Breaking the Cycle of Asymmetries Using 24-Hour Postural Management

For those of us who work with children with disabilities, we seem to intuitively know that if the child stays in one position too long, then the body will take the "shape" of that position, and if the position is not in good alignment, the child will begin to develop postural asymmetries. So, we try to create a program that offers alternative positioning throughout the day while supporting the child to prevent asymmetries.

The Cycle of Asymmetries

Our goal is to break this cycle of asymmetries by using 24-hour postural management.

24-hour postural management is a planned program that considers all relevant positions a child uses throughout the day and intervenes to improve or maintain a body shape while promoting the child's function and development. It should then be incorporated into the child's everyday life at home, at school, and during social activities. The three core postural orientations are lying, sitting, and standing. However, postural management strategies should be applied across all activities from bathing to floor play to upright movement.

Healthy individuals can move freely in and out of lying, sitting, and standing for functional activities. When an individual has complex rehab needs, they are often unable to assume these positions, and therefore their functional ability has been compromised. Many times, an individual with complex rehab needs may be in a standing position for one hour, seated for 15 minutes, and lying down for seven hours in a given day. Because we know the effects of sitting for long periods of time, great attention has been given to seating systems. We know that good supportive seating provides an individual with a stable posture in sitting, creating a good foundation for function and promoting active participation in daily living.

Orientations for Positions

Goal in all orientations is always a neutral body.

When the body is in an unsupported position, we know that gravity will negatively influence this position. These positions become habitual and eventually lead to obligatory positions and ultimately create non-reducible asymmetries. As the child ages, these harmful postures change the child's body shape. This often leads to the need for custom positioning equipment.

Let's also consider the amount of time someone with complex rehab needs may be in a standing position. Most times, it is inadequate, and therefore they spend the majority of their day in positions that result in loss of joint range of motion, shortened muscles, and muscle weakness. This ultimately causes changes to the spine and hips. It can also result in difficulties with respiration, digestion, and elimination, as well as reduced function and pain.

In 2020, Sunrise Medical welcomed the Leckey family to our family of seating and mobility complex rehab technology (CRT) products. Leckey products support the child's clinical needs to maintain posture, accessing the child's abilities to function on everyday tasks, and promoting comfort while using the equipment. This product line is specifically designed to achieve the clinical benefits of 24-hour postural management. These products can be your go-to line for the child with complex rehab needs and complements various products offered from the ZIPPIE line.

Leckey's full range of products can now offer a solution to those with all levels of ability from Mild to Moderate to Complex, and will take a child right through school to adulthood.

Leckey products provide positioning during all of the child's activities. These products are practical and fun while helping children with special needs participate in daily family life with optimal postural support.

A Day in the Life...

Morning (Getting ready)

• Get dressed
• Eat breakfast
• Leave for school

Daytime (School)

• Circle time
• Gym/playtime
• Lunch
• Leave for home

Afternoon (Family time)

• Free time
• Dinner

Evening (Getting ready for bed)

• Bath
• Get dressed
• Bed (sleep)

When we evaluate our children with special needs, it is important that we not only look at their positioning for the time they are with us. We need to consider all aspects of their daily life: family/home, school, and entertainment. When we provide options for their positioning, we are not only improving their positioning, but also their social and communication opportunities. 24-hour positioning equipment is critical for a child's quality of life.

For more information on 24-hour postural management:

• Mobility Management: 24-Hour Posture Management
• Posture 24/7

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