ISS 2017 Program


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PC15: Postural Care: Supporting People Night and Day

24 hour postural management has been discussed and developed since the 1980s outside North America, but here it is a newer approach and not commonly used. Parallels between lying and sitting posture can readily be seen during mat evaluations, but are often not fully understood and addressed in the process of planning seating interventions. Gravity and asymmetrical postures are forces that must be reckoned with during hours spent in bed or relaxing outside the wheelchair, for the habitual postures of a person with impaired movement can easily become obligatory over time. Eventually gravity coupled with asymmetry can lead to or worsen distortions of body shape such as pelvic obliquity and rotation, rib cage distortion, scoliosis, hip and other joint dislocations. These complications often require complex and expensive seating systems, whose benefit is counteracted by unsupported postures out of the wheelchair. Such problems are threats to the health, function and quality of life for wheelchair users and challenge seating practitioners. However body shape distortions can often be limited, avoided or improved with supported lying and sitting postures used 24 hours per day, while improving sleep and reducing pain. 24 hour postural care involves analysis and understanding of destructive and supportive postures and the forces of gravity that affect the human body. This workshop will provide background and theory for an eclectic approach to 24 hour postural management/care, including instruction in practical strategies for implementation. Hands-on practice with therapeutic positioning using a variety of common household and more specialized supports will offer experience in planning night postural care interventions that will support successful daytime seating outcomes.


Learning Objectives:

Upon completion of this session, attendees will be able to;



Tamara Lee Kittelson-Aldred, MS, OTR/L, ATP/SMS
Posture 24/7
Missoula, Montana
United States

Tamara is an occupational therapist, RESNA certified ATP/SMS and passionate about the power of 24 hour postural management. Tamara has given presentations, webinars and workshops in the United States and Peru, and is Project Director for the Montana Postural Care Project. Her most memorable teacher was her daughter, Eleanore, who was born with complex needs. Tamara provides positioning and mobility equipment services integrating 24 hour postural care for children, youth and complex adults in Montana.

Lee Ann Hoffman, OT, MScR
Grand Prairie, TX
United States

Lee Ann qualified as an Occupational Therapist in 1999 in South Africa. She completed a Post Graduate certificate in Posture Management for complex disabilities in 2010, and obtained a Master of Science degree in Rehabilitation: Posture Management, 2015, United Kingdom.
Lee Ann has experience in working with children and adults with complex disabilities, and adopts the 24-hour approach to postural management. She is a clinical educator for Invacare United States.



    1. Crawford, S., & Stinson, M. (2015). Management of 24 hour Body Positioning In Soderback. International Handbook of Occupational Therapy Interventions. Springer International Publishing Switzerland. 189-203.
    2. Fulford, G.E., & Brown, J.K. (1976). Position as a cause of deformity in cerebral palsy. Developmental Medicine and Child Neurology, 18, 305-14.
    3. Gericke, T. (2006). Postural Management for Children with Cerebral Palsy: Consensus Statement. Developmental Medicine and Child Neurology. 48, 244.
      Hill, S., & Goldsmith, J. (2010). Biomechanics and Prevention of Body Shape Distortion. Tizard Learning Disability Review, 15(2), 15-29.
    4. Pope, P. (2007). Severe and Complex Neurological Disability: Management of the Physical Condition. Butterworth-Heinemann Publishers.
    5. Rodby-Bousquet, E., Czuba, T., Hagglund, G., & Westbom, L. (2013). Postural asymmetries in young adults with cerebral palsy. Developmental Medicine & Child Neurology. 55(11), 1009-1015.
    6. Sato, H., Iwasaki, T., Yokoyama, M., & Inoue, T. (2014). Monitoring of body position and motion in children with severe cerebral palsy for 24 hours. Disability and Rehabilitation. 36(14), 1156 - 1160.
    7. Wynn, N., & Wickham, J. (2009). Night-time positioning for children with postural needs: What is the evidence to inform best practice? The British Journal of Occupational Therapy. 72(12), 543-550.

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