Talking About Posture Care & Disability

March 22, 2016 by Tamara Kittelson Aldred

student sitting in a Rifton Activity Chair in a classroomUsing 24-Hour Postural Care to Combat the Twin Foes of Gravity and Time

The word “posture” often conjures memories of being told to “sit up straight” as a kid – but that is not what we are talking about here. Postures that are used persistently as a habit will have a huge impact on the lives of people with motor disabilities – and not for the best! While most of us take for granted our choice of the postures we assume, this is not the case for people with impaired movement. When we have the intrinsic ability to control our bodies against gravity we can choose to move, assume and maintain all kinds of positions. We may choose whether to slouch as we relax or sit erect as we work, but what if we did not have that choice?

Limited ability to move is a game changer when gravity takes over. This is true not only for those who can move little or not at all, but also for individuals who move in limited ways because of muscle tone irregularities, sensory impairment, poor coordination, joint contractures and other factors. We can describe this as having a limited movement repertoire. When one cannot easily and frequently move into a variety of different postures during the day and night, gravity and time become the foe.

The Unbalanced Body

Basic laws of physics and our own experience teach us about equilibrium and stability. When muscles contract equally and simultaneously we are able to lie, sit and stand in balance. Combined with an adequate base of support, functional proprioceptive and balance mechanisms and body mass balanced relative to our center of gravity, we are able to lie, sit, and stand with stability and move with postural control.(1) Thus we are able to live our lives and do what we need to do. The process is amazing, but people who need positioning and mobility equipment struggle with these biomechanical forces. Too often they lose the battle with gravity, and the long term result is a complex, unbalanced body shape.

When body posture is unequal between sides we call it postural asymmetry. This is not a bad thing when counteracted by movements or postures in the opposite direction. It is even important for function – we all use one side of the body differently than the other for certain activities. The problem arises when a person spends many hours over weeks, months or years in the same or similar posture without ability or assistance to move into better symmetry.

Distortion and Limited Movement  

When that happens a person’s body shape will slowly and inexorably change from symmetry to skeletal distortion.(2) It can be so gradual that the progression toward scoliosis, dislocated hips and a flattened chest is not noticed and addressed until it is so obvious that it cannot be ignored.  By then the person’s health is already compromised and surgery is considered the only alternative. Over 32 years living and working as an occupational therapist in my community, I have seen what happens over time to children born with beautiful, symmetrical little bodies as they become adolescents and adults with distorted, painful bodies limiting their daily activities. For most this happened with ample opportunities for therapies, equipment and other interventions.

Getting Postural Care During Critical Hours  

Providing a variety of positioning and mobility options throughout the day will foster health and an active lifestyle for people with disabilities, but what about night-time? Studies have shown that children with cerebral palsy move less at night compared to their typically developing peers, with prolonged periods of immobilized posture while they sleep.(3) What is happening to their bodies as they sleep in crooked positions all night long? We are missing a crucial piece of the puzzle if we are not assessing lying posture, understanding what occurs and addressing it. The time spent sleeping and relaxing outside of typical positioning/mobility equipment far exceeds school and therapy hours, and can be harnessed for good during sleep when muscle tone relaxes. Twenty-four hour postural care is a gentle, non-invasive way to provide the foundation that every person needs in order to develop and/or rehabilitate to their own personal best functional level – a symmetrical, balanced body shape.

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1. Pope, P.M. “Severe and Complex Neurological Disability: Management of the Physical Condition”. 2007. Elsevier, Ltd. Pages 3-6.

2. Hill [Clayton] S., Goldsmith J. (2010) “Biomechanics and Prevention of Body Shape Distortion.” Tizard Learning Disability Review, Vol. 15, No. 2, pages 15-29.

3. Sato, H., Iwasaki, T., Yokoyama, M., Inoue, T. “Monitoring of body position and motion in children with severe cerebral palsy for 24 hours”. (2014) Disability and Rehabilitation; 36(14): Pages 1156–1160.

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Reply by Carrie Luse on March 24, 2016 at 12:56 AM
Great article! I am working with a client right now to try to get the Pro bed/ freedom bed (lateral rotation therapy bed) funded.
Reply by Tamara on March 28, 2016 at 9:28 AM
Hi Carrie, Lateral rotation therapy beds can be great from some perspectives but stable positioning could be a challenge. I'd be interested to know how you manage!
Reply by penelope anderson on March 24, 2016 at 4:30 PM
Hi Tamara I enjoyed your article...but I asked myself where is the rest of it? What to do to harness those sleeping hours? What does the" 24 hour postural care" consist of. I'd like to use her sleeping hours to help her maintain good body mechanics and posture. Thanks for any information.
Reply by Tamara on March 28, 2016 at 9:31 AM
Hi Penelope, My article shared some concepts about postural care, but it is beyond the scope of a blog post to explain everything in depth. By understanding what is happening to a person's body spending hours in asymmetrical postures, we can then plan how to counteract the negative forces with more constructive ones. At a basic level this means supporting the person in a comfortable, symmetrical lying posture - ideally lying on her back. There are many angles to consider and often problem solving is required. If distortion is already occurring it becomes more complex but can still be successful when changes are made very gradually. It is even possible to improve body shape problems in some cases, and very often sleep is made better and pain reduced. Commercial sleep systems are expensive and often hard to come by in the United States - no one manufactures them here so they must be imported. BUT - you can do lots with improvised supports using materials you have at home or by re-purposing items. We put supports beneath the fitted sheet, so they stay in place better. If you would like more specifics please feel free to email me through our website at
Reply by Mary Kay on March 26, 2016 at 5:37 PM
Very clear article starting from the known to the unknown for those of us not in the PT/OT fields. It educated me. Thank you.
Reply by Tawonia on May 13, 2016 at 5:15 AM
Very nice article Tamera, I'd like to also look further into the Pro bed/ freedom bed for my son who is currently 16 and getting ready to have a major surgery the end of this month on his spine. He has developed scolliosis in his spine and needs surgery. I strive so hard to take care of my son and help him live as independently as possible. We have so much equipment in our home for him to utilize. And I have always been a big fan of Rifton's medical equipment;thanks to the wonderful physical therapist that have worked with him over the years. I look forward to reading more wonderful articles here to educate me on helping him.