Many consumers are in need of physical management, that is, the twenty-four hour-a-day techniques designed to develop movement and skills and to minimize the development of skeletal deformities or other secondary conditions. In the course of providing physical management, positioning devices may be employed to enhance other techniques. Use of such devices should start early in life in order to achieve maximum results. Positioning devices need to be adaptable for growth when used by children. It is important that the device and the manner in which it is applied promote peer interaction and be easy to use. There are a great many such devices in use today. Improper use of such equipment can lead to accidents or injuries. Equipment should be well maintained and used according to instructions.
Upright Positioning Devices
Equipment used for upright positioning includes three types of standing frames.
- A prone stander allows the person to face forward. The support is provided by the front of the device and the person may use hands and arms. It is intended for those who have good head control.
- A supine stander allows the person's back to rest against the frame. This type is best for persons with decreased head control. It may be tilted in order to achieve a more upright position. A tray may be added to provide a surface for work or leisure activities.
- An upright stander allows the person to stand erect with the weight supported through the feet. The individual must have both good head control and good trunk control.
Floor Positioning Devices
Floor devices help to minimize the likelihood of skeletal deformities from developing and to promote normal patterns of movement.
- A prone floor positioner allows the person to be in a prone position while the head, arms and shoulders are in front. Good head control may be developed in this position while maintaining elongation of the muscles in the trunk, shoulders and hips. A wedge-shaped cushion is often used for this effect.
- A supine floor positioner helps promote symmetry while lying on the back. A person in this position will be supported on bolsters that may be inclined. Very little motor function is required in this position.
- A side-lying positioner promotes elongation of the weight bearing side and shortening of the non-weight bearing side. The goal of this position is to maintain the head in midline with the shoulders extended and the hands toward midline.
Seating systems are for persons with poor postural control, abnormal tone (hypotonicity-low muscle tone and hypertonicity-too much muscle tone), muscle shortening or skeletal deformities. The system is needed in order to provide proper alignment. These seating systems fall into four basic types.
- A seat/back angle system is used to maintain the pelvis in the optimum position. The seat/back is usually at a 90 degree angle but may be adjusted somewhat for individual needs.
- A tilt-in-space system is either permanently adjusted so the seat is at an angle or is adjustable. A slight tilt enables the person to maintain an upright position with less effort than being fully upright.
- A back support seating system is used when the person needs to be aligned so that the head and shoulders can be properly positioned. Supports may be added to the sides of the back cushion and to the side of the pelvis.
- A base-of-support system refers to the support provided in the sitting area. Additional wedges or support blocks may be added to help maintain the hips in proper alignment.
Additional supports may be provided in order to attain optimal positioning in the seating system. These include supports for the lower extremities, shoulders, and head.
All positioning devices must be custom ordered to allow for maximum benefit. Physical or occupational therapists will take measurements and assist in ordering. When the equipment arrives, it is important for the therapist to make adjustments and assure that the equipment is properly used.
Appropriate positioning will allow individuals the maximum opportunities for comfort and function and limit the possibility of accident or injury.
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