POSTURAL MANAGEMENT FOR

PEOPLE WITH MS

Wendy HendrieSpecialist physiotherapist in MS

Norwich MS Centre

Aims

•Why bother about posture?

•Assessment

•Case studies

Aims

•Why bother about posture?

•Assessment

•Case studies

Posture is not usually something we have to think about

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

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

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

Many systems contribute to posture

POSTURE

SENSORY

VESTIBULAR CEREBELLAR

VISUALMOTOR

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

‘Good’ Posture

Sitting Standing

Good posture?

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

‘Normal’ Posture!

Sitting

Standing

Keeping upright in standing or sitting involves a constant struggle against

the force of gravity

Posture changes with weakness

in standing…

…and in sitting

In people with MS…•Things go wrong when automatic andvoluntary postural control is lost

•Compensatory strategies maximise balance, stability and function

•Secondary complications inevitably arise

Secondary complications•Pain•Pressure•Contractures•Breathing difficulties•Speech and swallowing difficulties•Digestion problems•Inability to function effectively•Decreased quality of life

Why manage posture?

•Improve function

•Increase quality of life for pwMS and family/carers

•To minimise or avoid secondary complications

Aims

•Why bother about posture?

•Assessment

•Case studies

Assessment

•Subjective (rarely about posture!) •Pain•Pressure ulcer•Spasms•Speech or swallowing problems•Breathing difficulties•Handling or positioning problems•ADL problems

Assessment

•Objective•ROM•Active movement•Functional independence•Tissue damage•Infections – urinary/respiratory•Pain•Preferred posture

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.

Preferred posture

Pelvis position – the key stone

Posterior pelvic tilt

Pelvic rotation – right ASIS forward

Pelvic obliquity – higher on left

Measure between the coracoid process and the ASIS – less useful if double curvature present in spine

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

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

Goals

•Emphasis on function

•Aim for dynamic and/or static success

•Patient/family/carer led and agreed

Aims

•Why bother about posture?

•Assessment

•Case studies

Early intervention is vital

•Stretch hip flexors

•Work hip extensors

•Upright standing

Standing fully upright

Sitting postures

Easier to control posture in sitting

Foam blocks – 1” and 2”

Using head support to push back in the chair.

Postures for function

Normal eating posture

Using the toilet/commode

Ataxia

Hoisting

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

Preferred posture

‘Windswept’ posture in bed

Head support

Headmaster collar

Good posture = function

Standing and good posture is great!!

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

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

24/7 management•Meeting of experts

•Care Plans that describe the correct positions

•Use digital cameras

•Family /carer awareness and training

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

Thanks for listening