1. How do we assess postural needs?

2. The checklist below is used to determine if a person needs postural management. Is the person limited to a restricted number of positions? Does the head seem to turn mainly to one side? Does the body seem to fall sideways? Does the body seem to fall backwards or forwards? Do the knees seem to fall mainly to one side? Do the knees seem to fall inwards or outwards? Is the body shape already asymmetric? If there are ticks in any of the yes boxes, the person needs postural management

3. How does the person become comfortable? What support (if any) is required to ensure the person is comfortable? Are they happy lying on their back? How long can they stay in one position before they appear to become uncomfortable? Can they wriggle? Are they comfortable when sitting? Are they comfortable when standing? Do they have any pressure areas? How do they communicate discomfort? To determine this, the ‘Safety checklist’ and ‘Consent and pain checklist’ should be completed in advance by someone who knows the person well.

4. Safety Checklist QuestionsYesNo Is the person happy? (being unhappy may affect their ability to sleep) Do they have epilepsy? (note type, duration, triggers) Can they breathe safely lying on their back? Sitting? Etc. (consider reflux, aspiration etc.) Are continence issues resolved? Do they have trouble regulating their body temperature? Do they suffer from pressure areas? (consider potential new pressure areas from change in sleeping position) Do they have problems with circulation? (consider the effect of gravity on limbs) Do they normally sleep on their front (prone)? Are there any other issues which need to be considered when changing to a new position? Comments

5. Consent and Pain Checklist Cry or make similar sounds? Withdrawn or depressed? Difficult to comfort? Self harms e.g. biting, banging? Have disturbed sleep? Screw up face? Frown or look worried? Appear frightened? Grind teeth or mouthing movements? Agitated or distressed? Tense, stiffen or spasm? Draw legs towards chest? Touch or rub particular areas? Resist being moved? Flinch or pull away when touched? Toss head, writhe or twist? Have involuntary movements or seizures? Never (0)A Little (1)Quite a Lot (2)Very Often (3) Grand Total……../51

6. How does the person move? Is the person normally passive or active? Do they remain in one position? Are they able to move for themselves? Can they roll, sit up or stand?  With or without assistance? Can they transfer independently?  With or without assistance? Can they walk independently?  With or without assistance? Do they use mobility aids?

7. Changes to sleeping position must be made gradually, gently and carefully The potential risks must be analysed by completing the safety checklist Take a long term view Allow the person time to adjust to the change This may mean using the postural management system for short periods at first during routine rest periods in the daytime. (Adapted from Postural Care Skills (2009) Safety Checklist)

8. Assessments It is important to obtain accurate measurements before all interventions or treatment This is to allow any improvements to be identified, quantified and recorded It also provides a good history of the person’s posture and subsequent changes In order to do this, three measurements may need to be taken. For this a tape measure is used

9. Measurement 1 Measure from the centre of the sternum to the surface of the bed (left and right) Sternum Left _______ cm Right _______ cm

10. Measurement 2 Measure from the hip bone to the surface of the bed (left and right) Left_____cm Right _____cm Hip bone

11. Measurement 3 Measure from the hip bone to the bellybutton (left and right) Left _____cm Right _____cm

12. Practical Task!!