P1: Posture & intro into handling Flashcards
how is ‘ideal’ posture measured
- use ‘plumb line’ as a reference point
- the intersection of sagittal and coronal planes of the body forms a line - comparable to line of gravity
- this is position of equilibrium - there should be a balanced distribution of weight and a stable position of each joint.
anatomical/ surface pointsof plumb line of reference for lateral posture
Slightly anterior to:
- lateral malleolus
- axis on the knee joint
Slightly posterior to:
- axis of the hip joint
Passess through:
- bodies if lumbar vertebrea
- bodies of most cervical vertebrae
- ear and should joint
Spinal curves - gentle ‘S’ shape
- cervical lordosis
- thoracic kyphosis
- lumbar lordosis
anatomical/ surface pointsof plumb line of reference for posterior posture
- head - neither tilted or rotated
- cervical spine - straight
- shoulders - level, not elevated or depressed
- scapulae - neutral position (medial borders parallel, 3-4 inches apart)
- Tx and Lx straight
- hip joints - neutral, neither abducted or adducted
- lower extremities - neither knocked knees (valves) or bowed (varus)
- feet - parallel of slight toeing out
curve of cervical spine
lordosis (inward curve)
curve of thoracic spine
kyphosis (outward curve)
curve of lumbar spine
lordosis (inward curve)
suggested framework for the postural assessment
- start at the top
- work methodically in one direction
- look at key bony landmakrs
- consider symmetry of the posture
- consider weight bearing (base of support)
- look at muscle bulk
- look at skin creases
- anterior, lateral and posterior aspects
what is the purpose of positioning a paitent
- improve alignment/ posture
- modulate tone
- improve engagement in surroundings
- stable base to be able to enable function
- promote normal movement patterns/ reduce unwanted compensations
- provide increased sensory stimulus
- reduce risk of pressure areas
- reduce pain
- reduce risk of aspiration and respiratory complication
- provide prolonged passive stretch and reduce risk of contractures
- improve venous return and decrease oedema
- decrease fatigue
autonomic ervous system functions e.g. digestion
describe lying on left side positioning of a patient
- use position oly if it does not affect breathing
- 1-2 pillows for the head
protract the scapula of the left shoulder, extend wrist & fingers - place the right leg forward on 1-2 pillows
- place pillows in front and behind
describe lying on right side positioning of a patient
- 1-2 pillows for head
- place left shoulder forward, scapula protrcated with arm supported on a pillow
- left leg backwards on 1-2 pillows
- place a pillow behind back
describe sitting up positioning of a patient
- sit well back in the centre of the chair or wheelchair
- place arms well forward
- the left arm may rest on a table or arm rest
- feet flat on the floor or footrests
- knees directly above feet
describe lying on back positioning of a patient
- head of bed 0-30 degrees unless contradicted
- place 3 pillows to support both shoulders and the head
- left arm on a pillow
- optional pillow beneath left hip
- ensure feet are in neutral position
describe sitting in bed positioning for a patient
- sit upright and well supported by pillows
- place both arms on pillows
- legs supported for comfort
how do you find out which position is best for your patient
- very much individual approach based on assessment
- active vs passive, consider what patient can do for themselves, their bed mobility and their transfer
- consider 24 hour positioning
- consider use of pillows, splints, Trolls, sleep systems, pressure cushions/ mattress and specialist seating as required
- MDT approach
- remember the best posture is the next posture!
considerations of facilitation
- knowledge of anatomy - relevant muscle groups and bony landmarks
- pressure - ‘helping’ patients move, not moving for them
- feedback - sensory stimulus for patients to aid proprioception, dont always need your voice
