A prospective case series to investigate current practice in the physical management of people in LAS and its impact on the pattern of limb and spinal deformities in people in low awareness states (LAS).

1. What are the patterns of limb and spinal deformities observed in adult patients in LAS?
2. What treatments (specifically related to spasticity and posture management) are provided as part of physical management to patients in LAS?
3. How do the interventions provided change the patterns of limb and spinal deformity?

Advances in medical sciences and technology have allowed more severely impaired people to survive in low awareness states (LAS). The main role of rehabilitation for this patient group is to maximise potential for recovery and to prevent deterioration. Soft tissue shortening, following prolonged periods of immobility and sustained posturing can hinder effective seating and provision of hygiene and ADL needs.
Management of LAS patients is multi disciplinary in which physiotherapy has a significant role. Posture management is a 24-hour approach carried out mainly by physiotherapists, Occupational Therapists and nurses. Regular changes in posture may prevent many secondary complications (e.g. contractures, pressure sores) and improve comfort and safety. However, robust evidence supporting these claims is limited and clinical practice has substantial variability.

This prospective case series aims to

• Explore the pattern of deformities observed in people in LAS
• Document the type, duration and frequency of physical (spasticity and posture) management interventions provided to patients in LAS
• Monitor the time course of development of contractures longitudinally 

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