Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [91], C).
2. 2.Show
   Wash hands thoroughly with soap and water or use an alcohol‐based handrub.
   To reduce the risk of contamination and cross‐infection (NHS England and NHSI [83], C; WHO [132], C).
3. 3.Show
   Ensure the bed is at the optimum height for the handlers. If two handlers are required, try to match the handlers’ heights as far as possible.
   To minimize the risk of injury to the practitioners (CSP [24], C).

Procedure

1. 4.Show
   Follow the basic advice for positioning the patient in the supine position (Procedure guideline 7.1: Positioning a patient: supine), side‐lying (Procedure guideline 7.3: Positioning a patient: side‐lying) or sitting up in bed (Procedure guideline 7.2: Positioning a patient: sitting up in bed).
   To ensure patient comfort. E

   To allow pressure relief. E

   As a part of the patient's rehabilitation programme. E
2. 5.Show
   Positioning the patient in supine: consider and apply possible modifications for positioning in supine (Action figure 7.24):

   • Place a pillow under a hemiplegic arm to support and align the shoulder.
   • Place additional pillows, wedges or T‐rolls under the knees to support hemiparetic legs or maintain the position of high‐tone legs.
   • Apply resting splints to hands and feet if provided (see Table 7.6). It is important to ensure any splint is fitted correctly, to only apply it for the recommended time and to check the integrity of the skin when removing the splint.
   • If the patient does not have resting splints, consider placing a folded pillow or rolled towel to support the feet in the neutral (plantargrade) position.
   To promote alignment of body segments for patients with high or low tone resulting in asymmetrical posture (Preston and Edmans [102], R).

   To control pelvic and spinal alignment. E

   To optimize patient comfort. E

   To maintain joint and soft tissue range (Duff et al. [35], E).
3. 6.Show
   Positioning the patient in side‐lying: consider and apply possible modifications as specified below for side‐lying (Action figure 7.25):

   • Ensure that the top hip is either directly on top of the lower hip or slightly in front of it (this prevents the patient rolling back).
   • Place a pillow between the legs.
   • Place folded pillows behind the back.
   • Ensure that the lower arm is not under the trunk. It is important to take care when checking this, particularly when moving a low‐tone shoulder.
   • If the patient is lying on their unaffected side (i.e. the hemiplegic arm is uppermost), place their affected arm on pillow(s) and apply a resting splint for the hand or forearm if required.
   To support the patient's affected shoulder and upper limb due to a risk of trauma, pain, or muscle and soft tissue shortening (Ada et al. [3], R).

   To reduce the influence of asymmetrical posturing of the head and trunk in patients with high or low tone. E

   To maintain soft tissue and joint range (Duff et al. [35], E).
4. 7.Show
   Positioning the patient sitting in bed: consider and apply possible modifications as specified below for sitting in bed (Action figure 7.26):

   • If possible, raise the knee break of the bed to prevent the patient slipping down the bed. If this is not an option, consider placing pillows under the knees.
   • Place folded pillows, blocks or rolled towels under the affected elbow to support a low‐tone or subluxed shoulder, or apply a shoulder brace.
   • Place rolled towels or wedges between the arm and the body in high‐tone arms to maintain range.
   • Place wedges, rolled towels or pillows along the trunk if support is required to prevent the patient leaning or falling laterally.
   • Place rolled towels or wedges under the head pillow to help maintain the head position.
   To promote alignment of body segments for patients with high or low tone when sitting (Preston and Edmans [102], R).

   To maintain soft tissue and joint range and minimize pain (Duff et al. [35], E).

Post‐procedure

1. 8.Show
   Reassess and record neurological symptoms. In the event of any worsening pain or neurological symptoms, arrange for a reassessment by the medical team.
   To ensure clinical status is maintained (MASCIP [69], C).