Sleepform System Selection Guide

Transcription

1 Sleepform System Selection Guide

2 This booklet is designed to illustrate the common procedures involved in evaluating a child s sleep support needs within their 24 hour postural care program and prescribing the optimum solution. It is accompanied by the Sleepform System Selection Form which is designed to record the procedure from assessment to product specification. It can also be used as a review form to help monitor progress. Identifying and introducing the best sleep system can be a complicated and challenging process for everyone involved. More and more research indicates the benefits of providing night time postural support. It may appear obvious at first that it could only benefit the child to maintain a symmetric posture during these long spells, however, there is increasing pressure on therapists to ensure their decision making is supported by evidence. This requires them to follow best working practice, gather evidence and carefully document their goals and conclusions. Sleep systems are relatively new, with the UK and Ireland at the forefront of development of fully funded 24 hour postural care programs. The assessment and evaluation process is similar to others such as seating or standing, however, the domestic setting places much more emphasis on the child s family influencing the outcomes. In our experience, all decisions must be taken jointly with the child, their parents, carers and therapist if they are to be successfully adopted. On occasions the introduction of a new night time support can be disruptive and challenging to all involved. Gradual introduction strategies need to be carefully planned and implemented. Record keeping is key to evaluating any gains made by a new sleep system. It helps maintain focus on the mid to long term aspirations which can be critical during nights of sleep disturbance. It also monitors progress, providing valuable information for regular reviews particularly if the system is being introduced in stages. It is clear that the provision of sleep support systems at the earliest possible age can greatly enhance the child s postural condition, their quality of life and that of those around them. A common goal for all of us. James Leckey

3 Assessment and evaluation The assessment and evaluation process, for night time lying, is the same for others such as seating or standing where we record the relevant clinical and dimensional data. It will form an essential part of their overall physical assessment which will gather their dimensional data indicating any abnormal posture. It should measure and assess the contributory factors such as tone, reflexes, range of movement and weight bearing. The child s assessment should measure their functional ability which will indicate their ability to roll or turn in bed and combat the forces of gravity by independently changing their position. The therapist will also need to consider the effect of the other postures (e.g. seating) and therapies they experience during their 24 hour postural care program. The sleep position assessment will help the therapist to gauge the impact their current night time posture may be having. It will help reinforce the understanding that the main forces affecting posture are abnormal tone, force of gravity and the corresponding supporting surface force. The Sleepform measurement charts are to record a summary of the child s assessment and how it impacts on their lying posture. The Matt assessment chart is to record their current posture while lying in supine. This would normally be completed in the therapy environment. Assessment and Evaluation Initial assessment (=1) Review (=2+) 1 Date 11th April 05 Child s name Age Height Weight Therapist s name Sean Rooney 5 3ft 8inches 4st. Joan Smith Diagnosis / Issue CP, contractures (knees), scoliosis, rib flaring L>R, deformity on head - left side due to side lying, abduction Matt assessment chart Daily routine (time spent in bed/lying) Goes to bed at 9pm, gets up at 7am = Approximately 10 hours in total each night Other equipment used (other postures) Tricycle, standing frame and powered wheelchair Additional notes Following surgery I recommend that Sean sleeps in supine

4 The Home assessment chart is a record of the second assessment which needs to be carried out in the child s sleep environment in their bed. This will record their current sleep posture and should be supported by a full assessment of their current night time sleeping patterns and care environment. Comfort is a major factor in achieving successful night time positioning programs. Assessing the child s night time temperature profile both before and after the introduction of a sleep system can provide valuable information relating to comfort and how one aspect of the new system may be affecting the child s night time comfort. Supporting the charts with photographs is strongly recommended as an additional record of their lying posture at the time of the assessment. These combined assessments are invaluable and should help the therapist predict the risk of future outcomes if the child s night time posture was to remain unchanged or unsupported. A summary column is provided to notate the key issues relating to their lying posture and comfort. This is designed to relate and cross reference the following columns where the process will evolve from goal setting to establishing the desired sleep posture, required support parameters and the sleep system prescription. Issues Head / Neck Deformity on left side - due to side lying Shoulder / Arms Shoulder girdle has tendency to rotate to L Trunk Rib flaring L > R, scoliosis Pelvis Tendency to rotate to L Hips R hip at risk of dislocation Upper legs Frogging, abduction/ windsweeping to L Home assessment chart Side profile Knees Risk of developing contractures Lower legs Frogging/ asymmetry Ankles / Feet Leg position causing external rotation Temperature / Moisture Overheating Pressure Build-up of pressure causing skin breakdown Medical considerations

