Moving in bed – different positions
People spend between a quarter and a third of their lives in bed; wheelchair users frequently even more. The manner and frequency with which we turn over in bed and change positions vary from one person to the next, as do the requirements for mattresses and storage material. The objective for people with a spinal cord injury is also to sleep with as few materials as possible to hold you in position.
Why different positions make sense
Skin that is exposed to stress is at risk of developing sores. Regular stress relief by changing posture (lying – sitting) or changing position (lying on your back – side – front) helps to avoid the formation of pressure sores. When sitting for prolonged periods of time in a wheelchair, particular stress in placed on the skin on your buttocks; therefore, it is very important to lie down at intervals to relieve that tension.
If joints stay in the same position for a very long time, e.g. always bent or extended, contractures (muscle contractions) may occur. Different positions can prevent contractures.
Remaining in one position for a long time increases the tension on the body (spasticity, spasms). Varying postures / positions support the regulation of body tension.
Why should the upper end of the bed only be elevated minimally or for a short period of time?
When elevating the upper end of the bed, the patient slides down – this causes shear forces that affect the skin of the buttocks. Being half-seated places great strain on the coccyx and on the ischial tuberosity, which means increased risk of pressure sores.
What should be taken into account when choosing a mattress?
The mattress needs to meet your particular needs. The mattress needs a solid edge to ensure safe transferring. Soft mattresses make mobilisation and repositioning more difficult.
Criteria for choosing a mattress:
- Skin situation – How will my skin cope with lying on a mattress, and how frequently do I need to change positions? Problems with pressure sores caused by lying down?
- Am I reliant on assistance when changing positions?
- Does lying down cause me pain?
It is important to check the effects of all positions on the skin. Areas of particular
risk are those covering the bones:
- hip bone
- pelvic bone
- toes (prone position)
- Knees (prone position)
Should I ask my relatives to assist me at night in changing positions?
Relatives should be given the opportunity to have a good night’s sleep. Choose a mattress that eliminates the need to change positions repeatedly at night.