The adhering to information is offered for instructional functions for student enrolled in the physical Therapist Assistant routine at Lane community College. The is not intended for commercial use or circulation or commercial purposes. That is not intended to serve as clinical advice or treatment.

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The patient"s place of lull is often the position of greatest contracture risk. Attention to correct placing is relevant to every treatment setting. A contracture is a resolved shortening or tightening that soft tissue resulting in restricted motion that the joint. A convulsion is a shortening or boost in muscle tension, denoting the normal function of muscle tissue.

Positioning and also draping are techniques which maximize patience comfort and dignity, and which minimize injury come tissue. In this lesson, we will define vital terms and also explore approaches for proper positioning and also draping. Methods covered in this lesson will certainly be implemented in activities practice, ability checks, and formal testing.

Course level objectives:

Describe theory, therapeutic benefits/outcomes, and also application (precautions, contraindications, and procedures) the interventions offered to promote healing, sensible recovery, and also pain management - positioning

Lesson Level Objectives

Use correct medical terminology to define a patience position activity during a instance simulation activity.Define incidence, etiology, and also stages of pressure sores.Identify an easy treatment interventions for prevention and treatment of press sores.Describe common contractures and also primary clinical and an additional conditions that may be impacted by bad positioning.Describe exactly how draping demonstrates respect for the individual in the paper definition of the health care settingDescribe how positioning and also draping impacts treatment in various treatment settings (outpatient, inpatient, skilled nursing).

Preparing because that Success - Textbook and also Lecture as Sources

This video provides some suggestions for just how to to organize your examine so the you can be effective with your time, and also through a systematic approach, learn course objectives at the level you must succeed in lecture and also lab. Note - several of the objectives have been updated due to the fact that the video, yet the strategies for success room still the same.

Why is efficient Positioning so Important?When joints and soft organization are organized in one position for an extended duration of time, a joint or muscle contracture can develop. Lose of motion leads to loss that function. Tight, stiff joints and muscles end up being painful come move.Sleep and rest times are disturbed by pain due to malpositioning. Rehabilitation is influenced by negative sleep and transition to sleep is tested by poor positioning in bed.Circulation, lymphatics, nerves, and skin maintain are at threat for permanent injury with lengthy compression. Pain, swelling, pressure sores, numbness and tingling, and also weakness deserve to all an outcome if her patient is positioned improperlyPositioning provides proprioceptive intake (joint position) to the concerned system. With proper positioning, patient can begin to reintegrate details from your eyes and also bodies to improve role and progression through rehabilitationPressure sores place patients at far-reaching risk for infection. Recovery deserve to take countless months and require constant (and costly) treatments with nursing and also wound specialists. Push sores have the right to lead to amputation.Patients with impaired sensation and also impaired language role may not be able to feel pain indigenous ischemic compression from soft tissues. Constant skin check and position changes can protect against tissue injury. If a reddened area walk not return to normal ~ an hour of press relief, close surveillance of this area is indicated.Comfortable positioning during mat exercises, modality application, and manual techniques is vital for a patient-centered strategy to treatment. Therapists must actively seek feedback from patients and show a willingness to adapt an exercise or various other treatment modalities based upon the positioning requirements of the patient. Pillows, towel rolls, bolsters, and also wedges room some examples of devices in the rehab room which permit both lull and accessibility during treatment. This leads united state to draping.

Why is effective Draping therefore Important?Draping allows your patient know you are pertained to for their privacy and also modesty. It sends a article that you space working clinically when offering hands-on care.Draping avoids inadvertent soiling throughout bedside activities. This is particularly true because that draping in the pelvic/genital area when performing lower extremity ROM in the in-patient and skilled nursing facility settings.Creases in pillows, sheets and bed coverings can result in boost shearing and also pressure pressures to the skin. By taking time to properly drape throughout positioning, friend are preventing pressure soresDraping consists of pulling the hospital or various other privacy curtain as soon as a human body part/segment is exposed. Knocking or asking for permission to enter before accessing a patient room is an important component of reliable draping.

Applying Anatomical Planes and Direction that Motion

Describe typical movement and abnormal movement conditions, together as limited movement or contracture, is based in a uniform use of anatomical position, planes, and also axes of motion. As pointed out in our conversation of body mechanics, there space three anatomical reference planes: sagittal, frontal, and transverse (horizontal). There space three referral axes in each plane that are offered to define motion: frontal, sagittal, and vertical:

Flexion / extension: movement occuring in a sagittal plane throughout a horizontal axisAbduction / adduction: motion occuring in a frontal plane throughout a sagittal axisRotation (lifwynnfoundation.orgl/lateral or external/internal): activity occuring in a transverse (horizontal) plane across a upright axis.

As you evaluation the images and also descriptions the the common contractures below, keep in mind the contracture is named based on the direction of the movement restriction.

