FINAL: POSITIONING AND HANDLING Flashcards
Positioning, defined:
Effort to maintain the body in the most appropriate alignment as possible so the child can perform tasks and interact with all aspects of her environment.
How child gets positioned:
- Child may assume (cross cross applesauce)
- Child may be placed (i.e., on lap)
- Child may be supported by external device (wedge, cushion, corner chair)
Varies according to demands of task/environment.
Positions to consider:
- prone
- supine (facilitates ER of hips)
- quad (reflexes may show in creeping: STNR, ATNR, palmar grasp)
- side lying
- sitting
- kneeling
- half kneeling
- standing
Work from one position to next throughout tx
Why use NDT?
- assist/facilitate child to change posture and movement patterns
- when lifting / moving a child
- goal: enhance function, minimize impairments
- remember: use proper body mechanics for yourself and the child
Good positioning and handling helps:
- promote symmetry (or asymmetry) and alignment
- reduce tone or stiffness
- initiate movement
- increase movement
- perform tasks that could not be done otherwise
- end goal: remove support ASAP.
9 purposes of NDT:
- Prevent bone deformities, skin breakdown, and muscle contracture
- Alignment and postural support
- Increase control of hands, arms and legs
- Improve body functions (breathing, digestion)
- Comfort / relaxation of muscles
- Develop head / trunk control, balance reactions
- Increase ROM, wt bearing, shoulder girdle stability, and strength
- Increase interaction
- Ease for caretakers
Precautions for NDT tx:
- seizures
- brittle bones
- non weightbearing
- ?
Is 90/90/90 a task-ready position for movement?
aw HELL no
Principles of positioning, re: alignment:
- Pelvis- symmetrical, wt. evenly distributed, small curve in lower back (awesome anterior tilt), 90-100 degrees flexion at hip
- Knees: 90-100 degrees flexion
- Feet: flat on floor, behind knees (esp. when transferring)
- Head: chin tuck (from side view)
- Shoulders: relaxed (press down gently to encourage release of elevation)
- Arms / hands: in front of body for midline work
Seating support, in order:
Posteriorly (under and behind) PELVIS
Laterally (sides) TRUNK
Anteriorly (front) CHEST
(seat: sling v. planar v. contoured v. custom molded)
What’s useful about side lying?
It breaks up tightness and extensor tone. Also:
- Shoulders are forward.
- Hands at midline and together.
- Top leg bent over bottom leg w pillow between.
- Head supported.
- Child uses eyes and hands together w gravity eliminated.
What’s useful about lapboard pegs with suction cups or screws?
They keep arm neutral (no supination or pronation) and can stabilize excess movement.
Five aspects of the theoretical base of NDT:
- Normal development of movement: stability/mobility; postural control is essential for all skill acquisition.
- Postural control: uses feedback and feedforward to modify through experience
- Postural activity is initiated at the base of support: higher skills as you go off BOS; size of base is reduced with improvement
- Dynamic influence from all systems impacts movement.
- Sensory input is used to bring about change.
NDT: Normal Development
- sensory-motor-sensory feedback
- sequences of motor development
- *variety of movement
NDT: Components of postural control
Postural reactions happen in response to unexpected changes in center of gravity relative to BOS, including:
- Antigravity
- Righting responses
- Protective responses
- Equilibrium response
- Tilting reactions
