The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) is calling for public comments on a new position paper: RESNA Position on Assistive Technology for Lying Posture Care Management.
In a Jan. 6 announcement, RESNA noted that the public comment period “is the final stage for a RESNA position paper. This paper has been previously presented at the International Seating Symposium and reviewed by SIG [Special Interest Group] members and other experts. Following the public comment period, the authors will review all comments and decide on any changes. After that, the paper will be submitted to the RESNA Board of Directors for approval.”
The position paper’s authors are group leader Patricia J. Toole, MAT, MsOT, OTR/L, ATP, Clear Path Occupational Therapy, Seattle, Washington; Tamara Kittelson, MS, OTR/L, ATP/SMS, executive director, Posture 24/7, and executive director of the Clinician Task Force, St. Paul, Minnesota; Lee Ann Hoffman, OTD, MSc., OTR, ATP/SMS, CAPS, University of Saint Augustine for Health Sciences, Dallas, Texas; Jennifer Hutson, Ph.D., OTR/L, ATP, St. Catherine University, St. Paul, Minnesota; and Kourtni Bopes, OTD, OTR/L, Central Wisconsin Center, Madison, Wisconsin.
Why 24-hour posture care management is crucial
The paper’s authors advocate for postural support “in the lying orientation” as being “a key element” in the overall goal of 24-hour posture care management (PCM).
The paper focuses on the appropriate use of lying posture care management (LPCM), “a subset of 24-hour PCM that addresses the time when an individual is in a lying orientation. LPCM involves providing whole-body support while the person is lying supine, which may include head elevation. The supine position optimizes musculoskeletal alignment not possible with other horizontal orientations while additionally maximizes pressure distribution.”
Because people with mobility-related disabilities can have difficulty lying in symmetrical positions, LPCM can include “skillful placement of therapeutic supports.” The ultimate goal of LPCM, as part of overall PCM, “is to protect healthy posture and maximize the user’s everyday function when customarily the individual may have spent hours in asymmetrical, unsupported lying postures.”
Assistive technology use in LPCM
The paper discusses the use of assistive technology in LPCM, starting with common household items such as rolled-up towels to increasingly complex materials and devices, such as “modular or custom purposefully manufactured systems designed for whole-body support.”
Interestingly, the paper also discusses types of equipment — including enclosed beds and adjustable hospital beds — that do not meet the definition of assistive technology for LPCM.
The paper lists contraindications and pointed out that clients using LPCM need to be monitored for conditions such as postural asymmetries and entrapment, as well as for thermal dysregulation because people with neurological impairments can have difficulty regulating their body temperatures.
Three case studies highlight how LPCM can improve client function — not just physically, but also emotionally and socially by decreasing chronic, debilitating pain throughout the day. While complex seating and wheeled mobility is custom configured and sometimes must be custom built, LPCM goals can often be achieved by using “specially applied everyday materials,” from firm pillows and stuffed animals to spacer mesh crib liners and custom-carved foam positioners for legs.
The position paper includes a literature review and discusses how assistive technology used for LPCM has impacted clients’ sleep quality and how much sleep they get.
Read the position paper and send in comments by Wed., Feb. 5.