Postural management for people with MS
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This presentation by Wendy Hendrie, Specialist physiotherapist in MS at the Norwich MS Centre, looks at why posture is important and provides information about assessment as well as case studies. It was presented at the MS Trust Annual Conference in November 2014.
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Postural management for people with MS
- 1. POSTURAL MANAGEMENT FOR PEOPLE WITH MS Wendy Hendrie Specialist physiotherapist in MS Norwich MS Centre
- 2. Aims •Why bother about posture? •Assessment •Case studies
- 3. Aims •Why bother about posture? •Assessment •Case studies
- 4. Posture is not usually something we have to think about
- 6. Posture… •is the shape and position our body adopts and is constantly changing •provides balance and stability which is vital before we can function •is a learned skill
- 7. Posture is complex •Adapting to the surface your body is resting on •Organising body segments when sitting, lying and standing •Being able to adjust quickly e.g. to the disturbance of moving a limb •Being able to position the body for movement
- 8. Posture is complex •Changing position •Taking the weight off limbs in order to move them – e.g. walking •Allowing muscles to act by providing a fixed point to act against •Keeping stable in order to function - balance
- 9. Many systems contribute to posture SENSORY VESTIBULAR CEREBELLAR POSTURE MOTOR VISUAL
- 10. What is ‘good’ posture? •Stable base - supported and balanced •A position from which we function effectively •Uses as little energy as possible •Causes the least damage to the body
- 11. ‘Good’ Posture Sitting Standing
- 12. Good posture?
- 13. What is ‘bad’ posture? •Any position that causes damage to the body •Asymmetrical postures can often cause the most damage •Damage often occurs when bad postures are held for a long time
- 14. ‘Normal’ Posture! Sitting Standing
- 15. Keeping upright in standing or sitting involves a constant struggle against the force of gravity
- 16. Posture changes with weakness in standing…
- 17. …and in sitting
- 18. In people with MS… •Things go wrong when automatic and voluntary postural control is lost •Compensatory strategies maximise balance, stability and function •Secondary complications inevitably arise
- 20. Secondary complications •Pain •Pressure •Contractures •Breathing difficulties •Speech and swallowing difficulties •Digestion problems •Inability to function effectively •Decreased quality of life
- 21. Why manage posture? •Improve function •Increase quality of life for pwMS and family/carers •To minimise or avoid secondary complications
- 22. Aims •Why bother about posture? •Assessment •Case studies
- 23. Assessment •Subjective (rarely about posture!) •Pain •Pressure ulcer •Spasms •Speech or swallowing problems •Breathing difficulties •Handling or positioning problems •ADL problems
- 24. Assessment •Objective •ROM •Active movement •Functional independence •Tissue damage •Infections – urinary/respiratory •Pain •Preferred posture
- 25. The ‘preferred’ posture •The posture which the body customarily adopts when placed in any position. •On release of passive correction the posture reverts to the original attitude indicating the existence of tissue adaptation.
- 27. Pelvis position – the key stone Pelvic rotation – right ASIS forward Posterior pelvic tilt Pelvic obliquity – higher on left
- 28. Measure between the coracoid process and the ASIS – less useful if double curvature present in spine
- 29. Assessing sitting posture •Lay the person on a flat bed •Look at the preferred posture •If the body is able to lay completely straight, a symmetrical posture can be achieved in sitting
- 30. Fixed postures •The aim is to adapt the surface so that no further deformity can take place •Referral to wheelchair service •Consider Botox, antispasticity medication change
- 31. Goals •Emphasis on function •Aim for dynamic and/or static success •Patient/family/carer led and agreed
- 32. Aims •Why bother about posture? •Assessment •Case studies
- 33. Early intervention is vital •Stretch hip flexors •Work hip extensors •Upright standing
- 35. Sitting postures Easier to control posture in sitting
- 37. Foam blocks – 1” and 2”
- 42. Using head support to push back in the chair.
- 49. Ataxia
- 51. Hoisting
- 54. Posture in lying •Most damage done in this position •Keep body as straight and in-line as possible, hips in line with knees and shoulders and avoid twisting in the middle •Keep knees apart and supported •Support arms and move them away from the sides of the body if possible
- 61. ‘Windswept’ posture in bed
- 66. Head support
- 72. Good posture = function
- 73. Standing and good posture is great!!
- 74. Summary •Often a compromise between posture and function •Try to make people feel stable and balanced •Change position regularly if possible •Most damage done in lying position
- 75. Summary •Pelvis is the keystone – correct pelvis first •Dynamic and static success is good •‘Sell’ the concept of good posture and ensure that people know what to do
- 76. 24/7 management •Meeting of experts •Care Plans that describe the correct positions •Use digital cameras •Family /carer awareness and training
- 77. What’s the point? •Function and independence •Prevention of unnecessary secondary complications which increase disability •To improve quality of life for pwMS their family and carers