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24-Hour positioning – where do we stand?

Related specialities: Paediatrics

People spend a lot of time lying down, so over time there’s been development of consideration and products for ‘in bed’ positioning under the banner of 24-hour positioning. The importance of correct positioning whilst seated is also a key area of 24-hour positioning that has had a lot of focus. However, we often see very little thought given to the role that standing plays in these 24 hours, especially for those with mobility challenges.

For those who spend the day sitting or lying, there is much concern about the health of the skin tissues as a result of staying in the same position for a long time. There have been reports over the years of people being moved from a bed with a good skin care mattress into a side chair without any tissue management properties. These reports show where the more concentrated forces of gravity’s pull on the body’s mass through bony prominences of the skeleton are potentially more dangerous.

Apart from tissue integrity issues, the effects of a long term position in bed or in a seat are important. If the body’s skeleton is misaligned in either circumstance, and the individual cannot change position easily, then there is the risk of the prolonged effects of gravity leading to permanent deformities, contractures, and other elements detrimental to the health of the individual.

The third aspect of 24-hour positioning is the importance of standing. Standing is important for optimizing many physiological functions managed within the torso, such as breathing, blood circulation, bladder and bowel functions. In addition, there are many anatomical benefits derived from standing, such as reduced contractures and spasticity, better range of motion, normal bone growth and joint development (particularly in children), and pressure relief for most of the body.

The further benefits come from the psycho-social side, where communication, ability to speak, etc. are so much easier in the standing position, and the ability to interact eye-to-eye, means improved self-confidence and self-esteem. An additional benefit is that those who have the opportunity to stand during the day sleep better at night.

This is why it is important for those who are mobility-impaired to spend an hour a day in the standing position. For the majority of people an upright stander to support the individual will cover this need – for more complex challenges where being fully vertical is not appropriate, then prone (face down) or supine (face up) standers are more appropriate.

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