these abilities, then their capability to be mobile also decreases.

Over time skeletal deformities can develop and this can lead to asymmetrical postures. This in turn, can cause pressure related injuries, compression of internal organs which cause bodily functions to become less efficient. All of which can have a knock on effect, leading to a multitude of physical health problems and a plethora of secondary complications, which is why 24 hour postural care is so important for children and adults with complex disabilities.

The foundation of postural management is control over a 24 hour period. A therapy team in the 1980’s, who were working in a residential home, realised that their current regime was not effective in avoiding or slowing the development of secondary complications (related to posture).

The typical therapeutic interventions including passive stretches and orthotic splints had little effect on correcting these problems. It was found that managing a person posture whilst in bed, sitting and where possible, standing, had the most long lasting positive impact. Instead of looking to fix/cure these issues, a new approach of trying to manage and prevent damage occurring was pioneered.

Why are we trying to do it? 

There is a considerable amount of evidence demonstrating the negative outcomes for people with complex disabilities, when they don’t have appropriate management (Asher 1974, Bax 1988, Thomson 1951). No matter the current state of someone’s posture, it is extremely likely to worsen over time. It has become increasingly clear that ‘hands on therapy’ only, as a way on intervention is not enough to disrupt the destructive capabilities of gravity, as shown in the following studies.  (Charliefue 2005, Condie 1991, Pope 1988, 1992)

What do we need to do?

As previously discussed in my previous article, The Importance of Postural Management at Home, the three main aims of postural management are: maximise function, minimise damage (secondary complications), and to reduce energy expenditure.

The more immobile a child/adult is, the more at risk they are of developing damage and further complications. This lack of movement really is the root of most, if not all issues relating to postural management. To be able to build a robust postural management regime, we first need to recognise the following (Pope, 2007):

    • Movement is essential
    • Movement, active and/or passive, must be balanced and symmetrical
    • Postural stability forms the basis of functional activity
    • Posture influences most, if not all, bodily functions
    • Posture influences many positive neurological phenomena, e.g. spasms.
    • The influence of gravity acting on the body can be controlled by appropriate organisation of posture and position
    • Handling influences tissue integrity, positive neurological phenomena, comfort and effort of care

It is safe to say that the past 4 months have been a challenge for everyone. We have all had to drastically adapt our lives, jobs and the way we interact with one another. Many none emergency NHS services have been placed on standby and healthcare professionals re-deployed into alternative services to help fight the virus. To these healthcare professionals, we at Jiraffe could not be more thankful and appreciative to these brave and selfless real life hero’s!

We are now beginning to see the easing of restrictions around the country, and the re-opening of services to the public. On 3rd June, the clinical Directors of NHS England issued a document to instruct and guide NHS Trust’s on how to begin the re-integration of their services: “COVID-19 restoration of community health services for children and young people: second phase of NHS response

In section 19 of this document (in relation to community paediatric services) it advises to ‘Continue essential services.’ This includes all interventions that are deemed to be a ‘Clinical Priority.’

We at Jiraffe understand that postural management is a clinical priority to the health and wellbeing of children with disabilities. That is why we have set up a number of additional services to help support these families and healthcare professionals who are involved in their care, such as Emergency Posture Provision – click here to find out more

If you would like to request a product assessment, review, or simply require advice, contact us today!

References:

Asher R 1947, The dangers of going to bed. British Medical Journal 12(13):967-968

Bax M, Smyth D, Thomas A 1988, Health care of physically handicapped young adults. British Medical Journal 296: 1153-1155

Charliefue SB 2005, Life after SCI. Age at injury vs aging issues. Presentation, International Conference on Posture and Wheeled Mobility. Exeter 11-15 April p 154

Condie E 1991 A therapeutic approach to physical disability. Physiotherapy 77(2): 72-77

Pope PM 1988 A model for evaluation of input in relation to outcome in severely brain damaged patients. Physiotherpay 74(12) 647-650

Pope PM 1992 Management of physical condition in people with chronic and severe neurological pathologies

Pope PM 2007 Severe and Complex Neurological Disability: Management of the Physical Condition. Elsevier

Thomson AP, Lowe CR, McKeown T, 1951 The care of the aged and chronic sick. E & S Livingston, London

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