Assistive Technology for Positioning

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Introduction[edit | edit source]

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. [1] 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. [2]

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.[3][4]

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. [5] The following explores some of the range of assistive devices available to support patient positioning.

Postural and Limb Alignment Devices[edit | edit source]

Devices to support postural and limb alignment including pillows and wedges are versatile tools used to support specific body areas during rest or sleep. They help maintain proper alignment of the spine and limbs, relieve pressure on vulnerable body parts, and reduce the risk of contractures. These devices come in various shapes, sizes, and materials, allowing for customised support based on individual needs.

Towels[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

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[edit | edit source]

A splint is a rigid support made from metal, plaster, or plastic. It's used to protect [6], support, or immobilise an injured or inflamed part of the body and reduce the risk of contractures.[7] Splinting can help both to prevent and manage length-associated changes in muscles and connective tissue. A splint can be a generic model or custom fit to support a specific limb to maintain is optimal alignment.

You can read more about the range splints available here and further information specifically for burns management here.

Offloading Devices[edit | edit source]

Cushions[edit | edit source]

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. [8]

You can read more about the range cushions available here.

Bed Mobility Devices[edit | edit source]

Slide Sheets[edit | edit source]

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.[9] 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. [10]

Side Rails[edit | edit source]

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[edit | edit source]

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 Devices[edit | edit source]

Bed positioning aids include devices such as bed rails, positioning straps, and adjustable beds. These assistive devices support individuals in achieving comfortable and safe positions while lying down. They can be used to prevent falls, support side-lying positioning, or assist with elevating the head, back, or legs for improved breathing, circulation, or digestion.

Specialised Beds and Mattresses[edit | edit source]

There are a wide range of specialised beds which can support patient positioning with varying levels of control including full-electric, semi-electric, and manual beds. Profiling beds allow the patient to be positioned in a wide range of position allowing adjustment of both the head and the foot of the bed, and frequently allowing adjustment of the height of the bed. 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. The levels of care to consider when choosing mattresses include pressure reduction, pressure relief and fluid including profiling beds that allow the patient to be positioned in a wide range of position.

Sleep Systems[edit | edit source]

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.[11] [12] Improved posture reduces the likelihood of secondary complications such as contractures, pain and poor sleep quality, thus improving quality of life. [13]

Seated Positioning Devices[edit | edit source]

Seating and positioning systems are specialised devices designed to provide optimal postural support and stability for individuals who spend extended periods in a seated position. These systems often also consist of offloading devices such as cushions, backrests, and positioning components that can be customised to address individual postural requirements and prevent pressure injury.

Adaptive Seating[edit | edit source]

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.[14] [15] 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.[16]

You can read more about the range of adaptive seating available here.

Wheelchair[edit | edit source]

Wheelchairs are widely used assistive devices for individuals with mobility impairments. They provide seating support, stability, and manoeuvrability, allowing individuals to move around and maintain proper positioning. These devices may offer adjustable seating options, such as recline, tilt, or elevating leg rests, to accommodate specific postural needs. The aim of wheelchair design is to provide appropriate seating and postural support without compromising strength, durability and safety.[17] Design features must be matched to the users functional ability and posture support needs, and also to the environmental and durability requirements.[18]

You can read more about the range of wheelchairs available here.

Standing Positioning Devices[edit | edit source]

Inability  to  weight-bear  through  the  lower  limbs  is  believed  to  have  a number  of  physiological  consequences,  including reduced  bone  mineral  density,  muscle  atrophy  and lower limb contractures. Positioning in standing for children and adults who are unable to stand independently can be attained by using assistive devices such as tilt tables, and standing frames, which provides alternative positioning to sitting in a wheelchair by supporting the person in the standing position.[19][14]

Abdominal Binder[edit | edit source]

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. [20]

Tilt Tables[edit | edit source]

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 [21] [22] [23]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.[22]

Standing Frames / Standers[edit | edit source]

Standing frames, also known as standers or standing devices, allow individuals with limited mobility who are unable to stand independently to assume an upright standing position. These devices promote weight-bearing and assist in maintaining proper alignment of the spine, hips, and lower extremities. Regular use of standing frames can offer various health benefits, including improved circulation, bone density, and bowel and bladder function.

An  effective  standing  frame  should  provide  users with  adequate  postural  support  while  enabling them  to  maintain  a  comfortable  and  functional position. A  broad  range  of  needs,  including changes  arising  from  growth  and  the  demands  of multi-user settings, make it essential for frames to offer optimal  flexibility  if  these  needs  are  to  be met, which can  be  facilitated  by  multi-adjustable  components. [19] Positioning in a standing frame utilises a range of straps to support and maintain optimal position and ensure device safety.

  • Chest Strap - The chest strap should be in the middle of the chest and you should be able to slide your hand comfortably in and out. If the chest strap is too low the patient maybe leaning forward.
  • Pelvic Strap - The pelvic strap should be in line with the patient's hips.
  • Knee Straps - The knee straps should be directly over the patient's knees. If the knee straps are too low, the patients's knee may bend a little bit and won't be supporting the patient enough.
  • Foot Straps – All straps should be comfortably fastened on top of shoes.

