Supporting someone with a physical disability with complex needs can be challenging, particularly if the person is not able to move themselves independently or communicate how they’re feeling.

The body moves thousands of times every day. Many regular movements are subconscious, and the full extent of stiffness or pain is often not felt until a position has been held for a long time. Think about how often you reposition yourself when in a meeting or while watching a movie.

Now consider the people you support with complex needs, who may not be able to reposition themselves or express discomfort. It is essential for everyone in the individual’s support team to tune into their subtle changes and reactions during the day and overnight, to best understand their needs.

What is 24 hour positioning?

24 hour positioning is a term used to describe the needs of people across the entire 24 hour period, every day of the week, including all aspects of their life. It includes participation, social interaction, mobility, mealtimes, pressure management, sleep and positioning for function.

Positioning for function considers the whole body and all the activities that go on in the home and community. People often think equipment is all there is to 24 hour positioning. Movements, repositioning, activities completed, overall health, diet, fluid intake, sleep and rest, family and home dynamics as well as equipment all play a role in supporting someone over the 24 hour timeframe.

Habitual postures

Habitual postures can lead to deformities that will later impact on participation and independence. Poor habitual postures can lead to postural deformities that can cause pain, discomfort and ill health.

People’s body’s can progress over time and it can be confronting for those who care for them. It is vital that people who support those with complex physical disabilities understand that they have an essential role in assisting comfort and wellbeing. The extent of deformity and impact on someone’s life can be significantly reduced by supporting the person as a whole. It is important to note that sometimes even when every attempt is made to improve someone’s position, deformity can still occur.

The role of different positions

Different positions across the day impact other aspects of their life. How someone lies in their bed can impact how they sit in their chair and see their world. How someone sits and moves during the day can impact their sleep.

For example:

People who lie in the foetal position every night and have tight muscles, often take up the same position in their chair. This makes it difficult for them to look up and see their world. It can mean that their feet do not sit comfortably on their footplates, their knees and hips bend and they cannot stand anymore.

People who lie on their stomach all night and are at risk of a scoliosis (curved back) can end up with very severe scoliosis which means that they cannot sit upright in their chair. This can mean they need lots of support to hold them in their chair which can make them hot and sweaty and painful along the side of their body.

People who lie on their side every night and are not able to move themselves can change the shape of the rib cage which makes sitting and breathing difficult as they get older. They can also have pain in the shoulder they lie on and the upper hip if their knee is resting on the bed. This can lead to problems with sitting due to pain.

People who only sit in the one chair all day with limited supports and the chance to move can find their muscles and joints become tight and stiff at the hips, knees and ankles. This can mean they can’t lie in different positions or stand which can then cause problems for the respiratory and gastrointestinal systems as well as pain in the joints.

What can be done to help the long term needs of people?

Supporting all positions and movement from as early an age as possible can help people’s comfort and wellbeing and mean that people can participate in whatever way is best and enjoyable for them.

What support can be provided?

Positioning

When determining suitable positioning for an individual, it is important to consider their general health, comfort, pain levels, safety within their surroundings and participation in activities.

Everyone feels comfortable in different positions. The aim when providing positioning support is always a neutral body.

Postural supports can be helpful in ensuring a neutral position. Supports range from simple pillows purchased from a department store, through to customised pieces of equipment. While some people tolerate or want lots of pieces of equipment for support, others prefer just one or two pieces.

Regular consultation with the therapy team for postural supports and positioning can greatly enhance participation in activities. A 24-hour positioning plan can be useful for people who are supported by multiple support staff across the week. The therapy team can assist with putting together a plan that best meets the needs of the person.

Movement and Repositioning

Experiencing a range of movements and different positions across a 24-hour period is important for comfort and wellbeing.

Suggestions for providing optimum comfort to an individual with complex needs inclue:

• Make use of the recline and tilt in space functions on wheelchairs
• Regular re-positioning – make sure to re-position someone even when they “look comfortable”
• If they can, offer the opportunity to stand or walk
• For those who do not stand or walk, can they be hoisted into another seat or bed? Ask the therapy team to assess for alternative positions during the day. Always consider safety
• Encourage participation in exercises, stretching or other movement. Ask the therapy team for specific ideas and programs