Postural Care
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Issues with body posture are common in spina bifida/hydrocephalus, but you don’t need to put up with the problems they can cause. Tailored care can give your body the support it needs to function better.
Postural care involves protecting your body shape with a combination of equipment, positioning techniques and active movement. This may include special pillows and supports, standing and walking frames, and exercises. Postural care used to be focused on daytime activities, but it’s now understood that it’s also important to address lying-down postures at night. That’s why you may hear the term “24-hour postural care”.1
Why is postural care important in spina bifida?
Whenever we change position, gravity acts on a different part of the body, putting pressure on it. If we spend a while in the same position, the pressure on that part of the body starts to become uncomfortable, so we adjust the way we’re sitting, standing or lying. For most people, that eases discomfort and prevent longer term problems that would come from extended periods of poor posture.1
When you have spina bifida/hydrocephalus, you may have some issues that affect the position of your body, so there’s already extra pressure on certain areas. This means it’s especially important to keep adjusting your position. However, difficulties with moving, balance and strength can make that difficult. That’s why you may benefit from structured support to correct and protect your posture.1-3
How having spina bifida/hydrocephalus can affect your posture
Let’s look in a little more detail at some of the complications that can affect the position of the body when you’re sitting, standing and/or lying down.
- Problems with the way the spine curves – scoliosis, lordosis and kyphosis are all different issues with the curve of the spine. They can affect mobility and balance and raise the risk of pressure sores because body weight is distributed unevenly.
- Hip dislocations and deformities – these can lead to pain and challenges with sitting and moving around.
- Problems with your feet and ankles, such as clubfoot, can develop due to unbalanced muscle groups, and can affect your ability to stand and walk.
- Joint contractures – permanent stiffness of the joints can occur in the hips, knees and ankles, making movement and daily activities challenging.
- Limited mobility – sitting or lying in the same position for long periods can cause pain, stiffness and weakness, put you at risk of pressure sores, and can also make other issues worse over time. If you find it difficult to move during the day, it’s likely you spend most of the night in the same position – this is sometimes called the “habitual” or “preferred” position and over time, it can cause body shape changes.
- Loss of sensation – if you’re not getting the pain signals that prompt you to change position, you’re at increased risk of problems such as bed sores. 1-3
The problems that affect your body shape can often make each other worse if they’re not managed. For example, if you sleep in a habitual position every night, your body shape can change permanently, restricting mobility, comfort and function even more.1
The benefits of 24-hour postural care
Regularly correcting and supporting your body’s position can help to:
- manage musculoskeletal issues and prevent them getting worse
- reduce the risk of complications, such as dislocations, pressure sores, digestive problems, osteoporosis and pain
- improve balance and stability while you’re going about your daily activities
- preserve your independence and improve your quality of life1-3
What does postural care involve?
Postural care covers a wide range of things that can help you to look after the shape of your body. It’s a gentle approach that’s personalised to you and your needs, so it’s different for everyone, but techniques may include the following.1,3,4
- Supported seating – special seating systems may include supports and harnesses to keep your body stable, improving posture and balance.
- Therapeutic positioning – this may include lying in certain postures to align your spine and prevent prolonged pressure on parts of your body. A caregiver may help with this at night.
- Sleep systems, which may include pillows, brackets and rolls to support posture overnight. You can also get special beds, with adjustable head and foot sections, which help to keep you in a comfortable, supported position.
- Orthotic bracing – braces may be used to support different areas, such as your hips, spine and legs, to increase stability and correct poor alignment. Spinal braces can help to manage scoliosis, while ankle-foot orthoses (AFOs) may be used to correct the position of your foot and ankle, reduce muscle imbalances and improve the way you walk.
- Standing frames can support you when you’re standing, which is important for muscle and bone health, as well as your body’s alignment.
- Wheelchairs and other walking aids.
- Advice to help you check your posture and safely adjust it.
- Exercises to help improve your body shape, balance, strength and mobility.
How to get the support you need
Physiotherapists and occupational therapists can assess you, recommend equipment, train you and your caregiver to use it correctly, and suggest exercises that may be helpful. It’s also important that they carry out regular reviews to monitor your progress, check the fit of orthotics, aids and other supports, and make any adjustments to your programme of care.
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