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Why 24 Hour Postural Management is Important

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Posture is the way we hold ourselves or position our body segments in relation to one another and their orientation in space.  This might be intentional or unintentional, because posture can be influenced by many factors, including our body shape and size, the task at hand, and even the supporting surface on which we are sitting, standing or lying.

       The human body is made up of many different systems that work together to achieve good posture.  As we grow and our brains develop we learn from information that is sent from various sources, including visual, vestibular (balance system) and proprioceptive (sense of position) input, and gradually responses become automatic.

 Damage to any of these systems, through injury or disease, can affect our ability to interact with the information and go about our daily lives. We can experience difficulty attaining postural control and stability, vital for function; consequently impacting on normal movement.

Remember that stability can only be achieved with comfort!  Gravity can also affect posture; by making it difficult to control our head, trunk and upper limbs against the pull of gravitational forces. It can exaggerate postural asymmetries, thereby increasing the risk of further damage to body systems.

Comfort, stability, and function are all interconnected and essential for achieving good posture.

Failure to protect an individual’s body shape can result in many secondary complications, including pain and discomfort, increased risk of pressure injury, deterioration in health, and even early death.

Postural management is the use of any technique to minimise postural abnormality and enhance function. It is a multi-disciplinary approach that encompasses a person’s daily life across the full 24 hours, respecting all activities and interventions that impact on posture and function. It must be considered on an individual basis following a comprehensive assessment.

 To ensure optimum positioning during the day, we must consider the position that a person adopts throughout the night.

Imagine an elderly lady with dementia who instinctively curls up in to a foetal position when she gets in to bed, but lacks the cognitive function to change position throughout the night.  Or a young man with cerebral palsy who, due to gravity and neurological involvement, remains restricted in a windswept position, but lacks the physical ability to change position. Prolonged periods of abnormal postures increase the risk of postural deterioration and the associated secondary complications.

Both the aforementioned individuals are at risk of contractures in their lower limbs. It is unlikely either will be able to achieve a comfortable sitting position during the day after a full night fixed in one asymmetrical position.

 So it is important to consider the management of posture throughout the full 24 hours, otherwise it will be difficult, if not impossible, to sit out.  This will impact on other aspects of daily living and quality of life.

We want to ensure that everyone is able to achieve the best position for comfort, freedom of movement, independence, and interaction. Ultimately, we want to enable a happy and healthy life.

References:

  1. Ham et al. 1998
  2. Farley R, Clark J, Davidson C, Evans G, MacLennan K, Michael S, Morrow M, Thorpe S (2003) What is the evidence for the effectiveness of postural management? International Journal of Therapy and Rehabilitation 10(10):449-455
  3. Ham R, Aldersea P, Porter D (1998) Wheelchair Users and Postural Seating A Clinical Approach London: Churchill Livingstone
  4. Mencap, Postural Care Action Group (2011) Postural care: protecting and restoring body shape
  5. Pope PM (2007) Severe and Complex Neurological Disabilities: Management of the Physical Condition London: Butterworth-Heinmann

 Rebecca Dunstall

BSc Physiotherapist (Hons)

CareFlex Clinical Specialist

www.careflex.co.uk

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