Assistive Technology for Positioning

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Introduction

Positioning involves placing the patient into a specific static alignment, which can involve their entire body, or just a single body part or limb, which involves patient handling, transporting or supporting a load (i.e., lifting, lowering, pushing, pulling, carrying or moving) by using hands, bodily force and/or mechanical devices. Positioning can be achieved either;*actively by the patient, meaning they are able to move under their own volition, or

• passively, where the patient is placed into a specific position with assistance of one or more other persons.

Positioning frequently requires high physical demands and awkward postures for health and social care professionals (e.g., leaning over the bed or working in a confined space). Studies have shown that patient positioning, in particular positioning people in bed, is one of the most highest risk tasks performed by health and social care workers and is the cause of approximately 25% of all patient handling musculoskeletal injury compensation claims.

An assistive device is an object or piece of equipment designed to support a patient with activities of daily living. Assistive devices also support the health and social care worker to position and move patients in a way that reduces risk for injury to themselves and patients. The following explores some of the range of assistive devices available to support patient positioning.

Limb Alignment

Towels

Towels are easy to obtain, easily washed to maintain good hygiene and can be folded for many purposes. May be used to provide support for a range of body parts to minimise strain on limbs.

Pillows

Pillows provide support, elevate body parts and splint incision areas, and reduce postoperative pain during activity, coughing, or deep breathing. They should be of the appropriate size for the body to be positioned.

Wedges

Positioning wedges provides essential support to keep patients safe and comfortable in bed. They can provide back and side support, help to alleviate pressure and prevent slipping down the bed. In paediatrics wedges are frequently used to support prone positioning to help promote cervical extension and use their arms for play.

Trochanter Roll

Trochanter roll refers to a cylindrical prop such as a rolled-up towel, foam roll, cylindrical cushion / pillow, or rolled-up blanket, which is used to prevent external rotation of the hips when a patient is in a supine position.

Hand Rolls

Hand rolls maintain the fingers in a slightly flexed and functional position and keep the thumb slightly adducted in opposition to the fingers to minimise the risk of flexion contractures and reduce skin breakdown. Hand rolls made from face cloths can be easily washed to maintain good hygiene.

Splints

A splint is a rigid support made from metal, plaster, or plastic. It's used to protect , support, or immobilise an injured or inflamed part of the body. A splint can be a generic model or custom fit to support a specific limb to maintain is optimal alignment

Offloading

Cushions

Cushions provide comfort, pressure relief and offloading, provide postural support to assist patient with optimal positioning and compensate for any deformations. There are a range of classification systems developed to describe cushions that provide useful information in relation to construction materials, different functions of the cushions and their ability to prevent pressure injuries.

Bed Mobility

Slide Sheets

A slide sheet is a slippery piece of cloth, typically nylon, used under the patient to reduce the effort required to move a person and to help reduce friction during patient repositioning. They are designed to be used to aid with the positioning and transfer of a patient with requiring varying levels of assistance, and eliminate the need for lifting a patient and as a result have been shown to reduce work-related musculoskeletal pain and disability while increasing job satisfaction when used during positioning tasks. Sliding sheets also have been shown to significantly reduce interface friction and internal shear forces of the skin, which reduces the risk of pressure injuries.

Side Rails

Side rails are bars along the sides of the length of the bed. They ensure patient safety and are useful for increased bed mobility. They can assist with rolling from side to side or sitting in bed.

Trapeze

A trapeze positioned above the patient near the head of the bed allows the patient to grasp and reposition themselves or to help with re-positioning. These can be fixed to the bed or free standing. They are contraindicated in some situations including new spinal cord injury, post abdominal surgery, and shoulder conditions.

Bed and Sleep Positioning

Specialised Beds

There are a wide range of specialised beds which can support patient positioning including profiling beds that allow the patient to be positioned in a wide range of position. The roto rest bed provides continuous, slow, side-to-side turning of the patient by rotating the bed frame. Keeping the patient in maximal rotation assists with prevention of skin breakdown and provides the most effective therapy for pulmonary indications.

Sleep Systems

Sleep systems are prescribed postural support systems used in lying that contain components, held in place using a base or sheet, forming part of a 24h posture management programmes, for children and adults with severe motor disorders and neurological conditions.[27] [28] Improved posture reduces the likelihood of secondary complications such as contractures, pain and poor sleep quality, thus improving quality of life. [29]

Standing Positioning

Abdominal Binder

Abdominal binders are elasticated binders typically used when reintroducing patients to the vertical position and are associated with a significant reduction of orthostatic hypotension. Commonly used during tilt tabling the binder works by reducing splanchnic venous pooling under orthostatic stress. [26]

Tilt Tables

Tilt tables are commonly used in intensive care and rehabilitation settings as a technique to minimise the adverse effects of prolonged immobilisation such as orthostatic hypotension, reduced oxygen consumption, venous pooling, reduced lung volumes, impaired gas exchange, muscle atrophy, joint contractures, peripheral nerve injuries, and pressure areas[30][31][32] and to reintroduce patients to the vertical position. Benefits of tilting include increased ventilation, increased arousal, improved weight bearing of the lower limbs, and facilitation of antigravity exercise of the limbs.[31]

Seated Positioning

Adaptive Seating

Specialist seating is a tool which offers continuous posture management and enables a patient to receive a maximum quality of life. A commonly used intervention to enhance head and trunk stability for optimal positioning.[33][34] The use of adaptive seating can help develop motor skills, facilitate arm and hand mobility, self-feeding, visual scanning and tracking and reduce the need for assistance from caregivers.[34] Studies have shown that individuals using adaptive seating often have positive experiences, including increased performance of activities of daily living and social interaction.[35]

Wheelchair

A wheelchair provides both wheeled mobility and seating support for a person with difficulty in walking or moving about. The aim of wheelchair design is to provide appropriate seating and postural support without compromising strength, durability and safety.[36] Design features must be matched to the user`s functional ability and posture support needs, and also to the environmental and durability requirements. [37]