Positioning
The way the patient is positioned and monitored while sitting or lying down can have a significant effect on their tone. Does the person have:
- An appropriate chair or cushion
- An appropriate bed and mattress
- Direct support – using pillows, cushions or tables
- A normal position – some people may need individual equipment such as a splint
- A regular change of position in the care plan
- Regular observation and adjustment as required
- Appropriate pain control if required
For positioning to be most effective there needs to be:
- Staff awareness of tone management plan and good communication
- Patient should be aware if possible of their position and be involved in correcting their position if they are able to comply
- Carer education of positioning, what to do and when to get help
Remember that sudden changes such as coughing, sneezing or laughing may increase tone and change positioning. Look for exacerbating factors.
Video notes
0:30 Watch how Allan uses his left (unaffected) side to pull up in to a sitting position.
How does this affect the tone in his body?
0:38 Notice the flexor spastic patterns generated in his right arm.
1:12 What happens to Allan’s right arm and leg when he rolls on to that side in comparison to pulling to the left?
What is different?
1:47 As Allan sits up at the right side of the bed, how does this differ from the opposite move?
How does his muscle tone differ?
Video transcript
Getting on and off a bed – How method can affect tone
M. OK Allan. What I’d like to do now is have a look at how you get out of bed and the effect it has on the tone in the muscles on your right side. You told me that at home you’ve got a little bed rail that you can hold on to?
A. Yeah a grab rail.
M. Yeah a grab rail. So I tell you what. This is a slightly longer rail on this bed but if you can just show me how you get up out of bed at home using the rail. OK that’s perfect. Excellent. OK we’ll stop there. So we can see that caused a bit of tension in your muscles to do that. That was quite an effortful movement wasn’t it.
So thanks for that Allan. You showed me the way you get out of bed when you are actually at home. We were just observing that caused quite a lot of tension in your muscles to do that. I want to try a different way with you just to see how that might work. It might involve getting out of the other side of the bed which we can negotiate at home. So this time what I’d like you to do is bend up your left leg. That’s it and then just look towards me. Reach over to the right hand side of the bed with your left hand. That’s it; reach over to the side of the bed and roll on to your right side. Perfect, now you see in that position your arm is still quite extended and quite relaxed. It’s very relaxed in fact because you are lying on your right side.
A. Yeah.
M. So you are weight bearing through this side. So this arm is actually in contact with the base of support. So what I’d like to do is just get you to swing your legs over the side of the bed. OK. Alright, excellent. So you can see the effort of doing that and the result in your limbs of doing that was quite different.
A. Yeah.
M. So this arm is much more relaxed.
A. It felt easier.
M. And it felt a lot easier.
A. Yeah it did yeah.
M. OK. Now going back is just the opposite. Can you just make sure your hand is not going to get crushed so we move it here. Reach across, lean on your left hand and just lower yourself back on to the pillow and then roll back on to your back again. And relax. Excellent. So that’s a possible solution that you could use at home to get in and out of bed with more relaxed muscles.
A. I’ll try to remember that.
M. OK.
Page last reviewed: 04 May 2020
