Introduction
After a spinal cord or brain injury, the skin will still protect the body, but there may be changes in some of its functions. Because there may be limited or absent feeling as a result of the injury, the skin may not be able to tell a person if pain is present or if an injury to a limb has occurred (such as a burn, bruise or cut).
Lack of movement decreases blood flow to the skin which makes it less healthy and more apt to break down (turn into a sore).
When resting in bed, it is important to be properly positioned in order to protect the skin, muscles and joints. Proper padding and positioning can promote range of motion, comfort and rest, as well as keep the skin from developing sores.
This lesson will review padding and positioning techniques for those with absent or limited movement in certain body parts.
Resting on the Back
- Support the head with a pillow.
- Put a foam pad under the heels so they do not touch the bed surface.
- Keep the feet from leaning on the bed's footboard.
Foam pads may be placed above and below the sitting area. This technique, called “bridging,” takes pressure off the buttocks while lying in bed. It is very helpful when sores are present on the sitting area.
Resting on the Side
- Support the head with a pillow.
- Place a pillow behind the back for support.
- Place a pillow lengthwise between the legs. Do not let the knees or ankles touch each other while on the side.
- Place a foam pad between the ankles and between the bed and the ankle.
- Keep the feet from leaning on the footboard.
- Support the top arm with a pillow (let the arm rest on top of the pillow).
"Bridging" can also be used on the side if necessary. For example, foam pads can be used above and below the hip area to protect that bony area while lying on the side. This is helpful when sores are present on the hip area.
If you have been instructed to not rest on the side where the sore is present, follow the advice you were given by your therapist.
When on the side, the shoulder blade and arm should be moved forward by grabbing the shoulder blade and sliding it forward and out from underneath the person. Move the arm away from the body as you do this. Doing this promotes a more comfortable position for a person who cannot move his/her arm out of the way.
- Do not pull or jerk the arm out from the side.
- Support the top arm with a pillow (let the arm rest on the pillow).
Resting on the Stomach (Proning)
Support the head with a pillow.
Place two or more pillows under the chest and thighs (this keep pressure off the hips).
Support the feet with pillows or foam pads (this keeps pressure off the tops of the feet).
Proning is a nice option for people who enjoy or can tolerate lying on the stomach. No turning through the night is necessary. Proning also straightens the hips and helps to prevent tightness in the hips and knees. You will want to change the position of the neck during the night (turning it from side to side) so it will not be "stiff" the next day.
Only try the prone position if suggested by your doctor or therapist, as it might be difficult for people with breathing problems.
