Postural care

What is postural care?

Postural care is a gentle approach aimed to protect and restore someone’s body shape through the use of the equipment for the day and night for people with movement difficulties and can include:

• specialised seating
• standing frames
• support in the lying position especially at night
• moving and handling advice
• advice and training for carers, school and respite

Why does my child need postural care?

Children and young people who find it difficult to move and are unable to sit, stand or walk unaided are at risk of changes in their body shape. This is because they often sit and lie in a limited number of positions which can be asymmetrical and affect the way their body grows.

The way we lie down, is the way we sit, and the way we sit often dictates what we can do. Including how we feel, what we can enjoy, and the extent to which we can participate in things.

For example a child may lie down with knees to one side when they are young and as they grow older they still like this position when they sit or stand, suggesting that body shape changes might have occurred.

By protecting a child or young person’s body shape you are encouraging them to grow as straight and symmetrical as possible.

Why is postural care important?

Changes in body shape can result in lots of health complications. For example:

• contractures where the muscles tighten up and your child cannot fully straighten their limbs
• hip dislocation
• scoliosis (curving of the spine)
• poor digestion
• constipation
• pressure on internal organs
• difficulty breathing

These complications may be painful and restrict movement. They can affect how much your child can use their supportive equipment and participate in fun and educational activities both at home and school.

Does my child need postural care?

Any person who finds it difficult to vary or change their position during the day or at night may be in need of postural care.

If you can say yes to any of the questions below it suggests your child may benefit from postural care:

Your child may benefit from postural care if:

• they have a restricted number of positions
• their head turns mainly on one side
• their body seems to fall sideways
• their arms are often in one position which makes it difficult for them to use their arms
• their body falls backwards or forwards
• their knees are mostly on one side
• their knees fall inwards or outwards
• their body shape is different on one side to the other

How will the therapist help my child’s body shape?

Your therapist can carry out a standardised assessment called the Goldsmith Indices of Body symmetry to work out what your child’s body shape changes are. This will help to monitor change and how best to support and restore your child’s body shape. Your therapist might take photographs to help monitor any changes and may ask you to do the same.

Night time positioning

Most individuals spend one third of their life in bed, so it makes sense to look at supporting an individual in a comfortable symmetrical position at night as well as during the day.

The only position to allow a symmetrical posture is with your child lying on their back. If this is a new position for your child to sleep in please discuss this with your physiotherapist and or occupational therapist.

Safety checklist

If lying on their back to sleep is a new position for your child. There are a few things to consider before you try it.

Does your child have any of the following?

• reflux or risk of aspiration (when something goes down your throat ‘the wrong way’)
• uncontrolled epilepsy
• pressure issues
• continence issues
• respiratory issues
• circulatory issues
• temperature regulation issues

Sleep

Sleep is so crucial to family life and can have a big impact if it is challenged. It is essential to implement changes in night time routine when it is a good time for the family as a whole. Some families do this during school holidays when they have less pressure to get up early for school and work for example, but how you do this will vary from family to family.

Changes in routine are often challenging especially when they are around sleep, however it is about small manageable changes and building upon them. It can often take up to 6 months or a year to fully embrace night time positioning. Therapists are here to support you during this time and to working collaboratively with you to address any difficulties you may face along the way.

It is important to understand the risks and benefits of implementing a postural care programme and your therapists are available to support you, to share their knowledge with you in relation to your child and their needs and to work in partnership with you to develop your postural care programme.

What will my child’s therapist do?

You child’s therapists will:

• share expert knowledge of postural care with you in relation to your child and their needs
• work in partnership with you to develop your child’s own postural care programme
• work with everyone involved with your child to make sure they have 24 hour postural care

What do I have to do?

You can help your child by:

• developing your understanding of postural care and its importance for your child
• work in partnership with the therapist to carry out your child’s postural care programme
• work with everyone involved with your child to ensure 24 hour postural care