Positioning yourself in bed is very important because you will be spending
at least eight hours of your day lying in bed. Please make sure that you are
positioned properly and that you change your position often. With each and every
sleeping position we will show you in this video, you should change positions
every two hours to eliminate increased pressure on bony areas to reduce skin
breakdown and help reduce tightening of your muscles. If you have any problems
with your sensation, please make sure you are checking your skin for reddened
areas. If you can't see all of the areas you may need to use a device such as a
long-handled mirror to check. If your reddened area does not go away within 15
minutes, please stay off the area. You will need to check with your therapy
team to make sure you are utilizing the proper mattress for pressure relief. You
should speak with your physician or primary therapist to see if this
schedule is appropriate for your specific needs. The following video will
instruct you on some options for positions while you are in bed. First
laying supine in your bed, position the head of the bed as flat as you can
tolerate. There are many factors that can affect how flat that you are able to lie
while in bed. Please use the minimum amount of pillows under your head to
avoid any muscle tightening in your neck as this could affect your breathing and
swallowing. When lying on your back you may need to place pillows under your
arms to elevate them off the bed if you have edema in the arms or hands. Be aware
that when you elevate the head of your bed, make sure your legs remain straight
with your knees flat. Please place a pillow under the ankles to elevate them
off of the bed, this will take pressure off of your heels. Please speak with your
therapist or physician regarding any assistive devices that you can use to
achieve this position. If you need to elevate your legs off of the bed, place
one pillow lengthwise under each leg. Do not place the pillow crosswise under the
knees because this can cause tightness in the muscles of your knees. When you
are lying on your side, you should try to keep the bed as flat as possible and
also only use one pillow underneath your head to place your head
and neck in proper position, your head and shoulders should form a straight
line. Please make sure you start lying in the center of the bed, for safety you do
not want to be sleeping close to the edge. Once you are on your side, please
have one pillow placed between your knees to relieve any pressure on bony
areas on your legs, your hips and knees should be bent about 30 degrees. Place
one pillow under your arm to keep your shoulder in a good position. Keeping your
shoulders positioned well will help to alleviate pain and will help to keep
your shoulders, hips and knees properly aligned. Position the head of the bed as
flat as you can tolerate keeping yourself in the center of the bed. If you
need to elevate the head of your bed, make sure your legs remain straight with
your knees flat. Position yourself part of the way on to one side and have
pillows placed behind your back and hips depending on the size of the pillows you
may also need a separate one for under your arm so your body stays in a level
position and your arm doesn't hang down. You may also need a small pillow to
place between your knees to avoid any chance of pressure on the bony areas.
If you prefer a 3/4 prone position, stay in the center of the bed with the head
of the bed as flat as possible keep your legs straight with your knees flat. Place
pillows under one side of your body, one pillow will be lengthwise under your
shoulder and one will be along your hip and leg. This will slightly elevate one
side of your body off of the bed. Your hands will need to be placed in a
comfortable position for you. Some may find that they bring their hands up by
the pillow at their head, others will keep their hands on the bed down at
their sides. Please make sure that you are keeping track of what positions you
are lying in so that you are changing them often.
Proper posture is important for people after having a spinal cord injury. They
need to protect their skin integrity by allowing for even distribution of
pressure while they are sitting in their wheelchair. Proper posture will also
assist in the prevention of muscle imbalances, contractures or tightening
that may develop. When sitting in your wheelchair your feet should be flat in
the middle of the pedals, your knees and hips should be positioned at right
angles, your buttocks should be all the way back in the center of the seat. If
your hips and knees are not in a good alignment, this will lead to your trunk
flexing forward which can cause increased pressure on your backside and
will also lead to your knees rubbing together.
While you are sitting in your wheelchair your trunk should also be upright with
your shoulders relaxed, your elbows should be resting at right angles on
your arm rests. If your trunk and chest area is forward this can decrease ease
and effectiveness of breathing and the reaching ability of your arms.
Maintaining good head and trump posture while sitting in your wheelchair is very
important. Proper posture while sitting in your wheelchair can give you improved
use of your arms for wheelchair propulsion with decreased effort and
protect your shoulders from injury. If you find that you will need more trunk
and head support while you were sitting in a wheelchair you may need a reclining
wheelchair or a tilt-in-space wheelchair. These may or may not be power
wheelchairs. Be aware of your hip knee and ankle position, make sure that your
feet are flat on the pedals with your hips and knees at a 90 degree angle, your
knees should not be touching together, also make sure that you are sitting with
your buttocks all the way back in the seat while
keeping your trunk upright in the center of the backrest and your head is
centered leaning against the headrest. When you don't sit back the whole way in
your wheelchair you can find that your knees may turn in and there is increased
rubbing on those bony areas you can also find that it can be harder to reach
things with your arms, take a deep breath or even swallow. Your shoulders should be
relaxed so that your elbows can bend and your forearms are able to rest on the
armrest. If you have any swelling in your arms please speak with your physician or
therapy team regarding any adaptive devices that you can place on your
wheelchair to elevate your arms. Please remember that before you are fitted for
your permanent wheelchair you may be in a loaner chair that is not a perfect fit.
Please continue to be aware of all the positions while you are sitting in this
wheelchair. As with everything else if you have any questions please contact
your physician or therapy team.