5 Goal Setting Against the background of a full assessment and as part of their 24 hour postural care program, it is now necessary to establish goals where of their night time lying posture may make a positive contribution to their physical development and quality of life. The overall goals will look at how their night time positioning affects their posture and how changing this could bring about or contribute to maintaining or correcting asymmetrical or abnormal posture. They will establish aspirations relating to comfort which affect the child s sleep patterns, sleep disturbance where change could impact on them, their family and carers. The comments in the goal setting column will concentrate on specific physical objectives which should correct or accommodate the issues indicated in the first column. These will begin to indicate the optimal sleeping posture and required support measures. They will also consider comfort relating to temperature, moisture and the alleviation of pressure. Selecting the sleep posture Supine lying Providing there are no health and safety issues, Supine lying is generally accepted as the best sleeping posture. Supine is the easiest position to enable symmetric positioning and generally minimises pressure by spreading their weight over the largest surface area. Supine is also recognised as the posture which can offer the greatest opportunity for undisturbed sleep. Side lying Side lying is a common sleep posture which may be an established sleep pattern. It is generally accepted as a less desirable sleeping posture and could be where abnormal tone and gravity would have its greatest impact on a child s posture. The Side lying posture is normally asymmetric and presents the child with the minimum surface on the support layer. This combination means that a Side lying posture is normally less stable and the child may expend more energy endeavouring to maintain a comfortable sleeping posture. It is also the posture where the child is more likely to experience discomfort and need to turn, or be turned, from side to side during the night. Changing established sleep patterns is possible and should be considered where benefits of an alternative would assist correcting or accommodating asymmetric posture and improve the child s sleeping patterns. Change can be challenging. It may mean considerable effort is required over several weeks or months where it may have to be introduced gradually. Selecting the sleep posture and choosing whether a change would be desirable and achievable can be a complex process which will involve considering many factors, some of which may be conflicting. Health and safety. Minimising the risks associated with medical conditions such as reflux, respiratory complications, and epilepsy. Postural and functional development. Maintaining a symmetric posture to enable and maximise their daily function. Pain. Providing supportive positioning to prevent the child expending energy and minimise pain, possibly after surgery. Comfort. Maintaining a comfortable posture managing temperature, moisture and pressure alleviation. Tolerance. Maintaining a comfortable supported posture where they have the freedom to move with the required support. Sleep. Improving the quality of sleep and reducing the sleep disturbances for the child and their family. Existing sleep pattern. Understanding how fixed the existing sleep pattern is and the likelihood of mid to long term change. Sleep. What will the investment be in effort required to achieve a new sleep posture and are the environmental and social circumstances conducive? Having considered the many factors with the parents and care givers, the therapist will arrive at the preferred sleep posture. The form has a desired lying posture column which will contain comments relating to the sleep position. It can also contain any comments relating to comfort in the lower rows. Prone lying Night time lying in prone is generally the result of a fixed sleep pattern developed at an early age. Whereas it may be thought to present as having a degree of body symmetry it is inevitable that the head will be turned to one side. Additionally, Prone lying may present respiratory concerns and is recognised as a contributory factor in SIDS. For these reasons prone positioning is generally considered to be an unacceptable night time sleep posture.

6 Issues Goals Desired lying posture Head / Neck Deformity on left side - due to side lying Midline Sleep in supine Shoulder / Arms Shoulder girdle has tendency to rotate to L Promote midline symmetry Trunk Rib flaring L > R, scoliosis Promote midline symmetry Supine Pelvis Tendency to rotate to L Promote midline symmetry Hips R hip at risk of dislocation Promote midline symmetry Upper legs Frogging, abduction/ windsweeping to L Keep legs neutral Neutral Knees Risk of developiong contractures Prevent fixed contractures Slight flexion to accommodate hamstrings Lower legs Frogging/ asymmetry Keep legs neutral Slight abduction Ankles / Feet Leg position causing external rotation Keep legs neutral Slight abduction Temperature / Moisture Overheating Maintain a comfortable temperature Supine and dynamic Pressure Build-up of pressure causing skin breakdown To prevent build-up of pressure points Supine Medical considerations

