Hesperian Health Guides

Maintaining Healthy Positions

The position that the body is in during the day and night is also important to prevent contractures.

Contractures that cause ‘tiptoeing’ of the feet can develop easily, especially when there is spasticity. Keep the feet in a supported position as much of the time as possible:

DVC Ch23 Page 184-1.png
when lying down, and when sitting.
DVC Ch23 Page 184-2.png
CAUTION! A support like this works well with floppy feet, but may trigger spasticity or jerking of the feet. Position them slowly.
Teach the child to make sure his feet are in a good position.

Even for the child who may never walk, maintaining the feet in a flat position makes moving from chair to bed, toilet or bath easier.

Another common problem for children with spasticity is that the knees pull together and in time contractures prevent the legs from separating. To prevent this, when the child lies on her side
she should learn to

DVC Ch23 Page 184-3.png
place a pillow between the legs, and to keep it there most of the time.
DVC Ch23 Page 184-4.png

A common problem with wheelchair users is that they slump forward. In time this can deform the spine.

In a wheelchair with a straight-up back a person with spinal cord injury slumps like this in order to balance. A chair can be designed (or adapted) so that it tilts back. This provides balance for a better position. A special cushion also helps keep the butt from sliding forward (and helps prevent pressure sores).
DVC Ch23 Page 184-5.png
DVC Ch23 Page 184-6.png
a special cushion for sitting
dip at back of cushion to fit butt
hollow in middle to take pressure off butt bones
raised section to hold legs apart
curved bottom to fit sag in seat of wheelchair
LESS APPROPRIATE MORE APPROPRIATE If possible, make cushion out of ‘micropore’ foam rubber (foam with very tiny bubbles). Rubber-coated coconut fiber also works well.

For more suggestions for wheelchair adaptations, see Chapters 64 and 65. See more ideas on cushions and padding.

This page was updated:21 Nov 2019