Page 20 - Mobility Management, June/July 2020

ATP Series
Kyphosis: Correct or Accommodate?
How Kyphosis Is Related to Nighttime Posture
Sarah Clayton, BSc (Hons) PGCE, is CEO of Simple Stuff Works, a manufacturer in the United Kingdom focusing on nighttime/sleep positioning. Clayton
is a therapeutic nighttime positioning specialist, and a passionate believer in the importance of positioning at all times, not just when someone is in a wheelchair.
“We need to have an understanding
of how the lying and seated postures
are related,” Clayton said. “The way
you lie is the way you sit, and so rather than thinking of a kyphotic posture as a stand-alone phenomenon that has an impact in sitting and lying, we need to look at how different postures develop over time.”
She said a kyphotic posture “is usually associated with a habitual side-lying sleeping position with hips and knees flexed. It can be very difficult for an individual with a kyphotic posture to adopt a less destructive, supported supine position. They often need very deep support, and difficulties can arise if their head is not supported well in terms of swallowing. As kyphotic postures are often associated with tight hamstrings, support for the legs can also be an issue. As always, prevention is far better than cure, and ideally the earlier a person can be supported to move toward supported supine lying, the better.”
Why is it so important for the seating and mobility team to also pay attention to a client’s lying-down posture?
“If we analyze where an individual may spend their time, it becomes obvious why the need to address lying makes such sense,” Clayton answered. “If we consider children, for example: They will be in bed on average three times longer than they are in school. Combine this with the fact that children release growth hormone and grow when they are asleep: We start to see how important it is to ensure that this time is as beneficial as possible.
“Sadly, many adults have not had access to supported lying.
It is important that we look not only to prevent distortion, but also to consider restoration of body shape. Ultimately, if we don’t address the thousands of hours spent in bed at night, our seating solutions will always be limited.”
A Consideration for All Wheelchair Users
Clayton believes all wheelchair users should be assessed for nighttime/lying postural needs.
“It is vital that we recognize that people exist 24 hours a day,” she said. “Their disability affects them 24 hours a day, and gravity is a force that is with them 24 hours a day. That we don’t routinely consider seating and lying together seems illogical — without supporting people to understand the impact of their sleeping posture, seating services will forever be playing catch-up.”
People with postural problems while lying down can also expe- rience poor-quality sleep.
“When we think of our beds, we tend to think of a place of comfort, rest and relaxation,” Clayton said. “But for those who are unable to move independently, [beds] can often become a place of discomfort, pain and restlessness. Changes in body shape take place slowly night after night — Rachel Wright at www.bornattherighttime.com describes a lack of postural care in bed as the carbon monoxide of disability. Any person who finds it difficult to change position inde-
pendently, if at all, should be assessed with consideration to all of the places and positions in which they may find themselves.”
The seating and mobility team can start out by asking how
a client sleeps at night, Clayton said: “The problem, once you establish that they are not in supported supine, is how do you support them to make that transition? Changing your sleeping posture is not simple, particularly if you have established changes in body shape. When we support people to make any changes, we have a comprehensive safety checklist to consider the physical implications of any changes. But then we also need to consider the emotional support that is needed. In the same way that people need help to make lifestyle changes around diet and exercise, they also need support when making lifestyle changes at nighttime. Here we need to explore an alternative, co-productive way of working. We can make recommendations, but unless a person understands the impact of their lying posture, they will not be motivated to change it.”
And Clayton confirmed that working on seated posture and lying posture concurrently is the optimal approach.
“To work in seating and lying in tandem is essential if you are to establish a long-term seating solution that will continue to meet an individual’s needs,” she said. “If you are prescribing a seating solution, it is important to understand the goals of the nighttime positioning plan. If restoration of body shape is the goal (and unless there are specific safety reasons, it should be), it is important that the seating solution is suitable.
“For example, if you are supporting someone who is able to adopt a therapeutic night position (one in which restorative forces can be safely applied), a custom contoured solution may not be appropriate, as you know that within weeks/months the person’s shape will change, and the seat will no longer be suitable.”
And the approach that has the best chance of working is one that includes plenty of communication between the postural team and the wheelchair user.
“The other thing to mention here is the level of collaboration needed between therapist and individual,” Clayton said. “Delving into nighttime is a highly personal and emotive aspect of a person’s life, and as such great care should be taken!”
Visit Simple Stuff Works Associates at www.simplestuffworks. co.uk. m
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SLEEPING BABY: DEPOSITPHOTOS/LURICAZAC