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דף הבית >> ארכיון כנסים >> כנס "תחת קורת גג אחת" 2014 >> תקצירים ומצגות >> התערבות מוטורית בילדים עם שיתוק מוחי >> Postural Care

Postural Care


דליה צוויק
 

 
How posture goes wrong:
Body Shape Distortion in Cerebral Palsy
Distortions in posture and impaired movement are key challenges in the care of both children and adults with cerebral palsy.  During early development, a child with CP inevitably stays in limited lying postures for long durations, due to difficulty changing positions.  This often results in habitual asymmetrical posture that continues to cause distortions at the hip, pelvis, spine, knees and feet.  These distortions are further influenced by factors such as abnormal reflexes, muscle tone (high or low), joint ligament type (loose or stiff), the force of gravity, and motor impairment, which might be asymmetrical as well. The resultant body distortion sequla was appropriately identified in an original article (1976): “Position as a cause of deformity in children with cerebral palsy.”  
The purpose of this presentation is to further explore the mechanism within the “position leading to distortion” hypothesis.  The presenter will elaborate on how and where distortions can be predicted, prevented and cared for by supported supine lying.   To counteract asymmetrical postural distortions, it is proposed that therapeutic night positioning can be an effective intervention.  The positioning technique is part of an educational initiative called Postural Care.  Postural Care involves educating therapists, families and caregivers to safely and humanely apply therapeutic positioning.  Postural Care highlights the benefit of relaxation and elongation of the body via gravity and targeted prop support. 
The latest evidence-based literature on postural care interventions will be reviewed.  Currently Postural Care programs are being successfully introduced in the US, Canada, Australia and at other locations.
 
The presenter is a Physical Therapist trained in Postural Care.
Reference
1. Mutch L., Alberman E., Hagberg B., Kodama K., Perat MV. (1992) Cerebral palsy epidemiology: where are we now and where are we are going Dev Med Child Neurol 34: 547–555.
 
2. Sato H1, Iwasaki T, Yokoyama M, Inoue T.  (2013) Monitoring of body position and motion in children with severe cerebral palsy for 24 hours. Disabil Rehabil [Epub ahead of print]  
 
3. Porter D1, Michael S, Kirkwood C. (2008) Is there a relationship between preferred posture and positioning in early life and the direction of subsequent asymmetrical postural deformity in non ambulant people with cerebral palsy? Child: Care, Health and Development, Vol. 34, No. 5. (September 2008), pp. 635-641.
 
4. Fulford GE, Brown JK. Position as a cause of deformity in children with cerebral palsy. Dev Med Child Neurol 1976; 18: 305–14.
 
5. Sarah Hill, John Goldsmith, (2010) "Biomechanics and prevention of body shape distortion", Tizard Learning Disability Review, Vol. 15 Iss: 2, pp.15 –
 
6. Piper, M. C., & Darrah, J. (1994). Motor assessment of the developing infant. Philadelphia: Saunders.  Page110
 
7. Learning Disability Physical Therapy Treatment and Management A Collaborative Approach (2nd ed. ed., pp. 180-198). (2007). Practical Treatment and Management Postural Care. West Sussex: John Wiley & Sons, Ltd.
 
8. Goldsmith, E., Golding, R.M., Garstang, R.A. and Macrae, A.W. (1992). A technique to measure windswept deformity. Physiotherapy, 4(78), 235-42.
9. Windward and leeward. (2014, February 16). Wikipedia. Retrieved March 13, 2014, from http://en.wikipedia.org/wiki/Windward_and_leeward
 
10. Scrutton, D. (2008), Position as a cause of deformity in children with cerebral palsy (1976). Developmental Medicine & Child Neurology, 50: 404. 
 
 
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