Case 1: Chanda's religious beliefs do not allow for much exposure of skin, especially on the trunk. She is 7 months pregnant and is undergoing an examination for low-back pain. The physical therapy preferred practice guidelines call for assessment of the spine at the low back and sacrum. The objective is to position Chanda in a way that is respectful and allows you to examine her low back visually and manually. What is the best way to achieve this goal?
Case 2: Katsu has very limited voluntary motor function in her right arm and leg because of a recent stroke (cerebrovascular accident). Her family (two sons and three daughters) is very supportive, and at least one family member has been present in her room since Katsu was admitted to the hospital through the emergency department. What are the objectives of Katsu's positioning? Are there particular precautions you may need to consider? How might you involve her family?
Positioning, or placing a patient in a static posture, can be used both to increase stability and to facilitate mobility. Positioning patients to keep them from falling out of bed or to receive treatment of sacral wounds, for example, is a matter of establishing temporary static stability. Careful and consistent positioning of patients who will be in one position for a long time, on the other hand, can facilitate maximum functional mobility later on. For example, long-term positioning that maintains the flexibility of joints and soft tissues allows patients to maintain the capacity for mobility, fulfilling the first step of the mobility-stability continuum. Use of a lap belt to provide pelvic stability can create a stable core (static stability), from which a person is better able to achieve controlled mobility by moving the arms in a controlled and purposeful manner.
Because the objectives of short-term and long-term positioning are different, a basic distinction needs to be made between procedures for short-term positioning and long-term positioning (Fig. 7-1). The first question you must answer when deciding how to position your patient most effectively is, “What am I trying to accomplish?” Your answer will guide your decision-making process (Table 7-1).
Articulating the purpose of a device helps guide the clinician in making optimal mobility choices. (A) For temporary transportation, wheelchair fit and accessories are less important. (B) The addition of a lap tray may increase the functional use of a wheelchair for longer periods of time. (C) Wheelchair fit and accessories have a large impact on the independent wheelchair user's mobility.
Table 7-1Situations Calling for Short-Term and Long-Term Positioning |Favorite Table|Download (.pdf) Table 7-1 Situations Calling for Short-Term and Long-Term Positioning
|Short-Term Positioning Is Used When ||Long-Term Positioning Is Used When |