3. Sarah Clayton
Sarah Clayton – Sarah started working with
families whose children were using nighttime
positioning in 1998, this work was published
in Physiotherapy in 2000. In 2004 she co-
wrote the accredited Postural Care courses
using her skills as a fully qualified teacher. In
September 2007 Sarah’s oldest daughter
Abigail was diagnosed with a malignant brain
tumour aged just 6, she has undergone
extensive treatment. Abi is currently in
remission and continues to do well although
her future is by no means certain.
4. The Principles of Postural Care
There are 24
hours in a day
Out of 8,760 hours of the year, a
person with movement problems will spend
approximately:-
1,140 hours in school, this will be slightly longer if you
are at work
7,620 with their family and supporters
3,640 in bed
5. Patterns of Distortion
of the Legs
• the knees together
• the knees out to the side
• A “windswept” position, with both knees to
one side
Once the hips and knees lose the ability to
straighten fully the legs will adopt an avoidable
position with either:-
10. The hip joint is formed by the
head of the femur (thigh bone)
and the acetabulum (part of the pelvis).
11. When the hips are strong the they are held tightly together by
tight ligaments….
If we don’t support the weight of a persons legs these ligaments
become loose and the hips are at risk of dislocation…
12. The evidence demonstrates that position is both a cause of distortion and the
key to developing the hips in the first few months of life
“Cultures that hold infants with the
hips apart have very low rates of hip
dysplasia”
“Cultures that keep
infants’ hips extended on
a cradleboard or papoose
board have high rates of
hip dysplasia in their
children”
International Hip Dysplasia Institute
13. For children and adults with movement difficulties the hips may
be subject to ongoing destructive forces and damage
14. X ray shows how much the ligaments have stretched and how
the head of the femur is coming out of the acetabulum
this is called the “Percentage Migration”
33% is called subluxed …..75% is dislocated
Scrutton D , Baird G Arch Dis Child 1997;76:381-384
15. The direction of dislocation will depend on
the position the person lies in as a habit
16. The direction of dislocation will depend on the
position the person lies in as a habit
18. InWakefield, UK hip dislocations have been
dramatically reduced…
GMFCS
Gross Motor
Function
Classificatio
n Scale
1 Children
who can
walk, run,
jump and
climb stairs
but who
have some
impairment
of speed,
balance
and/or
coordination
2 Children
who can
walk in and
outdoors
and climb
stairs but
have some
difficulties
with such
things as
uneven
ground or
crowds
3 Children
who use
walking aids
but use
wheelchairs
for long
distances
4 Children
who use
walking aids
for short
distances
but use
wheelchairs
most of the
time
5 Children
who use
wheelchairs
for all
mobility and
need
postural
support in
order to be
able to sit
comfortably
Number of
children
supported
by the
service
75%
Migration
over 75% of
femoral
head
uncovered
by
acetabulum
Wakefield 122 106 46 274 0
Pontefract 48 79 50 177 2
19. (CIPOLD 2013) Recommendation 9:-
“CCGs must ensure they are commissioning
sufficient and sufficiently expert, preventative
services for people with learning disabilities
regarding their high risk of respiratory illness.
This would include expert, proactive postural
care support”
20. Some people may need support to correct
established problems such as chest rotation
24. The answer does not lie in
equipment.
The answer lies in the
development of co-produced,
asset based, problem solving,
creative solutions that have a
clear person-centred outcome
31. Further information and contact details
www.in-control.org.uk/webinarschedule2014
www.in-control.org.uk/stayconnected
communications@in-control.org.uk
