24 Hour Positioning

We live in the greatest country in the world, yet our Health Care system fails compared to the world. Our current system reacts to sickness, and tries to cure the problem or the symptoms; hopefully soon we will take more steps towards prevention.

In Europe, they realize that long term wheelchair users are at high risk for deformity, and health complications from the body sitting for long hours.  They believe in 24 Hour Positioning. Anyone requiring the use of a wheelchair long term, are issued alternative positioning devices; as they know the need for standing, and positioning to counter the affects of gravity, spasticity and tone. 

Here in the US most insurance provides standers and/or gait trainers for children as they know that growing children have high risk for deformity and contacture. There is clear evidence that not providing alternative positioning equipment results in higher medical costs. 

For children who attend school, there is protocol for alternative positioning. The research shows that not only does sitting all day affect posture, but it also affects the ability to learn.

Why then do we not address sleeping and positioning as when a wheelchair user is not in their chair they are usually in their bed.  If sleeping consitutes 8-10 hours per day, why are we not using this time to improve posture, and/or reduce the destructive affects for nearly half of every day?

For over 20 years, I have been involved in the assessment and recommendation of equipment for people with special needs. I have seen children become adults, and have seen that with consistent therapy and caregiver involvement children have much better flexibility, posture and function. Most of these individuals had gait trainers, standers or other alternative positioning equipment. When these individuals had progressive therapists, that put in place alternative positioning programs in addition to stretching and range of motion; these individuals had greater outcomes.

It is important to first look at the primary equipment the individual is using. Their posture is dramtically affected from it.  I am sure you have seen an older man/woman in the mall or grocery store, and they are sitting in a basic wheelchair, and their body had formed to the shape of the upholstery.  The wheelchair and seating needs to be monitored in children every 1-3 months, and every 6 months to a year in adults. If an individual has a change in condition, the equipment should be reviewed.

Once the wheelchair or primary equipment is addressed, alternative positioning equipment can be added. It is my belief, that every wheelchair user should be using a stander- as long as a physician has cleared them for safe standing. Standers are avaiable in prone, supine, manual and power options. They come in table style or sit to standers.  If there is the ability to take steps, then a gait trainer may be more approriate.

If standing and gait trainer is not an option, there are other positioning chairs including hi/lo variety. 
There are side lyers that can be used where the user lies on their side, which can counter the affects of gravity, tone and spasticity.  Wedges, and moldable bags can be used for positioning and support.

Many wheelchair users, have issues with swallowing and breathing where their bed needs to be adjustable. Hosptial beds are used to raise the head and/or foot area.  There are low pressure mattresses to reduce pressure or help with skin breakdown. A newer product to the US is the Dreama bed. I believe there will be more of these types of systems soon, as it makes sense that when sleeping 8-10 hours per day, we have a good amount of time to impact change on body position, posture, tone and spasticity. 

I would suggest to parents, to read, ask questions and learn from others on how to help counter destructive postures.  Please feel free to contact me with any questions or comments about 24 hour positioning.