Positioning and Handling to Foster

Motor Function
Made Hendra Satria Nugraha, S.Ft.

PS Fisioterapi
Fakultas Kedokteran Universitas Udayana
• Positioning
– Improving head or trunk control
– To accommodate a lack of muscular support
– To provide proper postural alignment
– To decrease high muscular tone
• Handling
• To improve the child’s performance of functional task such as
sitting, walking, and reaching by promoting postural
alignment prior to movement.
Children with neurologic deficits
General Physical Therapy Goals
• Low tone & joint hypermobility  stabilized
• Increased tone & limited joint range  mobility
• Transitional movement
– Supine  prone position (prone  supine)  sitting
position  standing position
• Normal development (prone position  four-point 
kneeling  half-kneeling  standing)
• The ability to shift weight within a posture is the
beginning of movement control (athetoid or ataxic CP).
Function Related to Posture
• Supine position
– Flat on the back on the support surface.
– Motor function (rolling, reaching with upper extremities,
looking, propelling the body by pushing off flexed LE).
• Prone position
– Lying flat on the tummy with the head turned to one side
or lifted, prone on elbows, or prone on extended arms.
– Mobility (rolling or crawling on the tummy, many
children push themselves backward before they are able
to pull themselves forward.
– Commando crawl (drag crawling)  children with weak
LE, using only their arms to pull themselves along the
surface.
• Sitting
– Eyes oriented vertically and mouth horizontally.
– The muscle of the neck and trunk are in the same
orientation with gravity.
• Quadruped
• 12% of typically developing children do not creep before
walking
• This position can provide excellent opportunities for the child
to bear weight through the shoulders and hips and thereby
promote proximal stability at these joints.
• Standing
• Cruising maneuver (9 months) & walking independently (12-
18 months).
 Physical Therapy Intervention

• Daily Care
– 6 months (the child unable to sit
with slight support  it necessary
to use an assistive device such as
feeder seat or a corner chair  to
provide trunk control & more
upright position can be fostered.
• Home Program
Positioning and Handling Interventions
• Positioning for Function
• Handling at home
• Holding and carrying positions
• Handling tips
• Use of sensory input to facilitate positioning and
handling (touch, vestibular system,
approximation, vision, and hearing)
Positioning for function
• The principle:
– Alignment
– Comfort
– Support
– Prevention of deformity
– Readiness to move
• All of that positions have a wide base of support
that provides inherent stability.
• W sitting
– The child does not have to use trunk muscles for
postural support, the stability of the trunk comes
from the position.
– Alternative to W sitting  some type of adaptive
seating (corner chair/floor sitter).
– Proper alignment of the trunk must always be
provided to prevent unwanted spinal curvatures,
which can hamper independent sitting and
respiratory function.
Handling at home
Holding and carrying positions
Handling Tips
• Allow the child to do as much of the movement as possible.
• When carrying a child, encourage as much head and trunk
control as the child can demonstrate.
• When trying to move the limbs of a child with spasticity do not
pull against the tightness.
• Many children with severe involvement and those with athetosis
show an increased sensitivity to touch, sound, and light 
encourage the child head in line and the hand in sight.
• Children with low postural tone  avoid placing in supine
position to play  they need to work against gravity in the
prone position to develop extensors.
• When encouraging movements from proximal joints, remember
that wherever your hands are, the child will not be in control 
if you want the control a body part or joint, you should not be
holding on to that area.
• Handling should be decreased as the child gains more control.
Use of sensory input to facilitate
positioning and handling
• Touch
• Vestibular system
• Approximation
• Vision
• Hearing
Touch
• Infant massage by their parents
• Awareness of the body’s midline is an essential
perceptual ability.
• Arms & leg length differences  unilateral
muscular paralysis & scoliosis.
• Tactile defensiveness  tactile stimulation
• Oral-motor therapy  speech
therapist/occupational
Vestibular system
• The tree semicircular canals of the vestibular
system.
• Movement stimulation  hammock method 
for the child who has low muscle tone because
the vestibular system has a strong influence on
postural tone and balance.
Approximation
• Compression through the length of the spine is
achieved from just sitting, as a result of gravity,
but this compression can be increased by
bouncing.
• Axial compression or pressure through the head
and neck must be used cautiously in children
with Down Syndrome because of the 20 percent
incidence of atlantoaxial instability in this
population.
• 45 degrees of
external rotation
Vision
• Provide important information for the
development of head control and balance.

Hearing
• Vestibular nerve
Preparation for Movement
• Postural readiness
• Postural alignment
• Key points of control
• Rotation
Postural Readiness
Postural Alignment

Key Points of Control

• Proximal joints are key points of control from
which to guide movement or to reinforce a
posture.
Rotation
Interventions to Foster Head and Trunk
Control
• Head control
• Positioning to encourage head control
• Interventions to encourage head control
Positioning to encourage head control
Interventions to encourage head control
• Trunk control
• Positioning for independent sitting
• Movement transitions that encourage trunk
rotation and trunk control
Positioning for independent sitting
Movement transitions that encourage
trunk rotation and trunk control
Adaptive Equipment for Positioning and
Mobility
• Goals for adaptive equipment
• Supine and prone postures
• Sitting postures
• Adaptive seating
• Side-lying position
• Positioning in standing
Goals for Adaptive Equipment
Supine and Prone Postures
Sitting Postures
Adaptive Seating
Side-lying Position
Positioning in Standing
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 Review Questions
1. What two activities should always be part of any
therapeutic intervention?
2. What are the purpose of positioning?
3. What sensory inputs help to develop body and
movement awareness?
4. Identify two of the most important handling tips!
5. Define key points of control
6. Give three goals to use adaptive equipment.
7. Why is standing such an important activity?