You can read more about the range of standing frames available here.

References[edit | edit source]

  1. Weiner C, Kalichman L, Ribak J, Alperovitch-Najenson D. Repositioning a passive patient in bed: Choosing an ergonomically advantageous assistive device. Applied ergonomics. 2017 Apr 1;60:22-9.
  2. Krug K, Ballhausen RA, Bölter R, Engeser P, Wensing M, Szecsenyi J, Peters-Klimm F. Challenges in supporting lay carers of patients at the end of life: results from focus group discussions with primary healthcare providers. BMC Family Practice. 2018 Dec;19(1):1-9.
  3. Weiner C, Kalichman L, Ribak J, Alperovitch-Najenson D. Repositioning a passive patient in bed: Choosing an ergonomically advantageous assistive device. Applied ergonomics. 2017 Apr 1;60:22-9.
  4. Kim H, Dropkin J, Spaeth K, Smith F, Moline J. Patient handling and musculoskeletal disorders among hospital workers: Analysis of 7 years of institutional workers' compensation claims data. American journal of industrial medicine. 2012 Aug;55(8):683-90.
  5. WHO. Definition of Assistive Technology. Available from: (accessed19 April 2023)
  6. VanBlarcom CW, editor. The glossary of prosthodontic terms. Mosby; 1999.
  7. Althoff AD, Reeves RA. Splinting. StatPearls [Internet]. 2020 May 24.
  8. Agence d’évaluation des technologies et des modes d’intervention en santé (AETMIS). Postural-support devices. Report prepared by François Pierre Dussault. (AETMIS 03-07). Montréal: AETMIS, 2005, x-47 p.
  9. Alperovitch-Najenson D, Weiner C, Ribak J, Kalichman L. Sliding sheet use in nursing practice: an intervention study. Workplace health & safety. 2020 Apr;68(4):171-81.
  10. Kohta M, Nakamura Y, Yunoki S. The effectiveness of topical aid sliding sheet potentially used for pressure injury treatment. Chronic Wound Care Management and Research. 2021;8:1.
  11. Humphries, G., King, T. & Jex, J. Clinical Practice Considerations for postural support in lying for children and adults with neurodisability. 2019.
  12. Sato, H. Postural deformity in children with cerebral palsy: Why it occurs and how is it managed. Phys Ther Res. 2020; 23(1): 8-14.
  13. Wood N, Brown S. An exploratory study: The effects of sleep systems on sleep quality, pain and carer goals for non-ambulant children and young people with cerebral palsy. Journal of Rehabilitation and Assistive Technologies Engineering. 2022 Jan 22;9:20556683211070729.
  14. 14.0 14.1 Elsayed AM, Salem EE, Eldin SM, Abbass ME. Effect of using adaptive seating equipment on grasping and visual motor integration in children with hemiparetic cerebral palsy: a randomized controlled trial. Bulletin of Faculty of Physical Therapy. 2021 Dec;26(1):1-8.
  15. Inthachom R, Prasertsukdee S, Ryan SE, Kaewkungwal J, Limpaninlachat S. Evaluation of the multidimensional effects of adaptive seating interventions for young children with non-ambulatory cerebral palsy. Disability and Rehabilitation: Assistive Technology. 2021 Oct 3;16(7):780-8.
  16. 2009. Available at
  17. William Armstrong, Johan Borg, Marc Krizack, Alida Lindsley, Kylie Mines, Jon Pearlman, Kim Reisinger, Sarah Sheldon. Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings. World Health Organization; Geneva: 2008.
  18. Di Marco A., Russel M. & Masters M., 2003, ‘Standards for wheelchair prescription’, Australian Occupational Therapy Journal 50 (1), 30–39.
  19. 19.0 19.1 Daniels N, Clift M, Armstrong J, Gopsill C, Pinnington L, Ward C. A review of standing frame features and their impact on user acceptability. International Journal of Therapy and Rehabilitation. 2005 Aug;12(8):363-7.
  20. Fanciulli A, Goebel G, Metzler B, Sprenger F, Poewe W, Wenning GK, Seppi K. Elastic abdominal binders attenuate orthostatic hypotension in Parkinson's disease. Movement disorders clinical practice. 2016 Mar;3(2):156-60.
  21. Webber B and Pryor J (1993): Physiotherapy skills: Techniques and adjuncts. In Webber B and Pryor J (Eds): Physiotherapy for Respiratory and Cardiac Problems. Edinburgh: Churchill Livingstone, pp. 113–173.
  22. 22.0 22.1 Chang AT, Boots R, Hodges PW, Paratz J. Standing with assistance of a tilt table in intensive care: a survey of Australian physiotherapy practice. Australian journal of physiotherapy. 2004 Jan 1;50(1):51-4.
  23. Jang MH, Shin MJ, Shin YB. Pulmonary and physical rehabilitation in critically ill patients. Acute and critical care. 2019 Feb 28;34(1):1-3.