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Positioning a neurological patient with tonal problems in bed

Pre‐procedural considerations

Equipment

Splints and orthoses

An orthosis or splint is an external device designed to apply, distribute or remove forces to or from the body in a controlled manner in order to control body motion and prevent alteration in the shape of body tissues. The aim is to compensate for weak or absent muscle function or to resist unopposed activity of a high tone muscle (Charlton [20]).
They may be used to:
  • enable a high‐tone muscle to be stretched to improve or maintain joint range of movement, with the aim of enabling participation in personal care, positioning, transferring and feeding, and reducing the risk of pressure ulcer development
  • help the patient to gain better joint alignment for proximal and truncal activity
  • enable more balanced and efficient walking
  • maintain and assist function (ACPIN and College of Occupational Therapy [2], Ada et al. [3], Shumway‐Cook and Woollacott [116]).
As with all therapeutic interventions, splints and orthoses (see examples in Table 7.6) should only be used after detailed assessment and based on sound clinical reasoning. If a splint or an orthosis is required, then this will normally be provided and fitted by a physiotherapist, occupational therapist or orthotist. They will also give instructions on how to use it.
Table 7.6  Examples of commonly used resting splints
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A resting ankle splint – used to maintain ankle range of movement in patients who are resting in bed for prolonged periods.
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Resting splints to maintain wrist and finger position.
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Palm protector – used where spasticity pulls the hand into a fist, risking the integrity of the skin of the palm, but where contractures in finger flexors mean fingers cannot be stretched out.

Positioning aids

When patients do not have normal postural control, we often need to use equipment to help support or prevent certain postures. This can consist of simple things such as pillows and towels, or specialist postural management equipment such as wedges and T‐rolls (Preston and Edmans [102]) (Figure 7.23).
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Figure 7.23  T‐roll.
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