Sumber: www.physio-pedia.

net
Introduction
The aim of positioning the patient is to try to promote optimal recovery by modulating
muscle tone, providing appropriate sensory information, increasing spatial awareness and
prevention of complications such as pressure sores, contracture, pain, respiratory problems
and assist safer eating.[1][2][3]

Correct positioning can help to reduce the risk of;

 Aspiration
 Contracture [2][1]
 Pressure Areas
 Shoulder Pain [1]
 Swelling of the Extremities

Aims of Positioning
 Normalise Tone or Decrease Abnormal influence on the Body
 Maintain Skeletal Alignment
 Prevent, Accommodate or Correct Skeletal Deformity
 Provide Stable Base of Support
 Promote Increased Tolerance of Desired Position
 Increased Stimulation to Affected Side
 Increased Spatial Awareness
 Promote Patient Comfort
 Facilitate Normal Movement Patterns
 Control Abnormal Movement Patterns
 Manage Pressure
 Decrease Fatigue
 Enhance Autonomic Nervous System Function (Cardiac, Digestive and Respiratory
Runction)
 Facilitate Maximum Function
 Improved Ability to Interact with the Environment [4][5]

Who is Responsible
Who is Responsible?

 All members of the MDT

 Nursing Staff play key role in ensuring 24 Hour Adherence

Types of Positioning
The most appropriate position in which to place a patient following a stroke remains unclear.
There is no RCT evidence to support the recommendation of any one position over another
but five main positions have been recommened, a survey of physiotherapists’ current
positioning practices found the most commonly recommended positions to be: sitting in an
armchair as recommended by 98% of respondents; side lying on the unaffected side then side
lying on the affected side. Sitting in a wheelchair (78%, 95% CI 74 to 82%) and supine lying
were less commonly recommended. [5][3]

Sitting in a Chair or Sitting in a Wheelchair

(98% CI 97 to 100%) or (78%, 95% CI 74 to 82%)[5]

It is vital that as soon as the person is capable of sitting out that they are facilitated to do so.
Sitting out is essential to build up tolerance; provide maximum stimulation; give a sense of
normality.

 Head over Pelvis

 Hips at 90 degrees
 Knees at 90 degrees
 Slight extension of lumber region
 Feet in neutral position and supported
 Weight evenly distributed between both buttocks
 Arm should be protracted forward and supported

Side Lying on the Unaffected Side

(97%, 95% CI 95 to 98%)[5]

 The stroke arm should be well forward, keeping the elbow straight and supported on a
pillow.
 The stroke leg should be brought far enough in front of the body to prevent the patient
rolling on to the back, the knee bent and leg supported on a pillow.
 A small pillow can then be placed under the patient's waist to maintain the the line of
the spine.
 When lying on the side position, the patient should have two pillows only under the
head.

Side Lying on the Affected Side

(92%, 95% CI 89 to 95%)[5]

 This should always be encouraged with the stroke shoulder well forward so that the
body weight is supported on the flat of the shoulder blade and not on the point of the
shoulder.
 One or two pillows for head
 Place the stroke leg with the thigh so that it is in line with the trunk, and bend the knee
slightly.
 The unaffected leg should be brought forward and placed with the knee bent on a
pillow in front of the affected leg for comfort. This prevents the patient rolling onto
his back.
 Lastly, bend the head forward a little.
Lying Supine

(67%, 95% CI 63 to 72%)[5]

 This is the position most likely to encourage spasticity, but some patients do like to lie
on their back for a while and it will be required for some treatments.
 Place two pillows under the patient's head and help him/her bend their head slightly
towards their unaffected shoulder and gently turn their head towards their stroke side
but do not uses force.
 A small pillow is placed under the buttock of the stroke side and should extend just to
the knee, this will relax the leg and prevent it turning out at the hip.
 A pillow is placed under the stroke arm which is kept straight at the elbow and if
possible, the palms of the hand facing upwards.
 The bed must be the correct height to promote independence and safety for the
patient, family and health care workers.

Sitting up in Bed

 Sitting in bed is desirable for short periods only

 Must be upright and well supported with pillows
 Consider extra support using pillows under arms or knees