Peds Positioning/Handling Ch. 13
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| Positioning | static process that improves a child’s ability to maintain postural control while participating in acts. EX: holding or placing a child in a particular posture or to involve the use of specialized adaptive furn. or equipment.
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| Handling | tech’s are dynamic/guide a child’s movement by influencing the state of muscle tone or triggering new automatic movement responses that result in fxl actions. Used for children whose movement disorder stems from damage to CNS (CP).
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| Benefits of positioning/handling | These methods create opportunities for children to interact more effectively with the environment.
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| Benefits of positioning/handling | Increasing a childs physical comfort/reducing fatigue. This eliminates the risk of pressure sores developing.
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| Benefits of positioning/handling | Promoting skeletal alignment. Proper alignment of bones/joints minimizes or prevents muscle/connective tissues contractures & bone/joint deformities, thus promoting better movement.
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| Benefits of positioning/handling | Providing the child with a range of sensory experiences that enhance learning. The environment can be experiences differently from different positions.
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| Benefits of positioning/handling | Assisting child while learning movement. Handling tech’s can facilitate development of righting/equilibrium reactions. Can also reduce strength of primitive reflexes that prevent child from developing ability 2 coordinate both sides of body.
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| Positioning as a Therapeutic Tool | Positioning tech’s begin as early as possible for children with neuromotor dysfunction (one of best ways to help children use any movement abilities they already have.)
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| Positioning as a Therapeutic Tool | Affect all act’s. (sleeping, going to bathroom, traveling, eating, attending school/playing)
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| Positioning as a Therapeutic Tool | OT practitioner tries to choose those positions that more closely resemble the typical ones in which act’s. are performed.
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| Positioning as a Therapeutic Tool | As a ther. modality, positioning can promote normal development; compensate for lack of fxl. abilities; and prevent, minimize, or delay the onset of contractures/deformities that may result from loss of movement, surgeries, compromised health.
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| General Principles of Positioning | Provide support: Use positioning to only support those parts of body that can’t achieve or maintain postural stability. Too much support will stop child from using movements they already posess.
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| General Principles of Positioning | Position for symmetry/skeletal alignment: Keep head neck, trunk, pelvis aligned. It also maintains joint integrity, preventing joints from subluxation.
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| General Principles of Positioning | Offer variety: The variety of positions stimulates perception as the child makes sense of position in space and views things from different angles.
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| General Principles of Positioning | Select developmentally appropriate positions. Ex:feeding a small infant in a reclined position vs. using upright positions for eating for older children for development of mature swallowing, sucking, chewing movements/for socializing during mealtimes.
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| General Principles of Positioning | Consider safety/comfort
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| General Principles of Positioning | Determine whether handling interventions are needed to achieve proper positioning.
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| Positioning Methods | Choice of positioning method is also determined by targeted activity.
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| Positioning Methods | - Reach/manipulation skills demand isolation of small movements; therefore, good proximal support optimizes the child’s ability to concentrate on those movements.
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| Positioning Methods | Spatial relationship influencing the interaction among the child.
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| Positioning Methods | A child who isn’t able to move in/out of positions shouldn’t stay in any one position form more than 20-30mins.
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| Positioning Methods: Supine | - Helps infants develop flexor tone/abdominal control as they bring their hands/feet together.
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| Positioning Methods: Supine | Important element: the head needs to be midline/flexed slightly forward.
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| Positioning Methods: Supine | - Children who exhibit strong extensor muscle tone must also have their hips/knees held in flexed position.
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| Positioning Methods: Supine | The strong presence of ATNR must be counteracted with symmetrical body positioning.
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| Positioning Methods: Supine (Advantages) | Allows child to see environment
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| Positioning Methods: Supine (Advantages) | Easiest position for visual fixation/tracking when head is positioned/supported
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| Positioning Methods: Supine (Advantages) | Allows children to actively work to strengthen neck and abdominal flexor muscles.
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| Positioning Methods: Supine (Advantages) | Provides position of rest/comfort.
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| Positioning Methods: Supine (Disadvantages) | Most difficult position from which to raise the arms against gravity
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| Positioning Methods: Supine (Disadvantages) | May increase extensor tone
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| Positioning Methods: Supine (Disadvantages) | Places minimum demands on child to develop head control
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| Positioning Methods: Supine (Disadvantages) | Encourages shallow abdominal breathing
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| Positioning Methods: Supine (Disadvantages) | Often elicits ATNR
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