Handling and Positioning

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Handling and Positioning
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Sensory Systems

• Somatosensory (light touch, pain, pressure,
  temperature, and joint and muscle position
  sense).
• Discriminative touch.
• Pain and Tempurature
• Proprioception
• Vestibular (orientation of the headin inner ear)
• Visual
• Auditory (hearing)
• Olfactory/Gustatory (smelling and tasting)

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Motor Development

• Developmental Perspective (skill acquisition
  based on age) is not useful for children with
  multiple disabilities
• Functional Approach use of motor skills for
  task performance (especially tasks that are
  important for adult life)

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Movement

• Purposes
• Restore equilibrium
• Combine movement to create action
• Increase and refine skill
• Component Parts
• Reaching, grasping, manipulating, and releasing
• Locate and explore objects
• Require a combination of arm hand movements
• Movement Cognitive Skills
• Functional movement
• Motivating factor and the capabilities to act

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Movement (cont.)

• Postural control the ability to manage ones
  body parts with and against the forces of gravity
• Typically head-to-foot and truck-to-extremities
• Children with multiple disabilities often lack
  balance between stability and mobility
• Functional Importance
• Motor systems use maps to create accurate,
  smooth, well-timed movements
• When systems are disrupted, so is the
  experimentation process causing difficulty
  developing the ability to perform functional life
  tasks

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Problems that interfere with typical development
and functional outcomes

• Abnormal muscle tone (higher or lower)
• Primitive reflexes can interrupt functional
  performance.
• Difficult movement and posture control
• Effects the ability to interact with objects and
  people which limits learning experiences
• Orthopedic Changes can cause stiffness, skin
  infections, and even deformities
• Difficulty acquiring and using functional life
  skills

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General Guidelines

• An OT or PT should always assist in the
  development of handling and positioning
  procedures
• Methods should be consistent across all
  individuals who handle, position, and position
  the child
• Handling and positioning should be an integral
  component of the daily routine

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The Importance of Positioning and Handling

• Combinations of positioning and movement skills
  are required for even the simplest daily activity
• Minimize the influence of abnormal postures and
  movement patterns
• Children need extensive practice to learn new
  movement patterns
• Poor position will impact performance
• Children with disabilities are handled, moved,
  and positioned each day by numerous
  peoplewhether they know appropriate techniques
  or not!

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Current therapy models and methods

• The goal is to maximize functional performance
  and minimize the interference of the sensorimotor
  problems
• Models
• Direct (one-to-one)
• Monitoring (creates plan, monitors someone else)
• Consultation (adjust task demands, adapts
  environment, alters materials, creates optimal
  posture, establishes movement parameters,
  instructs classroom personnel on methods)

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Goals of Handling

• Normalize muscle tone
• Facilitate upright positions with normal posture
• Facilitate normal movement patterns

• Secret to success!!!
• Frequent Practice in meaningful contexts

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Normalize Muscle Tone

• Consider heath, emotions, and environment
• Increase pain, excitement, fear, over stimulated
• Decrease fatigue, illness, complacency,
  depression, medication, under stimulated
• Use posture and movement to encourage contraction
  or relaxation
• Break up atypical posture
• Key points of control
• Range of Motion

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Facilitate Upright Positions and Normal Posture

• Advantages
• Improve alignment
• Provide wide base of support
• Free hands to accomplish tasks
• Reduce pressure on hips and other body parts
• Social acceptance
• Increase ability to interact
• Others. . . .

• Disadvantages
• Can be harmful if used incorrectly
• May require bulky equipment
• Equipment can be expensive
• May become overly reliant or used too much
  (especially wheel chairs)
• Others. . . .

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Service Approaches

• Establish/restore when problem can be at least
  partially corrected
• Adaptive neutralize the effects of the problem
• Alteration address the possibility that certain
  environments may be better match

• Preventative possible problems in the future
  like orthopedic deformities
• Creation enhance the development of all children

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Service Approaches

• Establish/restore when problem can be at least
  partially corrected
• Adaptive neutralize the effects of the problem
• Alteration address the possibility that certain
  environments may be better match

• Preventative possible problems in the future
  like orthopedic deformities
• Creation enhance the development of all children

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Goals of Positioning
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Types of Positioning

• Dynamic
• Achieved through therapeutic handling
• Static
• A supplement to dynamic positioning
• Use of adapted equipment
• Prone standers, wedges, sidlying board, supine
  stander

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The Importance of Teaming

• Alternative ways of solving a problem
• Members have different frames of reference and
  perspectives
• More experience and expertise is represented
• Ability to make observations throughout the day
  in different environments
• Should be viewed as a cohesive unitnot as
  individual parts that are put together
• Keeping up on medications and behaviors

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Benefits of Using Adaptive Equipment

• Therapeutic
• Make the student more mobile
• Frees student from 11 with parents and teachers
• Free staff from positioning to allow other
  instruction
• Enable students to participate in activities with
  their nondisabled peers

• Functional
• Learn tasks quicker and performed more
  independent
• More time interacting with others
• Improve self-help skills
• When therapy also provides a means of mobility
  (i.e. wheelchair)
• More places outside home, more often
• More positive social interactions

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Positioning

• In adapted chairs
• Refer to Checklist for Seated Positioning (page
  97)
• Pelvis
• Thighs
• Feet
• Trunk and head
• Arms

• Cautions
• Positioning aids can be considered restraints
  consult with team members an receive legal advice
  if necessary
• Never place wedges against pelvis
• Numerous adaptations may elicit undesirable
  reactions from others
• Over-reliance on adaptations can actually cause
  students to lose abilities

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Determining Positioning Techniques

• Considerations
• Postures to be reinforced
• Postures to be avoided
• Functions and activities to be performed
• Social contexts
• Positioning alternatives possible throughout the
  day

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FYI. . . . .

• Elementary students are typically very accepting
  of less traditional positioning for their peers
  with disabilities, especially if they understand
  the reasons!
• Immobility has adverse effects on motor,
  cardiovascular, respiratory, gastrointestinal,
  urinary, and metabolic functions. Prolonged
  sitting can lead to non-reversible hip and knee
  contractures and deformities, circulatory
  problems (in as little as 30 minutes), skin
  irritation or breakdown, and osteoporosis.
• Students should have at least two different
  positions they can alternate between and should
  be repositioned every 30 minutes to an hour!

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Lifting and Transferring

• Children should learn to participate in the
  transfer from a very young age
• Get help if child is larger than ¼ your weight
• Lifting and lowering
• Position feet to provide stable base of support
• Keep lower back slightly arched
• Tighten ab muscles (breath!)
• Bend at the knees and hips
• Lifting and transferring

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Developing Implementing Programs

• Decisions made by the team
• OT PT
• Offer expertise in positioning and handling,
  current technology available, and fitting
  equipment
• Develop procedures to facilitate normal movement
  patterns and sequences
• Create task analysis or checklists
• Train teachers in techniques
• Checklists, pictures of positioning and use of
  equipment, and schedules for positioning can be
  posted on bulletin boards for all to use