Adult Sleep Systems - Prone Sleeping? Burnett System?

[emma1]

Hi,

I was wondering whether I could gain some peoples thoughts on
a) prone sleeping in sleep systems
b) the new sleep systems/body supports being produced by RBF smirthwaite. has anybody had any experience of this sleep system?
c) or any advice or thoughts regarding the below case...?

Background info:
I am currently trying to get a sleep system that is suitable for a young gentleman (18yrs) with spastic quadriplegic CP. He has a lumbar/thoracic scoliosis of 90 degrees, right pelvic tilt with protrusion of right ribs meaning there is approximately 4cm gap between his ASIS and inf rib angles, and great lumbar lordosis, osteoporosis of most vertebrae and hips, fixed hip flexion deformities, and approximately 15cm leg length descrepancy due to previous hip surgery.

He currently uses half a symmetrisleep system, with some additional pillows, and he sleeps prone. Previously this has been causing difficulties with manual handling to assist him to turn over due to his physical disabilities- however the use of slide sheets has helped better, and I came across the RBF burnett body support system, and wondered if anyone has had any experience of this??? (As I am struggling to find any evidence to support the benefits of this).

Burnett system:- utilises small beads to fill a case, then the shape can be moulded into the position that is needed, a vacuum pump is then attached and the air drawn out, and then it retains the position it was in.

Cons: Obvious difficulties is training for staff to ensure that a good position is achieved at night, lack of evidence and previous knowledge by our team with this system,

Pros: could be slightly easier to position him in prone as the mould can be fitted once he is prone, it is half the price of the symmetrisleep system I have been quoted for him.

I would be grateful if anyone has any thoughts about this case, especially as I am only a band 5 physio!(?) Especially as I am quite sure the consultants are not planning /willing to operate at present therefore I feel getting the perfect sleep system is of paramount to his quality of life.

Many Thanks

Emma

[Caroline Havard]

You certainly have a very complex client.
I have used the Burnett body support for a client who needed to sit comfortably on an aeroplane and it worked well, though carers would need a high level of skill to use it . Also, I don't know if the pressure relieving qualities of this system would be suitable for night time positioning.
In theory, it ought to be possible to produce a carved foam support for him just as can be done with seating but it would probably be difficult to get rehab engineers to look at lying equipment as that is not their remit.
If you think the bean bag system would work well, have a look at the Leckey sleepform (Leckey.com) as that is mouldable.
I am guessing you have already looked at the memory foam pillows from Symmetrikit which might be more user friendly.They may be able to make you something bespoke.
The Smirthwaite one may be good too. i haven't come across that.
Presumably the risk factors of sleeping prone are outweighed by the young man's comfort requirements. Is it possible to look at other options?
Good luck with this and let us know how you get on.
Caroline

[emma1]

Thank you Caroline for a swift reply. It is timely as we are having the Burnett assessment tomorrow, therefore I feel armed to ask some of the Qs you have posed. They are some very good points and I will discuss them with my senior. My initial thought are that the Leckey system looks a lot more suitable for this gentleman, i.e. it will help him maintain an appropriate temperature range. It is interestnig to hear that the Burnett system has been used successfully by somebody.
I will keep you posted.
Thanks
Emma

[Jansen]

Hi Emma

I would like to refer you to the latest articles posted by Sarah in the evidence base section of this forum.
Lying in prone is arguably the most destructive (for body shape and related secondary complications) position you can put people with movement problems in. Unless you really have no other option I would strongly advice against long term prone lying/positioning.
If you are using it short term (1 or 2 hours) as a change of position it could be okay depending on the rational you are using.
Also avoid side lying as a long term positioning strategy unless safety becomes an issue.
It might not be easy to change someone’s habitual position (I like to lie like this) or for most people with severe body shape issues their obligatory lying position (I have to lie like this) to a supported supine lying position but if you set small goals and don’t expect to much to soon you will be likely to succeed and get the best outcome for your client.

Regards

[Sarah]

Hi Emma,
Happy to talk this through with you if you wanted to - 07729552626 Sarah@posturalcareskills.com
The whole idea of a moulded sleep system fills me with dread!
Do you have a measure of his body symmetry? Have you completed a posture analysis - from the description you give this young man is at serious risk of further complications and I would be seeking advice urgently regards restorative options - 18 is young. I have an article due for publication in the Tizard review in April which may help you understand the origin of his body shape distortion and to think through how to go about supporting him and his family in the future.
Hope to hear from you soon.
Take care
Sarah

[Dave Long]

Further to what everyone else has said, I would add that the Burnett system can be quite hard once the air has been evacuated but I wouldn't rule it out on this basis alone. Also, with regard to using a moulded sleep system, if the moulding is undertaken without a full and thorough clinical assessment, it is unlikely to be successful, which is what I believe Sarah is referring to. It takes a great deal of skill to a) mould for any form of postural support, be this lying or sitting, and b) to turn the mould into a finished system. If you have a thorough understanding of the person, a really good working relationship with the person taking the mould and the support and understanding of all involved, there is no reason why a moulded system should not work.

Hopefully you will be able to draw on the responses to your question and apply them to the particular requirements of the person you are working with.

Dave

[emma1]

Hi All,

I would like to thank you very much for all your responses and information. There is definitely a lot to consider. I have recently left the trust I was working in to complete my jnr rotations, therefore I shall contact my previous senior and ensure they are aware of the latest responses and hopefully contact the numbers so generously provided. I hope that they can keep us informed on posture24 as to the outcome.

Thank you,

Emma

[jennytinkler]

Hi Emma,
I have just been reading the discussion about your client and the pros and cons of the Burnett support and a moulded lying support. A client that I have been involved with, who is in her late 20's, uses a moulded lying support very successfully. She lies in supine. Although I was not working with her when she first got it I have been involved with some alterations to it. It was funded through our Home Equipment Loans Service and all the alterations that I have been involved with have been done in close collaboration with an Orthotist. Her parents use a sheepkin liner to reduce the risk of any problems with pressure. From talking to her parents this client has tried several other night time positioning systems over the years but due to her strong extensor spasm none were able maintain the support she needed overnight. As the moulded support holds their daughter in a more aligned supported position and there are no pieces that can move out of position it means that they are not constantly having to get up during the night to re-adjust the equipment. Although some people might not like the idea of such rigid support if you get it right, which can only be done after a thorough assessment, then for some clients it works.
Jenny.