Bed Positioning and Contractures

[Richie]

Hi Guys,

Was just wondering if anyone could help on what the best position would be for a traumatic brain injury/stroke etc patient in bed to prevent contractures?

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[umerphysio]

Hi Guys,

Was just wondering if anyone could help on what the best position would be for a traumatic brain injury/stroke etc patient in bed to prevent contractures?

hi,
first of all you should understand that with proper positioning you can prevent only bed sores not contractures Give him/her Passive ROM exercises minimum twice a day to prevent contractures.
must change patient's position after every two hours to prevent bed sores. when you put him/her laterally place a pillow between his knees(both legs).in the supine position place pillows under his arms to prevent edema and swelling.
best regards
umer physio

[dhirenshivji88]

depends from patient to patient a lot of information in Nerological physiotherapy by S. Edwards talks about positioning and Hemiplegia and spasticity and how to relieve/ break up flexor/extensor patterns!!

Really reccomended good read!!

[deanab123]

Please click one of the Quick Reply icons in the posts above to activate Quick Reply.
Additional Comment I forgot:
hi having worked for many years in postural management i would recommend an assessment by the Helping Hands company of a symmetrikit sleep system to minimize contracture development, these systems are modular, easy to apply and carer friendly, they will hold your patients in a midline position & control the trunk & head positions thus allowing better control of the limb girdles & hence positioning the limbs, the tone will reduce as the client relaxes. they have a good web site

[rajagiri1]

hi, sorry no idea thank u very much

[Pamela]

well To determine how elevations of the head of the bed of 20[degrees] and 45[degrees] affect cerebrovascular dynamics in adult patients with mild or moderate vasospasm after aneurysmal subarachnoid hemorrhage and to describe the response of mild or moderate vasospasm to head-of-bed elevations of 20[degrees] and 45[degrees] with respect to variables such as grade of subarachnoid hemorrhage and degree of vasospasm.
* METHODS A within-patient repeated-measures design was used. The head of the bed was positioned in the sequence of 0[degrees]-20[degrees]-45[degrees]-0[degrees] in 20 patients with mild or moderate vasospasm between days 3 and 14 after aneurysmal subarachnoid hemorrhage. Continuous transcranial Doppler recordings were obtained for 2 to 5 minutes after allowing approximately 2 minutes for stabilization in each position.
* RESULTS No patterns or trends indicated that having the head of the bed elevated increases vasospasm. As a group, there were no significant differences within patients at the different positions of the head of the bed. Utilizing repeated-measures analysis of variance, P values ranged from .34 to .97, well beyond. 05. No neurological deterioration occurred.
* CONCLUSIONS In general, elevation of the head of the bed did not cause harmful changes in cerebral blood flow related to vasospasm.

[gcoe]

Hi Ritchie

Here is the results of a PEDro search on contractures:

PEDro - Selected Search Results

You may find some good research-based methods here for preventing contractures in your unit.

Some points I have got out of looking at the literature and from my own practice:

There is some evidence out their that positioning does help prevent contractures. However the stimulus has to be quite high and sustainted - effective positioning often therefore means splinting.

Passive movements are probably not enough to prevent contractures

It seems to be all about preventing and not treating. Once contractures have formed it is really hard to change. Musculo-tendinous units may not be very mutable to lengthening once shortening has occurred and the evidence that stretching can help appears rather floored (Harvey, Batty, Crosbie, Poulter, & Herbert, 2000). So yes this is a really important issue you are asking about.

Ref: Harvey, L. A., Batty, J., Crosbie, J., Poulter, S., & Herbert, R. D. (2000). A randomized trial assessing the effects of 4 weeks of daily stretching on ankle mobility in patients with spinal cord injuries. Arch Phys Med Rehabil, 81(10), 1340-1347.

Hope this is of help

[neelpandey]

Really a very useful post and discussions.