7 Generating postural support parameters Having established the principal goals and desired lying posture you can now generate the postural support parameters. These are descriptions of the necessary support elements which will be needed to support the chid in the preferred posture. These elements will need to accommodate the child s posture and provide the level of fixed or flexible positioning. Depending on the child s sleep posture, in particular Side lying, the supports may have to be altered during the night to maintain a comfortable posture. Consider the nature of the support structures and the level of disruption it may cause to alter them during the night. A column entitled product parameters should be completed describing the necessary support elements and their position. It should indicate how secure or flexible the supports should be to provide the necessary support while maximising the child s acceptance to new elements. Indicate how contoured the support surface needs to be to maximise comfort. There is also a sleep Support position chart where you can sketch in the position of postural support elements you feel will be required. This will indicate where and how the supports will be used and how occasional change impacts on the product selection, where the child s position needs changed occasionally for example in Side lying. Selecting the sleep system Now that you have developed clear goals, established the preferred sleep posture and generated the product parameters, it is now time to select the optimum sleep system. The first consideration is which of the available systems provide the appropriate level of fixed and flexible support needed to maintain the desired comfortable and stable lying posture. Then consider comfort with issues relating to temperature, moisture and pressure. Look at additional issues relating to other activities and services. How important is it that the system permits easy access and transfer? Does it support and enable the night time routines of changing and toileting? Is the product acceptable in appearance to the child and their family? Is the system portable, where it can be moved from one bed to another when required without losing the postural positioning? Is the system easy to keep clean? Is the system easy to use? Are there information and training materials to support the parents and care givers? Is the equipment available for trial given that it may take weeks to make a reasonable assessment of the product suitability? Sleep Plan The introduction of a new and unfamiliar sleep system can be challenging. The development of a sleep plan can be very important to maximise the successful outcome. The plans should indicate the preferable outcomes and lay out a schedule for the introduction. It will take into consideration past experience of sleep disturbance and posture. It may also include strategies for partial introduction or a phased approach designed to lower the child s resistance to the new system. The Sleepform Night Night Sleep Tight Pack will accompany each Sleepform system. It includes a number of elements which will help record their progress and the position of the support elements as you progress. This is useful so that you can review progress, maintain focus and ensure the support is being maintained in the appropriate posture. The Sleepform Sleep Diary keeps a record of the night time progress. It records how often the child was checked, repositioned and how often they woke. It helps maintain focus on the sleep goals. Also the Sleepform Record Card and Sleepform Stickers keep a record of the position of the various support elements you choose to use. The stickers can be applied to the grid sheet inside the record card. They can be peeled away and reapplied time and time again. This is useful if you wish to remove the support elements for washing or if you wish to travel. This Sleepform Selection Form is intended to be used to record the initial assessment and selection process. It can also be used to record reviews where a change to the sleep system position may be required.

8 Product parameters Specify components Head / Neck Shoulder / Arms Trunk Pelvis Hips Upper legs Knees Lower legs Ankles / Feet Temperature / Moisture Allow supine lying only Keep trunk in midline Promote slight abduction, prevent frogging - allow movement Support under knees Prevent frogging and windsweeping - allow movement Help prevent frogging and windsweeping - allow movement Promote air circulation, allow movement and allow moisture to disperse with Leckey Sleepform mattress leg supports knee roll leg supports leg supports Air-flow mattress Support position chart Pressure Provide a breathable supportive base Air-flow mattress Medical considerations Allow moisture to disperse Air-flow mattress

9 This document is designed to be a supporting element in the overall assessment and evaluation process. It has been developed to assist the therapist navigate through the complex decision pathway to prescribing night time lying and sleep positioning systems. Prepared as an outcome of our two year Sleepform Product Development Program, it is considered as work in progress and we welcome any changes or improvements you would recommend. Please contact us at Leckey Kilwee Business Park Dunmurry BT17 OHD Northern Ireland United Kingdom T: F: E: info@leckey.com W: