Preface – by Pauline Pope

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What is ’24 Posture Management’?
‘Management’ in this context means ‘bringing under control’. The term is applied to the management of posture throughout the 24 hour period in people with severe and complex disability in which postural impairment is significant.

What is the purpose of this management?
The aim of such management is to maximise functional ability and to minimise the secondary complications associated with motor and postural impairment such as contractures, tissue damage, chest infections etc. It is well recognised in the literature that without appropriate management the physical condition of people with severe impairment will inevitably deteriorate to the point where the individual becomes virtually bedfast, with resultant poor quality of life and additional cost and effort of care.

In practical terms it is rarely possible to gain complete control of body posture throughout 24 hours and compromises must be made. These compromises can only be made when all the information relating to a given individual is available, that is relevant social, environmental and psychological facts are known in addition to a full examination of the individual’s physical condition. Thus assessment is the key to postural management.

What is the target population?
The people who require management of posture are those who are unable or have difficulty in altering their position and who spend lengthy periods in one position. Such people may have an acquired degenerating condition such MS, Parkinson’s disease; have been born with impairment such as in cerebral palsy or a genetic disorder such as Leissencephaly or have sustained severe trauma such as brain injury.

As a result of advances in technology and improved standards of care people with these conditions are living longer thus there are increasing numbers living with profound impairment and residual disability. In response to need, a relatively new specialist area of therapy is developing to meet the challenges presented by this group of people.

‘Posture Management’ or ‘Physical Management’?
In reality management of posture is only one component, albeit an important one, in the management of the physical condition in people with severe and complex disability. In addition there is the need to address maintenance of tissue length by movement (active or passive); to address general health issues such as nutrition, constipation, infections and to incorporate therapeutic leisure activities into a programme of management. Further, the effort of care and the needs of the carer must also be considered.

‘Physical Management’ is proposed as the more appropriate term to apply to this new and developing field of addressing the problems associated with severe and complex disability.

There is much work to be done if evidence of effectiveness (or not) of physical management procedures is to be shown. It is only with such evidence that the speciality may continue to develop and be in a position to lobby for the resources that are so desperately needed.

Pauline M Pope FCSP MSc BA MAE

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Pauline M Pope is a Fellow of the Chartered Society of Physiotherapy and she has a Masters degree in Biomedical Engineering and a Bachelor degree in science. She is a member of the Royal Society of Medicine, the Special Interest group of Physiotherapists in Medico-Legal work and of the Academy of Experts.

She gained a wide range of experience on orthopaedic and neurological disability in England and abroad. She has been involved in the setting up and running of physiotherapy departments in hospitals associated with large international construction sites in USA, Pakistan and Argentina.

Since 1980 she has worked in specialist centres dealing with people with moderate, severe and profound physical disability resulting from congenital and acquired neurological trauma and disease. Her expertise lies in the management of the physical condition in this group of people with the aim of minimising the secondary complications associated with these conditions and maximising remaining functional ability. In addition she is involved in the design and development of special equipment for the purpose of achieving the aims noted above and assisting those caring for people with severe disability. She has been involved in research relating to the above topics.

She is currently called upon to assess and make recommendations for those with significant physical disability, some of these assessments being for medico-legal purposes. She lectures widely and runs courses both nationally and internationally. She is visiting lecturer on Masters degree courses at the University of Surrey and in Neurological Rehabilitation at Brunel University and University College London.

She initiated and developed with colleagues, a Post Graduate Certificate at Masters level, on the management of people with severe and complex disability. This certificate course was subsequently validated by Oxford Brookes University, Department of Health Studies. She is currently Co-leader of this course.

In addition, she is leader for a Masters module in Assistive Technology at Kings College London, Department of Medical Physics and Engineering.

She is published widely on subjects relating to physical disability.

Adapted from Posture Course literature

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‘Severe and Complex Neurological Disability; Management of the Physical Condition’
by Pauline Pope, et al.

The complete physical management approach, within the context of the life-style of the disabled person and those who care for him/her, are detailed in a new book entitled ‘Severe and Complex Neurological Disability; Management of the Physical Condition’ published by Elsevier Science Publications. The book will be on sale from November 2006 and will cost £29.99. In addition, the book addresses the difficulties encountered that constrain the implementation of a regime of physical management and emphasises the importance of compromise. Allied Health Professionals working in the field require many and varied skills to be effective. The book provides theory, application and discussion from which the reader can develop analytical skills and gain confidence, the better to question and innovate.

Pauline Pope 2006.