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Newsletter: Stroke & positioning

This newsletter provides a review of resident positioning post stroke. During our work onsite in Nursing Homes, we find this is a vital topic to revisit with the care team so as to always ensure maximum comfort and independence for the stroke survivors that we work with!


Common Impairments post stroke: 

  • Altered consciousness/attention 

  • Dysphagia (Swallowing difficulties), Dysphonia (disorders of the voice), Dysarthria (motor speech disorder), Dysphasia (impaired understanding or use the spoken word)

  • Reduced muscle power and/or altered muscle tone (muscle tone may be increased e.g. spasticity, or decreased e.g. flaccid limb)

  • Altered sensations (i.e. may not feel hot/cold, tight/loose etc)

  • Reduced co-ordination 

  • Loss of visual Acuity

  • Reduced joint mobility/stability 

  • Balance and gait impairments


Considerations for positioning and handling

Motor function: ability to move and plan movements. Can patient change their position themselves when necessary? Can they use their limbs/hands in this position?

Sensation: feeling. Will the patient be able to feel if their ankle is against bed rail/ if there is pressure on a joint/ hand has slipped off the board?

Cognition and Communication: understanding of the movement/ position and what is happening. Can the patient tell you what is worrying them/ uncomfortable?

Level of consciousness: how alert is the patient? Will they fall asleep in this position and is it safe if they do?

Comfort and Safety: always be aware of the affected limb when positioning the patient. Is the patient comfortable and is the position safe? Is the manoeuvre safe for all involved? Is the patient’s dignity maintained at all times?

Co-existing pathology: another medical condition e.g. DVT, fracture, dementia, that may need special consideration for positioning and handling.

Skin condition: be aware of fragile skin, risk of pressure sores, dressings in situ etc.


Aims of positioning

To promote symmetry and normal alignment, thereby preventing secondary complications: e.g. to allow upright positioning and prevent shortening of neck muscles/ tight hip adductor muscles.

To encourage normal muscle tone: e.g. to prevent contractures.

To provide more normal sensory input: allow upper limb to feel different surfaces/fabrics, allow patient get accustomed to normal positions such as supported/unsupported sitting and be aware of position of limbs and joints.

To encourage awareness of affected side: prevent neglect of affected side, e.g. pusher syndrome.

To relieve pain and provide comfort: ensure regular positional changes to reduce pressure on one side, promote circulation and prevent pressure sores.

To encourage optimal circulation and respiratory function: e.g. position following chest auscultation to encourage deep breathing/increased aeration of affected lung. It is important to ensure regular positional changes, to avoid retention of lung secretions.

To provide support: provide support to prevent / minimise / delay any secondary complications e.g. supporting the subluxed shoulder using a sling to minimise discomfort, support feet on footplates of wheelchair/footstool and not restrict circulation at back of knees.


NB Upper Limb considerations

Up to 85% of individuals post stroke experience altered arm function, with approx. 40% of individuals being affected by UL function long-term. Loss of arm function adversely affects QOL (quality of life) and ADL’s (activities of daily living). Remember to check if the patient wears a sling or arm support!

 








Stroke transfers using a standing hoist.


The most important risk assessment is weight bearing ability and the affected sides’ arm profile. If the resident has a low tone arm, they should be using an additional arm sling (or collar cuff) for their transfers.


If your resident is not using a sling due to poor compliance, or does not have one, then the care staff have a key role in supporting the arm throughout the transfer.


Staff must NOT: Lift the affected shoulder to insert the sling or attempt to bring the hand towards the spreader bar.


Staff must bend the elbow to 90 degrees and support the arm at the elbow and keep the shoulder in neutral positioning, preventing it from raising to avoid any risk of injury through dislocation or subluxation, or dropping. This is very important to avoid any injury to the shoulder.


The sling attachment is very important so that it does not rise up during the transfer. To ensure a good attachment, ask the resident to look up or lean back so that their abdomen is lifted as this area drops in transfer causing the sling to become a lot looser – often causing the sling to rise.


Please use your nurses and physiotherapist team to assist in risk assessment.


The signs to stop

- Resident not weight bearing in the task.

- Poor understanding of the task and role in the transfer.

 

Suggestions to help promote stroke knowledge and posture are:

· Revise stroke/CVA - what it is, types & common deficits after a stroke.

· Refresh the FAST campaign from the Irish Heart Foundation.

· See what resident stroke profiles are in your home and refresh their specific individual needs with team.

· Refresh the common deficits that present post stroke and how your care team can adapt their roles to manage them.

· Refresh what equipment residents who have had a stroke are recommended to use (e.g. splints, adaptive cutlery etc) and ensure all the team are aware and able to assist.

 

Happy to help! Don't hesitate to get in touch if you have any questions on stroke positioning or manual handling. Contact one of our manual handling experts, physiotherapists or occupational therapists at info@fitforlife.ie or 01-2137915!


You can download this document below!


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