Departement of Physical Medicine and Rehabilitation Faculty of Medicine

Universitas Padjadjaran Hasan Sadikin General Hospital

THE AIM

PREVENTION AND TREATMENT OF CONTRACTURES AND DECUBITI

TO ACHIEVE THE AIM

PROPER EQUIPMENT, A WELL TRAINED AND WELL MOTIVATED NURSING STAFF, AND APPROPRIATE PHYSICIAN’S ORDERS ARE NEEDED

THE POSITIONING PRESCRIPTION SHOULD

IDENTIFY THE EQUIPMENT SPECIFICALLY NEEDED

POSITION TO BE USED

MOTION AND POSITION TO BE AVOIDED

FREQUENCY OF TURNING

PATIENT SHOULD ASSUME INCREASING RESPONSIBILITY FOR THE POSITIONING PROGRAM

THE STAFF ASSUME FULL RESPONSIBILITY IN ASSISTS CHANGING POSITION WHEN PATIENT NEED TO BE TURNED , KNOW WHERE THE EQUIPMENT IS KEPT

THE EQUIPMENTS FOR EFFECTIVE BED POSITIONING

HIGH-LOW BED,ADJUSTABLE TO HIGH 30 INCHES AND LOW 20 INCHES POSITION IS RECOMMENDED

BED BOARDS

- FIRM MATTRESSES

FOOTBOARD,PROVIDES SENSORY INPUT TO THE PLANTAR SURFACE OF THE FEET SO THAT EXTENSOR REFLEX DOMINANCE IS MAINTAINED. THE BOARD IS BLOCKED 4 INCHES AWAY FROM THE END OF THE MATTRESS

STANDING BED

SHORT SIDE RAILS, ARE USED FOR SAFETY MOVING TO SITTING POSITION AND TRANSFERRING IN AND OUT OF BED

HAND ROLLS AND TROCHANTER ROLLS

PILLOWS

THE POSITIONING PROGRAM

BASED ON INDIVIDUAL PATIENT NEEDS

GENERALIZATION CAN BE MADE ABOUT MOST DISABILITIES THAT ARE ASSOCIATED WITH MUSCLE WEAKNESS AND JOINT DEFORMITY

IT HAS BEEN FOUND DESIRABLE TO ESTABLISH A SET OF POSITIONING PROCEDURES FOR HEMIPLEGIA, QUADRIPLEGIA AND PARAPLEGIA

THE POSITION ARE PRESCRIBE TO

OVERCOME CERTAIN NATURAL AND PATHOLOGICAL FORCES

PROVIDE A VARIETY OF JOINTS POSITION FOR MAINTAINING JOINT RANGE

PLACE THE EXTRIMITY IN A MORE FUNCTIONAL POSITION

SUPINE POSITION

LOWER EXTRIMITIESTHE ENTIRE PLANTAR SURFACE FIRMLY AGAINST THE

FOOTBOARDCONTACT WITH THE POSTERIOR HEEL IS AVOIDEDTHE LEG ARE PLACED IN NETRAL POSITION WITH THE TOES

POINTED TOWARD THE CEILINGTHE POSITION IS MAINTAINED BY USING THE FOOTBOARD

AND TROCHANTER ROLLTHE KNEE AND HIP ARE POSITIONED IN EXTENSION TO

PREVENT HIP AND KNEE FLEXION CONTRACTURES

- UPPER EXTRIMITIES

SHOULD BE CAUTIONED TO POSITION ONLY WITHIN THE PAINLESS OR NON RESISTIVE RANGE OF MOTION

POSITION 1SHOULDER IS ABDUCTED TO 90 DEGREES AND

SLIGHTLY INTERNALLY ROTATEDTHE ELBOW IS AT 90 DEGREESTHE FOREARM IS PARTIALLY PRONATED

- POSITION 2SHOULDER IS ABDUCTED TO 90 DEGREES AND

EXTERNALLY ROTATED TO THE DEGREE COMPATIBLE WITH COMFORT

THE ELBOW IS FLEXED 90 DEGREESTHE FOREARM IS PRONATED

- POSTION 3THE SHOULDER IS IN SLIGHT ABDUCTIONTHE ELBOW IS EXTENDEDTHE FOREARM SUPINATED

- WRIST AND HAND

POSITION 1THE WRIST IS EXTENDEDTHE FINGER ARE PARTIALLY FLEXED AT THE

INTERPHALANGEAL AND METACARPOPHALANGEAL JOINTS

THE THUMB IS ABDUCTED, OPPOSED, AND SLIGHTLY FLEXED AT THE INTERPHALANGEAL JOINT

USE A HAND ROLL

- POSITION 2

SIMILAR TO THE POSITION 1 EXCEPT THAT THE FINGERS ARE EXTENDED AT THE INTERPHALANGEAL AND METACARPOPHALANGEAL JOINTS

USE A PALMAR POSITIONING SPLINT

SIDE-LYING POSITION

THE TOP LEG IS PLACED IN A POSITION OF FLEXION AT THE HIP AND KNEE

CONTACT WITH THE UNDER LEG IS AVOIDED

THE INNER (BOTTOM) ARM IS EXTERNALLY ROTATED AND PARTIALLY EXTENDED

THE OUTER (TOP) ARM IS KEPT AWAY FROM THE PATIENT’S CHEST

- THE PRONE POSITION

THIS POSITION IS ORDERED WHEN PULMONARY, CARDIAC, AND SKELETAL STATUS PERMIT

MANY PATIENT DO NOT TOLERATE IT WELL FIRST HIPS AND KNEES EXTENDED, TOES SHOULD NOT BE

ALLOWEDTO TOUCH THE FOOTBOARD THE FEET CAN BE ELEVATED SLIGHTLY USING A

TROCHANTER ROLL UNDER THE ANTERIOR ANKLE THE ARM IS ABDUCTED SLIGHTLY , EXTENDED AT THE

ELBOW, AND EXTENDED AND SUPPINATED AT THE WRIST FINGER AND HAND USES HAND ROLL

FREQUENCY OF TURNING

TURNING THE PATIENT EVERY TWO HOURS USUALLY A SAFE ROUTINE TO FOLLOW UNTIL THE PATIENT’S SKIN SENSITIVITY AND TOLERANCE OF THE POSITION HAVE BEEN DETERMINED

IT IS BEST TO ORDER THE MORE PROLONGED POSITIONING PERIODS FOR THE NIGHT HOURS

THE PHYSICIAN SHOULD FREQUENTLY CHECK THE SKIN IN VULNERABLE AREAS TO MAKE CERTAIN THAT NO DECUBITI ARE DEVELOPING AND TO EMPHASIZE TO THE ATTENDING STAFF THE IMPORTANCE OF THE PROPER TURNING SCHEDULE

THANK YOU