We all take our posture for granted and rarely think about how our activities affect our posture and how our posture affects our health.  Many of us don’t even know what good posture looks like.  Here are a few tips from our friendly physiotherapist.
 
Poor posture can lead to pain, discomfort and loss of function.  For example: 

• standing with uneven weight distribution may cause lower back pain
• rounded shoulders with a chin poking out may cause neck and upper back problems.

 
Good posture is the position of the body puts the least strain on the muscles and joints.  Your posture is good when the shoulders are down and the back and the three natural curves of the spine are maintained while standing, sitting, lying down or being active.
 
What does good posture look like?  From a side view if you were to put a straight line from your ears it should pass through the middle of your shoulders, knees and ankles.
 
Hints on maintaining good posture:

Check your posture using the reflections of shop windows or mirrors and correct if needed.

• Walk and stand tall, chin in, shoulders back and tummy tucked in (not sucked in).
• Wear well-supported shoes with a low cushioned heel (high heels though elegant are bad for your posture).
• Avoid standing or sitting in one position for too long.
• Have a firm mattress and pillows positioned so the curves of your spine are in line.
• Ensure your seats support your spine with your feet comfortably on the ground.  A lumbar roll may help keep your posture upright and avoid slumping.
• Plan your work areas to avoid unnecessary bending and twisting.
• When lifting loads - keep the load close and balanced, use your legs and don't twist.
• Exercise regularly.

 
If you want any help to improve your posture our friendly physiotherapist can help,
just contact Therapy Professionals Ltd .  Ph:           (03) 377 5280              Email:            [email protected]
 

Information for the Carer
 
In normal life people constantly change positions to achieve maximum comfort.  This need still exists for the person with disabilities or degenerative conditions like Motor Neurone Disease regardless of the level of disability especially since sensation is intact.
 
It is important to try to maintain range of movement in all joints.  This assists with hygiene, dressing and comfort and can help to prevent contractures and pain.  The following exercises help to stretch muscles and minimize shortening of other soft tissues surrounding the joint.
 
Changing position regularly increases overall comfort.
 
General Precautions
 

1. All movements should be gentle and pain free
2. Be careful with hand positioning – do not grip limb too tightly as this will hurt.
3. Do not force movement – if it is difficult to move a joint through full range of movement       do not force it.  This may cause damage to the joint and result in pain.
4. Only work within the pain free range.
5. If you have any queries or doubts consult your physiotherapist before continuing with          the exercise programme
6. STOP any exercise which becomes increasingly painful and consult a physiotherapist.

 
The exercise needs vary between individuals. To be sure that the exercise is appropriate for any one individual, assessment by a physiotherapist is advised.
 
These exercises are a guide only and should only be used in consultation with your physiotherapist.

 
Passive Range of Movement Exercises
 
Trunk
 
Lumbar spine rotation.  Lie on back with knees bent            
and feet flat on bed.  Gently rock knees from side to side
​allowing rotation at lumbar spine.  Aim to keep shoulders flat on bed.

Lumbar spine flexion.  Lie on back with knees bent and feet flat on bed. 
Carer assists both legs off bed, knees onto chest. 
​Hold for 10 seconds. Do not force movement.

​Shoulder Movements
 
Shoulder flexion – patient lies on back, or sits, arm by side palm facing inwards gently lift arm into air and above head, thumb to ceiling (Hold for 5 seconds at end of range). Carer holds arm above elbow and at wrist, keep elbow straight.
Repeat five times.  Once per day.
 
Shoulder abduction – lie on back or sit arm by side palm facing to ceiling.  Hold arm above elbow and at wrist.  Gently take arm out to the side as far as possible.  Keep elbow straight

​Shoulder rotation – lie on back or sit, with elbow bent to 90° place one hand under elbow, the other at the wrist.  Move wrist from side to side, causing rotation at shoulder.  Hold at end of range 5 seconds.  Repeat five times.

 
Flexion – bend elbow, bringing palm of hand to shoulder.
 
Extension -straighten elbow
 
Pronation/Supination – bend elbow to 90°. 
Twist forearm so that palm of hand moves from
​facing shoulder to facing feet

 
Wrist and finger movements
 
Flexion – lie on back or sit arm by side bend elbow to 90° palm facing towards body.  Keep forearm still.  Gently move hand forwards and down towards body.
 
Movement may be limited by tightness at back of hand.  Hold at limit of movement for 5 – 10 seconds.  Patient should feel slight stretch over back of wrist.  This should not be painful.  Repeat two to three times.

