184 chapter 23
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:
when lying
down, and
when
sitting.
Teach the child to make sure
his feet are in a good position.
CAUTION: A support like this works
well with floppy feet, but may
trigger spasticity or jerking of the
feet. Position them slowly.
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
place a pillow
between the legs,
and to keep it
there most of the
time.
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).
LESS APPROPRIATE
MORE APPROPRIATE
dip at back
of cushion
to fit butt
hollow in middle
to take pressure
off butt bones
raised sections
to hold legs
apart
curved bottom to
fit sag in seat of
wheelchair
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. For more
ideas on cushions, see p. 199 and 200.
Disabled village Children