Positioning

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Original Editors - Naomi O'Reilly and Stacey Schiurring

Top Contributors - Naomi O'Reilly, Stacy Schiurring and Jess Bell      

Introduction

Moving and positioning lie within the broader context of manual handling. Positioning is a key aspect of patient care.Optimum positioning is a good starting point to maximise the benefit of other interventions, such as bed exercises and breathing exercises; it can also assist rest and mobility, thereby facilitating recovery and enhancing function. However, although it is important, it must not be seen in isolation and is just one aspect of patient management where the overall goal is to optimize independence.

In medical terms, ‘position’ relates to body position or posture and positioning involves placing the patient into a specific static alignment, which can involve their entire body, or just a single body part or limb.  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 the assistance or one or more other persons.  A major challenge to positioning is the fact that we are trying to place a dynamic body into a prolonged static position. The human body was made for movement, it does not tolerate prolonged periods of immobilisation well. This means the positioning must be comfortable and allow the patient to reposition as needed, while maintaining the purpose behind the positioning. It is essential to frequently evaluate the effect that positioning is having on the individual to ensure that the intervention is helping to achieve the desired result or goal. Consider whether the positioning procedure is being clinically effective and, where possible, is evidence based.

Purpose of Positioning

The purpose and indications for therapeutic positioning vary depending on the patient population being treated. Needless to say, there are many justifiable reasons to use positioning as part of a rehabilitation plan of care. 

1. Positioning for comfort or rest
   • Pain Management
   • Energy conservation
2. Limb Management/Protection
   • Injury prevention
   • Prevent further damage to an affected limb
     • Fx, sensory, neglect
3. Improve or Normalize Postural Alignment for Optional Functional Ability
   • Contracture management
   • Modify muscle tone
   • swallowing/feeding/eating
   • Vocalization
   • ADL/s and hygiene
   • Positional tolerance
4. Improve Sensory Input, Awareness and/or Arousal
   1. Orientation to upright
   2. Orientation for reference point for movement
5. Offloading
   • Wounds
6. Improve Circulation
   1. Edema management
7. Improve respiration
   1. Postural drainage
   2. Positioning for COPD, cardiac pt
      • Improve/protect self esteem and psychological well-being

Indications

Patients should always be encouraged to move themselves. Assistance in positioning is indicated for patients who have difficulty moving or require periods of rest when normal function is impaired.

Contraindications

There are no general contraindications for positioning; however, some clinical conditions may require special considerations, preparation and specialist assistance

Principles of Positioning

When approaching any therapeutic intervention, it is important to fully assess your patient before proceeding with therapeutic positioning. A patient should never be placed in a static position which will cause them harm or pain. The main principles underpinning all interventions involving patient positioning should focus on their short‐ and long‐term goals of rehabilitation and management for each specific patient. It is imperative that a thorough assessment is carried out prior to any intervention in order to plan appropriate goals of treatment. Wherever possible, goal setting should be a joint patient and healthcare professional discussion. It may be necessary to compromise on one principle, depending on the overall goal.

Regular reassessment is necessary to allow for modification of plans to reflect changes in status. Communication and involvement of the multidisciplinary team will assist rehabilitation interventions as treatment can be incorporated during positional changes. This potentially allows an opportunity for multiprofessional working and allows many individuals to act with a common purpose and with co‐ordinated activity.

Conclusion

Positioning is a useful therapeutic tool that can be individualized to a patient’s unique needs and limitations.  It is a natural continuation of the assessment skills you have reviewed in previous courses.  While positioning can appear simple and straightforward at the surface, I hope this course has provided some insight into the skill and mindfulness that goes into effective and safe positioning.

Resources

References