24 Hour Posture Care and Management Committee Statement of Purpose

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24-7 Posture Care and Management Committee (24-7PCM) Statement of Purpose
 
The purpose of this committee is to globally advance the practice of 24 hour positioning in all contexts including low resource settings, through collaboration, education, advocacy, and research. People at risk of body shape distortion rely on application of purposefully placed postural supports in lying, sitting and standing, to promote function, improve sleep quality and reduce pain and secondary complications. Our goal is to support the knowledge base and creation of locally available solutions for persons with mobility limitations.
 
Frequently Asked Questions
 
What is the 24 Hour Posture Care and Management (24-7PCM) Approach?
This describes a non-invasive and gentle comprehensive intervention that includes day and night positioning in lying, sitting and standing. The approach is aimed at improving the quality of daily comfort and function of the individual with mobility limitations. This requires a process that includes a comprehensive understanding of how the positioning program fits within a person’s context and lifestyle.
 
Lying is the first orientation experienced by all human beings and is the foundational posture in which humans spend one third or more of each day because of the need to sleep. When people with mobility limitations spend many hours in their preferred/ habitual posture, gravity takes its toll. If we accept the theory that distortion of body shape is the result of habits - preferred posture + gravity + time – all postures in the day and night must be considered. Positive gains in body symmetry, pain reduction, sensorimotor integration, improved sleep quality, pressure injury prevention and overall function can be promoted with appropriate postural supports in all orientations available to the individual.
 
Who is at risk?
Every person with mobility limitations. Posture is unique to each individual depending on their physiological profile. Many assume that body shape distortions are inevitable for people with disabilities, but in most cases, these are secondary complications that can be prevented with correct positioning and sometimes restored or corrected - even later in life.
 
What does it mean to the people who need it?
Protection from avoidable changes in body shape and subsequent pain and difficulties with digestion, breathing and movement. With protection in place opportunities increase for people to participate and have active lives in society.
 
What are secondary complications?
When a person with mobility limitations cannot easily and frequently change position while lying or sitting, and cannot independently achieve and maintain a symmetrical position, they depend on others to provide supports enabling them to rest comfortably in midline.  Without these supports, the body “adapts” to the positions it spends the most time in.  Greater flexibility develops in soft tissues under constant stretch in the path of destructive tendencies, soft tissues in shortened positions develop tightness, and cartilage and bony changes follow.  Many of these primary processes are well understood in the greater literature and are the basis for physical training to improve function.  
 
When the primary problem (inability to change one’s own position, leading to long periods spent in asymmetrical postures) is not adequately addressed, secondary complications arise. Secondary complications of lying in asymmetrical postures are PREVENTABLE problems, led by body shape distortion – which then leads to a whole host of preventable life-limiting problems. 
 
  • Asymmetrical postures
    • Pain
    • Poor sleep/ rest
    • Body Shape distortion (Scoliosis, Kyphosis, Windswept Deformity)
      • Structural postural deviation and movement restriction
      • Decreased lung capacity/restrictive lung disease
      • Impaired digestion/motility/ elimination
      • Hip and other joint dislocation
      • Eating/swallowing dysfunction 
      • Increased difficulty with oral speech production
      • Pressure on vital organs impairing their functioning
      • Increased spasticity/ muscle tone/ spasms
      • Increased pressure injury risk
      • Increased cost/complexity of wheelchair seating required
      • High cost/complexity of assistive technology required for communication
      • Decreased options/ability for independent mobility (manual and power)
        • Limited access to the community
          • Isolation
          • Decreased quality of life 
          • Shortened lifespan
 
Much of the human and financial cost associated with mobility impairments results from these secondary, PREVENTABLE impairments.  24-7PCM is the foundation of good care: it improves the quality of life for individuals with mobility impairments and has potential for significant reduction in health-care costs.  
 
