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FEATURED JOURNAL ARTICLE

Long Covid

Clare Canale

PMG Conference 2022

11th to 13th July 2022 in Telford. Our annual conference provides an educational programme, industry exhibition and networking events for professionals working in the field of posture and wheeled mobility.

Pressure care and 24-hour postural management

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Paula Chester

Occupational Therapist


14 September 2017


As an occupational therapist who qualified in September 2014, I am only too aware that I am still considered new to the profession.  As a student, the importance of continuing professional development (CPD) was stressed, a message which is reinforced by both the Royal College of Occupational Therapists and the Health Care and Professions Council.  With CPD in mind, applying for a bursary place at the forthcoming PMG Conference in Cardiff seemed ideal, and the event did not disappoint.

I work for United Rehab Solutions Ltd, within the legal and medical field of practice.  We offer bespoke transdisciplinary rehabilitation to people who have experienced catastrophic injuries, such as lower limb amputees, or clients who are diagnosed within a minimal conscious state.  Both client groups have complex needs meaning that a high level of specialist knowledge and experience is required by the treating professionals; therefore I work under supervision by my manager.  Pressure care and postural management are an important part of post-acute treatment within the minimal conscious scope of practice (RCP, 2015) and the PMG Conference provided opportunities to learn and understand the topic in greater depth.

As regular reflection on learning is considered to develop a practitioner’s clinical reasoning (Willard and Spackman, 1998), I have reflected on what I learnt at the event and how this will influence my practice.  Every speaker and exhibitor at PMG Conference 2017 delivered an excellent presentation and greatly enhanced my learning, but it was the parallel session entitled A person-centred approach to the protection and restoration of body shape (Tess Ellis and Helena Poulton) that provided a learning opportunity most relevant for one of the client groups I work with. The presentation focussed on how body shape changes can be predicted, and how appropriate, client-centred and adaptable equipment in sitting and lying can be used effectively to protect and restore body shape.  For my own learning, although I was aware of the importance of postural management in the prevention of pressure ulceration, I gained a deeper understanding of the consequences of failing to provide postural care solutions for those who cannot change their position independently; for example, clients who are living in a minimal conscious state, where particular body shape changes may impact on an individual’s level of functioning and how, over a prolonged period,  this may develop into life-threatening complications (Crawford, S & Stinton, M, 2015). This learning was relevant to my practice as the clinical importance of 24-hour postural management falls within the scope of occupational therapy practice when working with clients who have a limited ability to change position (Crawford & Aisling, 2014; Crawford & Stinson, 2015).  An individualised postural management programme can improve communication, function and participation (Ellis and Poulton, citing Gericke, 2006).

Pressure care is included within the Prolonged disorders of consciousness: national clinical guidelines (Royal College of Physicians, 2015).  In the plenary session, Deformation is a cell killer, Professor Amit Gefen advised clinicians to be proactive rather than reactive, and to discuss the prevention of pressure ulcers with anybody who experiences a change in their mobility. In my case, this could be clients who have a lower limb amputation and are therefore at high risk of developing pressure ulcers on their residual limb.  Consequently, I now discuss the importance of maintaining healthy skin with my clients, and have advised the use of a compact mirror to regularly check the skin of the residual limb.  For another client, an alarm is set daily as a reminder to apply cream to aid prevention of an ulcer from forming.  [Photograph: Amit Gefen presenting at PMG Conference 2017].

As a member of a rehabilitation team working with clients diagnosed as minimally conscious, 24-hour postural management will now be at the forefront of my practice.  I have consolidated my learning through revision of the presentations from the conference, and the article Management of 24-hour body positioning (Crawford & Stinson, 2015).  Furthermore, the conference has provided me with a wealth of information on aids and equipment designed to prevent, restore or maintain body posture to improve function, participation and the overall well-being of those who cannot do this for themselves.  Although I have much more to learn on this subject, attending the PMG Conference 2017 has helped me start developing this knowledge, and given me new confidence as a key member of the rehabilitation team.

References

Crawford, S., & Aisling, C., (2014). 24 hour postural management for community dwelling adults with learning disabilities. Posture and Mobility, 31(1), 15-19.

Crawford, S., & Stinson, M. (2015). Management of 24 hr body positioning. In I. Soderback (Ed.), International handbook of occupational therapy interventions (pp.189-203).

Ellis, T., & Poulton, H. (2017). A person-centred approach to the protection and restoration of body shape: how can equipment in sitting and lying help meet individual goals and changing needs to improve quality of life? From https://www.pmguk.co.uk/data/page_files/Conferences/2017/PS3.pdf

Royal College of Physicians. (2015). Prolonged disorders of consciousness: National clinical guidelines. From https://www.rcplondon.ac.uk/guidelines-policy/prolonged-disorders-consciousness-national-clinical-guidelines

Willard & Spackman, 1998, 9th Edition, Occupational Therapy.  London: Lippincott, Williams & Wilkins.

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