Written by Kieran Murphy, Clinical Partnerships Manager. 
In our previous articles we have explained the ‘Importance of 24 hour Postural Management’ in children with more complex needs, and it’s significance for maintaining function, minimising damage and reducing energy expenditure.
At Jenx our innovative postural support products are developed with care and expertise to help children with individual postural needs to live happy and fulfilling lives.
Why do Sleeping and Lying postures matter?
These children often have difficulties adjusting and maintaining their own position against gravity, and this is a significant amount of time for their posture to be left unsupported. Gravity is constant and does not ‘switch off’ whilst we are lying.
Without the appropriate postural care, these children will regularly adopt preferred lying positions, influenced by gravity, tone and muscular imbalance (Sato, 2020).
These positions are often called ‘destructive postures’ (see images below) and if left unsupported can often lead to postural changes such as muscle contractures, joint subluxations and spinal curvatures (Bayliss, 2020). This in turn can have a significant effect on an individual’s independence and function, quality of life, skin integrity, comfort and life expectancy (Casey, Rosenblad & Rodby-Bousquet, 2020).
Look at the pictures above. Imagine these children, who have movement disorders, trying to move into a sitting position after a long period resting in the above lying positions – how difficult do you think this will be?
Think about how your body feels after holding the same position for a long time and how you move from lying to sitting yourself. Whilst you are sitting reading this, try to re-create the positions both children have adopted. Try and hold these positions whilst you are seated for just 1 minute.
Think about your comfort, your ability to breathe, your ability to concentrate, your ability to reach for your cup and drink from it.
Destructive lying postures can soon become these children’s destructive sitting and standing postures. Think about how drastically the child’s life is impacted through the entire day – let alone for the one difficult minute you may have just recreated.
What do we hope to achieve when providing postural care for sleeping and lying postures?
Firstly, we need to recognise they are many different occupational goals for lying – resting/relaxing, sleeping, active and functional lying, as well as lying as part of socialisation, learning and participation.
Your child’s therapist will be able to guide you on the appropriate postural care programme and should tailor it to your child’s individual, unique needs. There are a wide variety of supports and adaptive devices that can support help a child achieve specific goals. Your child may benefit from;
- A sleep system to support their posture for a restful sleep overnight,
- A prone wedge for functional and active lying in the day,
- A high low bed and accessories for education, participation or hygiene needs,
- Cushions and rolls for restful or functional lying through day.
Maintaining consistency in how we support resting lying postures through the day with the support lying postures overnight is often key for familiarity, routine, engagement and comfort.
Specifically consider night–time positioning, whilst supporting a posture to be symmetrical and can be hugely important, it should not be to the detriment of a restful night’s sleep for both the child and their carers. The delicate balance of maintaining or improving sleep quality requires a multi-faceted approach. The ultimate goals for any nighttime lying programme should consider maintaining/improving not only posture, but also sleep quality, function, comfort, tone management and pressure relief (Humphries, King & Jex, 2019).
Jenx Ltd strive to produce products that will help achieve these goals and that have rigorous clinical backing. For example, one clinical study has suggested our Dreama sleep system may have positive effects on hip stability and range of movement, and pain reduction (Hankinson and Morton, 2002). A small pilot acceptability and feasibility study has also recently suggested the Dreama may help support a novel side lying or three–quarters to prone lying position to act as a preventative intervention for children with significant movement and swallowing difficulties and recurrent respiratory problems.
We advise gradually introducing the supportive components for the Dreama to help build tolerance, minimise changes to routine and reduce sleep disruption. It is also useful to remember that the Dreama can be used for supporting lying postures throughout the day as well as the night.
Whether the goal is improving head control in lying during the day or achieving a restful night’s sleep, early intervention in sleeping and lying postures is extremely important. Destructive lying postures are adopted early in the development of children with movement difficulties and can quickly become associated with a child’s comfort or ability to sleep (Bayliss, 2020). These postures can then become very fixed during times of growth if left unsupported.
Children are long developing their skills in lying and floor mobility before they can sit and stand, and the ability to lie with good posture is inseparably linked to the ability to sit and stand with good posture. A consensus statement regarding children with Cerebral Palsy recommends postural care in lying should begin as soon as is appropriate after birth for those with the most severe motor difficulties (Gericke, 2006).
We offer a range of products for support in lying, and more information can be found by clicking on the links below;
Dreama – a pressure reducing 24hr positioning system, suitable for children and adults.
Ly-On – Feeding, Education and Access System – The ideal platform to build a structured yet safe and comfortable posture for users up to 70kg who have complex postural or medical needs.
Ziggy – Ziggy is a therapy product that can be used for play, support, therapy, rest or even imaginative play. It’s incredible versatility and flexibility mean it can aid a wide variety of therapy uses.
Rolls, Mats & Wedges – A range of soft, colourful and comfortable supports in various shapes and sizes, which can be used to create play opportunities and for specific therapy treatments.
References
Baylis, M. 24 Hour postural care and use of sleep systems in cerebral palsy. Paediatrics and Child Health. 2020, 30(8): 296-302.
Casey, J., Rosenblad, A. & Rodby-Bousquet, E. Postural asymmetries, pain, and ability to change position of children with cerebral palsy in sitting and supine: a cross sectional study. Disability and Rehabilitation. 2020; 3:1-9.
Chaput, J.P., Dutil, C. & Sampasa-Kanyinga, H. Sleeping hours: what is the ideal number and how does age impact this? Nat Sci Sleep. 2018; 10: 421-430.
Gericke, T. Postural Management for children with cerebral palsy: consensus statement, Dev Med Child Neurol. 2006; 48(4): 244.
Hankinson J and Morton R.E. Use of a lying hip abduction system in children with bilateral cerebral palsy: a pilot study. Developmental Medicine & Child Neurology. 2002; 44: 177-180.
Hill. S. & Goldsmith J. Biomechanics and prevention of body shape distortion. Learn Disabil Rev. 2010; 15: 15–32.
Humphries, G., King, T. & Jex, J. Clinical Practice Considerations for postural support in lying for children and adults with neurodisability. 2019.
Sato, H. Postural deformity in children with cerebral palsy: Why it occurs and how is it managed. Phys Ther Res. 2020; 23(1): 8-14.
About the author – Kieran Murphy
Kieran qualified as a Physiotherpist in 2016 at the University of Salford and later attained an MSc at the same university in Advanced Physiotherapy. He completed his core rotations before becoming a senior paediatric physiotherapist for the NHS in Great Manchester, UK.
Kieran’ s experience as a physiotherapist has seen him provide a wide range of holistic therapy to children with developmental delay, complex neurological and physical disabilities and musculoskeletal injuries. He continues to work alongside his role as Clinical Partnerships Manager for Jenx with a small caseload of private patients and as a locum therapist.
Kieran has a keen interest in supporting adolescents with cerebral palsy and the management of hip dysplasia.
In his spare time Kieran is passionate about football and enjoys fishing.