Who provides 24-7PMC?
24-7PMC is a multidisciplinary team effort.  The people who put the gentle physical supports in place every night and every rest period are caregivers who know the user well and who have learned both why the supports are needed and how to place them.  These team members (families, close friends, practical nurses, and other caregivers) partner with the user and the healthcare providers in sharing information and solutions with the goal of quality rest in a position that is healthy for the body.  
 
How does this work?
Direct supporters (caregivers and family members) learn why the support is needed and how it can be provided, then they work together with their health care providers to come up with materials to provide these supports.  Most people use a combination of generally available materials with some specialized ones.  Some commonly used supports include tightly rolled towels, pillows, non-slip rug backing, and carved foam.  In some areas, pre-fabricated items are available, in other settings, locally sourced general-purpose materials are adapted.
 
How can I learn how?
Learning is the most important part of the caring process. The first thing to learn is WHY? This involves understanding the body shape distortion process and its relation to secondary complications, as described above. Health complications like contractures, scoliosis, joint dislocations, constipation, aspiration, restrictive lung disease, and pain can result from failing to protect body shape. Premature death will follow from these complications. If you understand WHY, you started the path of HOW….
 
Some experienced therapists in this area can help you with the HOW. Begin reading and learning more – the basic reference list on this page is a place to start. Online resources are available as well, if you do not have access to in-person training in your geographic area. Give us feedback on what you need!
 
How can I share my experience?
Do you have expertise in this area? Share your knowledge with people with mobility limitations and their caregivers, families, nurses, therapists and physicians. Reach out to peers, use social media, write blogs and so on.
 
Reference List
 
Ágústsson, A., Sveinsson, T., Pope, P., & Rodby-Bousquet, E. (2018): Preferred posture in lying and its association with scoliosis and windswept hips in adults with cerebral palsy, Disability and Rehabilitation, DOI: 10.1080/09638288.2018.1492032
 
Ágústsson, A. and Jonsdottir, G. Posture Management 24/7. (2018) In Lange, M.L., and Minkel, J.L., Editors. Seating and Wheeled Mobility: A Clinical Resource Guide. SLACK Incorporated, Thorofare, NJ. 121-136
 
Blake SF, Logan S, Humphreys G, Matthews J, Rogers M, Thompson-Coon J, Wyatt K, Morris C. (2015) Sleep positioning systems for children with cerebral palsy. Cochrane Database of Systematic Reviews, 2015 (11). doi: 10.1002/14651858.CD009257.pub2
 
Crawford, S and Stinson, M. (2015) “Management of 24-hour Body Positioning” In Söderback, I., Ed. “International Handbook of Occupational Therapy Interventions”. Springer International Publishing Switzerland. 189-203.
 
Fulford, G.E., Brown, J.K. (1976). Position as a cause of deformity in cerebral palsy. Developmental Medicine and Child Neurology, 18, 305-14.
 
Gericke, T. (2006). Postural management for children with cerebral palsy: Consensus statement. Developmental Medicine & Child Neurology, 48(04), 244.
 
Hill, S., & Goldsmith, J. (2010). Biomechanics and prevention of body shape distortion. Tizard Learning Disability Review, 15(2), 15–32.
 
Kittelson-Aldred, T. and Hoffman, L.A. (2017) 24-Hour Posture Care Management:   Supporting People Night and Day. Rehab Management, September
 
Pope, P.M. “Severe and Complex Neurological Disability: Management of the Physical Condition”. (2007). Elsevier, Ltd.
 
Pountney T.E., Mulcahey, C.M., Clarke S.M., & Green E.M. (2000) The Chailey Approach to Postural Management. Active Design.
 
Robertson, J., Baines, S., Emerson, E., and Hatton, C. (2016) Postural care for people with intellectual disabilities and severely impaired motor function: A scoping review. Journal of Applied Research in Intellectual Disabilities. DOI: https://doi:External Links icon 10.1111/jar.12325.
 
Taktak, A., Ganney, P. & Long, D. (2013) Clinical Engineering: A Handbook for Clinical and Biomedical Engineers. Academic Press.