We can all relate to the need to have a stretch after a long car journey. For an individual who uses supportive seating it is important that they have regular opportunities to take a break, relax and experience a change of position. If we find it difficult to change position independently, and the people around us don’t realise when we need to, it can have a detrimental impact on our health and emotional wellbeing. For individuals who used to use standing devices, it is also important that they have an alternative position such as supported lying to be able to vary their position throughout the day.
Using positioning equipment and strategies is called postural care – the care of a person’s posture or body shape. If we don’t position people well and support them in their position, gravity can cause changes to their body shape over time which can have serious consequences and may be life limiting.
This guidance shows you how to enable a person who uses supportive seating to have a break from their chair and be supported in way that best protects their posture. Remember this is an on-going learning process for everyone involved, we might not get it right first time but if we keep in mind that our goals are providing comfort whilst protecting posture, we will be making a great start.
What you need
- The person’s moving and handling equipment to support a safe transfer from the chair to the lying surface, be that the bed or the floor
- A soft mat, if working on the floor
- A range of pillows – horseshoe pillows are ideal, other shaped pillows, towels, cushions, teddy bears can also be used
- Optional but recommended – A slide glove (which can be used to enable you to place your hands beneath the person to check contact with minimal force or pressure) – Seesimplestuffworks.co.uk for more information
- Something with a little weight, like a wheat germ bag or small sand bags
- Somewhere to write down or type your findings
- Safety checklist https://www.simplestuffworks.com/wp-content/uploads/2017/04/Safety-Statement-and-Safety-Checklists.pdf
Guidance and instructions
- Facilitate a safe transfer from the person’s chair to the lying surface.
- Ideally, support the person to lie comfortably on their back, this allows them to open up their chest and stretch their shoulders.
- Observe how the person lies without support (for a minimal amount of time as this may not be a comfortable position for them and will not safely protect their posture). Identify any gaps between the person and the supporting surface – we are going to fill these gaps with support so that the person has a sense of safety, containment and security.
- Use a horseshoe pillow, or similar to support the person’s head, making sure that their head is not brought too high or into a position in which they find it difficult to breathe or swallow.
- Now identify whether their legs fall to one side, out to both sides or turn in. Use another horseshoe pillow beneath their legs to enable them to be fully supported. If there is still a gap between the person’s legs and the support, you may need to place a standard pillow underneath the horseshoe to raise it.
- Using the slide glove, gently place your hand under the person’s lower back to ensure that there is good contact between them and the supporting surface – if not see what happens when you raise their legs a little, are you able to get better contact with the legs higher? Sometimes people look as though they are in a sitting position lying down, this is usually because of the position of their pelvis so we need to raise their legs enough to allow their lower back to make contact with the surface. Important – Don’t use anything to force any part of the person down, at any time – always work on the principle that you are going to bring the support to the person, respecting their body shape and any limitations on their range of movement.
- Now check the person’s feet. Make sure that they have support beneath their feet as this will give them a better sense of where their feet are as well as preventing gravity from flattening the feet to the supporting surface.
- Check the person’s heels. Use blankets or towels under their lower legs to raise them and prevent any pressure on the person’s heels if necessary.
- Take a step back and observe whether there are any gaps between the person and the surface they are on and the supports you have put in place (apart from the heels where you may have intentionally left a gap!).
- Now we are going to think about support at the person’s sides. Use pillows, bolster cushions or rolled up towels to provide support at either side of their trunk. You may not think the person needs it, but to provide the best support, this is important.
- The person may wish to experience a sense of weight on them to help them feel truly grounded and secure. This might be in the form of a weighted blanket or through the use of a small weight such as a wheat germ bag placed across their pelvis.
- Finally, take another step back and don’t be afraid to ‘tweak’ the support. Ensure that the supports are as close to the person as possible as this will enable them to feel contained and safe.
- Now take a few moments to observe how the person responds to this supported position. Do they appear relaxed? Can you see any changes in their muscle tone (how tight their muscles are)? Do they appear fearful or anxious? Are they still awake?
- Things are going well if the person is more relaxed. At this point you may wish to enjoy some music together, a story or a chat about the goings on around them. If the person is not happy, for any known or unknown reason, discontinue and support the person safely back into their chair and reflect on what might have caused them not to enjoy the experience. Does their body shape make it uncomfortable to lie in this position, even with support? Were they repositioned too quickly? Is it the wrong time of day? For example, first thing in the morning when ready to get on and enjoy the day may not be the right time for a lie down!
- Once the support pillows have been successfully placed in the desired position, it can be useful to take a photo as a reminder as to what worked and where each item was placed. This will make for a smoother set up next time.
- Everybody is different, the frequency and duration of supported lying will vary greatly depending on the individual. It is important to note that if the person sleeps while they are in supported lying, this may cause a disturbance in sleep pattern.
What to observe, assess and record
- How does the person lie with no support?
- How is their muscle tone when they have no support?
- How do they respond when the support is in place?
- Are there ways in which they are able to indicate whether the support is comfortable?
- How is their mood during the supported lying experience?
- Are there particular things they enjoy around them during this time, particular music or sensory experiences for example?
- Are there opportunities to combine other activities with supported lying, a hand massage, sensory story
- Does supported lying appear to have a positive or negative effect on the person’s emotional state?
- What impact does supported lying have on their emotional state, during and after the experience?
© Sarah Clayton, CEO Simple Stuff Works
For general postural care resources including translated introductions to postural care see:
Email: [email protected]
Created October 2020