Stroke: Positioning

Original Editor - Your name will be added here if you created the original content for this page.

Top Contributors - Naomi O'Reilly, Kim Jackson, Adam Vallely Farrell, 127.0.0.1 and WikiSysop  

Introduction[edit | edit source]

The aim of positioning the patient is to try to promote optimal recovery by modulating muscle tone, providing appropriate sensory information, increasing spatial awareness and prevention of complications such as pressure sores, contracture, pain, respiratory problems and assist safer eating.[1][2][3]

Correct positioning can help to reduce the risk of;
• Aspiration
• Contracture [2][1]
• Pressure Areas
• Shoulder Pain [1]
• Swelling of the Extremities

Aims of Positioning
[edit | edit source]

  • Normalise Tone or Decrease Abnormal influence on the Body
  • Maintain Skeletal Alignment
  • Prevent, Accommodate or Correct Skeletal Deformity
  • Provide Stable Base of Support 
  • Promote Increased Tolerance of Desired Position
  • Increased Stimulation to Affected Side 
  • Increased Spatial Awareness 
  • Promote Patient Comfort 
  • Facilitate Normal Movement Patterns
  • Control Abnormal Movement Patterns
  • Manage Pressure
  • Decrease Fatigue
  • Enhance Autonomic Nervous System Function (Cardiac, Digestive and Respiratory Runction)
  • Facilitate Maximum Function
  • Improved Ability to Interact with the Environment [4][5]

Who is Responsible[edit | edit source]

Who is Responsible?
• All members of the MDT
• Nursing Staff play key role in ensuring 24 Hour Adherence

Types of Positioning[edit | edit source]

The most appropriate position in which to place a patient following a stroke remains unclear. There is no RCT evidence to support the recommendation of any one position over another but five main positions have been recommened, a survey of physiotherapists’ current positioning practices found the most commonly recommended positions to be: sitting in an armchair as recommended by 98% of respondents; side lying on the unaffected side then side lying on the affected side. Sitting in a wheelchair (78%, 95% CI 74 to 82%) and supine lying were less commonly recommended. [5][3]

Sitting in a Chair or Sitting in a Wheelchair [edit | edit source]

(98% CI 97 to 100%) or (78%, 95% CI 74 to 82%)[5]

It is vital that as soon as the person is capable of sitting out that they are facilitated to do so. Sitting out is essential to build up tolerance; provide maximum stimulation; give a sense of normality.
• Head over Pelvis
• Hips at 90 degrees
• Knees at 90 degrees
• Slight extension of lumber region
• Feet in neutral position and supported
• Weight evenly distributed between both buttocks
• Arm should be protracted forward and supported

Side Lying on the Unaffected Side[edit | edit source]

(97%, 95% CI 95 to 98%)[5]

One or two pillows for head.
Affected arm forward and supported on pillow
Affected leg backwards on one or two pillows
Place pillow behind.

Side Lying on the Affected Side[edit | edit source]

(92%, 95% CI 89 to 95%)[5]

One or two pillows for head
Affected shoulder positioned comfortably
Place unaffected leg forward on one or two pillows
Place pillows in front or behind to give support

Lying Supine[edit | edit source]

(67%, 95% CI 63 to 72%)[5]

Place three pillows in a ‘triangle’, supporting shoulders and head
Place affected arm on pillow
Ensure feet in a neutral position

Sitting up in Bed
[edit | edit source]

• Sitting in bed is desirable for short periods only
• Must be upright and well supported with pillows
• Consider extra support using pillows under arms or knees

Sitting v Lying....
[edit | edit source]

What are the differences?

  • When seated, nearly half of the body weight is supported on 8% of the sitting areas at or near the ischial tuberosities (Crow,1988)
  • Therefore, interface pressures are much higher in sitting than lying

Distribution of Weight when Seated Normally
[edit | edit source]

Buttocks & Thighs 75%
Feet flat on floor 19%
Back 4%
Arms 2%
Total 100%

Pressure Relief
[edit | edit source]

• A person who has had a stroke may be susceptible to developing pressure sores
• Assess the person and decide on an appropriate cushiono use in order to:
  Prevent further skin breakdown,
  To assist with healing
  To facilitate the patient to sit out as much as possible

Recent Related Research (from Pubmed)[edit | edit source]

Extension:RSS -- Error: Not a valid URL: Feed goes here!!

References
[edit | edit source]

  1. 1.0 1.1 1.2 Ada L., Goddard E., McCully J., & Bampton J. (2005). Thirty minutes of positioning reduces the development of shoulder external rotation contracture after stroke: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 86(2): 230-34.
  2. 2.0 2.1 De Jong L.D., Nieuwboer A., & Aufdemkampe, G. (2006). Contracture preventive positioning of the hemiplegic arm in subacute stroke patients: a pilot randomized controlled trial. Clinical Rehabilitation, 20: 656-667.
  3. 3.0 3.1 Mee L.Y., & Bee W.H. (2007). A comparison study on nurses’ and therapists’ perception on the positioning of stroke patients in Singapore General Hospital. International Journal of Nursing Practice, 13(4): 209-21.
  4. Jones M & Gray S (2005) Assistive technology: positioning and mobility. In SK Effgen (Ed) Meeting the Physical Therapy Needs of Children. Philadelphia: FA Davis Company.
  5. 5.0 5.1 5.2 5.3 5.4 5.5 Chatterton H.J., Pomeroy V.M., & Gratton, J. (2001). Positioning for stroke patients: a survey of physiotherapists aims and practices. Disability and Rehabilitation, 23(10), 413-421.