Common Contractures


Clinical Considerations


ankle plantar flexion

prevented or reduced with braces, splint, weight bearing (e.g., standing) and habit modification (footwear)


hip and knee flexion

generally initiated with prolonged positioning through pillows under knees

if patients room using a gatched bed (mattress bows at pelvis v HOB and feet elevated), danger for i know good flexion contracture increases

certain neurological problems will reason the hip and knee to pull into flexion once at rest


Hip outside rotation

External rotation is the "open" place of the hip joint. As soon as there is significant extremity weakness, external rotation tendencies room often daunting to avoid


Cervical flexion

Patients space at hazard cervical flexion contractures as soon as positioned through too plenty of pillows or with HOB > 30 degrees for extended periods. Some patients with swallowing constraints or dysfunction, cardiac condition, lung condition can no safely lie flat. This patients have greater cervical flexion contracture risk

Wrist flexion

increased spasticity of muscle from neurological condition or injury or general disuse

generally accompanies finger and thumb flexion contractures


The Life that a press Sore

Pressure sores are detailed and documented based upon STAGES of tissue responses come pressure and also shearing.

The two hour guideline for checking in with patients/residents and also assisting v a adjust in place for push sore prevention is based on the lot of time that takes organization to progression from stage 1 to stage 2 push sore.








Non-blanching Hyperemia (redness that does not revolve white when you press on it)

within 30 min

skin redness; patients through dark skin may have discoloration rather of redness

1 hour after ~ removal of



Ischemia (decreased oxygen delivered)

2-6 hours

skin blanching (whiteness)

36+ hours and also after removed of pressure



Necrosis (tissue death)

6 hours

skin blueness, hard lump

varies (days/weeks)




Within 2 mainly of necrosis

ulceration, infection, bony prominences involved

months; commonly requires surgical repair or amputation. Might be fatal


Role that the PTA in press Sore Treatment

A physical therapist evaluates and checks the skin conditions as component of routine treatment for client under their care. PTs/PTAs check the epidermis, the dermis or the underlying area of organization damage. This may incorporate the muscles, tendons or bones. Wound care and also dressing changes are in ~ the border of exercise for PTA, however, treatment is complex. A PTA affiliated in straight wound treatment is most likely to have significant clinical endure and added continuing education in wound care

Wounds will certainly not totally heal unless the underlying reason of the press sore is addressed. Palliation of pressure and prevention the future breakdowns room a PT/PTAs top priority. A procedure to assess the amount of weight bearing throughout the pelvis is dubbed pressure mapping. Press mapping may be encourage to assess specific pressure loads when a patience is sitting in a wheelchair so an optimal wheelchair cushion and seat earlier can it is in identified. A wheelchair seating vendor, work-related therapist (OT), nursing and also physician space often part of the health treatment team giving assessment and also treatment for pressure sores.

Summary of positioning Procedures

The table listed below summarizes some simple positioning actions for clinical treatment and interventions. This procedure space for comfort. A threat of an extensive positioning in a preferred position (e.g., geriatric patient that likes to sit increase in she wheelchair to watch an NFL game and also post-game highlights) is at risk for progressive loss that joint and soft tissue motion. Together you review your text and also review the procedures, think about which structures are at danger for contracture with each position. (Hint: watch Box 5-2 in her text).

Take a look at the handout consisted of in the appropriate sidebar top top this internet page. Right here you will find some excellent images and procedures for positioning in bed. We will be practicing these techniques in lab.


head and also neck




small pillow/towel at head and also neck

positioned at side or supported on pillows; limbs completely supported by bed/mat

small pillow behind knees; "float" ankles come decrease pressure; may use towel rolls on lateral leg because that neutral rotation


small pillow/towel role at forehead

rolled bath towel under anterior scapula; hand under head or follow me sides

pillow in ~ anterior reduced leg/ankles;

side lying

aligned v trunk and also pelvis; sustained in midline position; may need bolsters or extra pillows to assistance trunk in midline

upper UE sustained on pillows and slightly forward

hip and also knee flexion v pillow in between knees


support together needed depending upon patient function

supported as required for the intervention; lap tray or use of arm rests ~ above w/c for prolonged sitting

supported through feet ~ above floor/footrests/stool

Considerations for details Patient Populations




Trans femoral amputation

A surgical removal that the lower leg over the knee

Prone to stop hip flexor contractures; border sitting; limit hip flexion

Trans tibal amputation

A surgical removal of the lower leg below the knee

Prone to protect against hip flexor contractures; border sitting; border hip flexion


Condition which may result in far-reaching weakness or spasticity on one next of the body

Avoid operation slings for upper extremity support; use resting hand splints to protect against contractures; monitor head and also neck and assist with placing in neutral; vary place of hip, knee and also ankle joints during the job to stop contractures as result of spasticity or diminished use

Rheumatoid Arthritis

An inflammatory disease process i m sorry affects joints in the extremities

Avoid prolonged immobilization; encourage gentle ROM with progressive return to active exercise as able when symptoms subside

Burns and Skin Grafts

May incorporate harvested (donor) or regenerating skin

Avoid location of comfort; soft tissue anxiety are crucial to avoid skin (and because of this joint) contractures; coordinate through health treatment team to assure ROM parameters follow doctor orders and PT guidelines.

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Sample placing Devices



Self Study

Use the linked tasks to examine your expertise of common bony landmarks which room at risk for press injuries

pressure risk locations when supine. Link



Optional Resources

The complying with videos are included to support instruction in the interactive lecture and your course readings. These room optional, so accessibility these together your time and also needs to happen .. Approaching the product in various ways and also different layouts helps v both memory and also application of understanding to the clinical setting. Nonetheless, the videos are strictly supplemental. Disclaimer: there room some graphic images of pressure sores.