Lower Limb
 
Hip and knee flexion – lie on back, carer holds leg at
heel and at a thigh behind knee.  Carer kneels on bed
or stands beside bed near knees.  Bend knee up toward
chest, then straighten hip and knee.
Repeat three times
 
 

Hip abduction -  lie on back, knees straight.  Carer holds leg at heel and at thigh behind knee.  Stand in same position as above.  Slowly and gently move leg out to side, keeping knee straight.  Continue to move leg until resistance is felt. Do not force movement.  Hold 10 – 15 seconds.  Repeat three times, once per day.
 

 
Hip internal/external rotation – lie on back, bend up one knee as for hip flexion.  Hold hip in bent position 90°.  Rotate hip by moving heel from side to side.  Do not force movement
 
 
 
 
Hamstring Stretch - lie on back knees straight.  Carer holds leg at heel and on top of leg just above knee.  Straighten leg slowly until stretch is felt behind knee.
 
 
 

Hip extension/quads stretch - Lie on stomach, bend knee to 90°.  Without moving leg sideways at all, lift thigh up off bed.  This is only a small movement – about 20°.
 

​Calf stretch - Lie on back, knees straight. Carer cradles foot with heel in palm of hand.  Lean towards patient.  Stretch should be felt in calf and behind knees.
 
As above with knee slightly bent. Maintain bent knee with rolled up towel behind knee.

Ref: Bethlehem Neurological Outreach service.

People with mild to severe disabilities depend partially or completely on their carers for their daily care.
 
It is a team effort between carers and dental professionals.
 
Healthy teeth and gums are important to people with disabilities
 
Sore or loose teeth make it hard to eat or sleep and they may not be able to tell you what is causing the problem.
 
Prevention of oral disease
 
Prevention of oral diseases (tooth decay and gum problems) for people with mild or severe disabilities is a challenging problem for carers and dental professionals.  Whenever possible, they should be encouraged and supported in their efforts to care for themselves.
 

Daily home care
 
a)         All people with disabilities
 
Diet:
 

• eat a well-balanced diet, high in fruit and vegetables
• consume minimal sugary foods and soft drinks (using straw) limited to meal times
• drink tap water after meals to rinse mouth and wash away food particles from teeth

 
Oral hygiene
 
Teeth:  Brush teeth with a manual or electric toothbrush twice a day – after breakfast and after dinner using a pea sized amount of a fluoride toothpaste and a soft toothbrush.
 
Lips, gums, tongue and palate (roof of mouth)  need  to be cleaned to keep healthy. Check with toothbrush, wipes or swabs to clear away food or medicines accumulated on gums, teeth or pouched (food held in the mouth and cheeks instead of swallowing)
 
Fluoride:  The fluoride in toothpaste and water strengthens tooth enamel, making teeth more resistant to decay.
 
b) People needing assistance from carers
 
Brushing other people’s teeth can be difficult, tips for carers include
 

• work in pairs, one carer supports the person’s head while the second carer brushes their teeth
• if it is difficult to keep the  mouth open, use three or four tongue depressors (or popsticks) taped together
• to create a better angle to clean the inner surfaces of the lower front teeth, modify the handle of a plastic toothbrush by placing it under hot water to soften the plastic and generally bend the brush handle
• if the person bites the toothbrush, use a second toothbrush to brush

• for people who pouch food, inspect their mouth after each meal or dose of medicine and remove any remaining food or medicine from the mouth by sweeping the mouth with a finger wrapped in gauze or using a disposable swab.

 
For people who are less compliant and at higher risk of developing:

• tooth decay - high strength fluoride toothpaste, gels or rinses can be used on professional dental advice
• gum disease – apply chlorhexidine get on the teeth gum margins before bed.

 
If person gags or cannot rinse or spit, a smear of high fluoride concentration toothpaste can be used or pour fluoride rinse or chlorhexidine into a cup, dip the head of the toothbrush onto it and then brush the teeth.  Repeat dipping and brushing until finished.
 
c) People with partial or complete dentures
 
Clean dentures (false teeth) after each meal with soap using a toothbrush and leave them in water overnight.
 
d). People not fed by mouth
 
These people need to have their teeth, lips, gums, tongue and palate cleaned like everyone else.
 
Dental healthcare checklist
 
✅        Healthy diet
 
✅         Brush teeth twice daily with  FLUORIDE toothpaste and a soft brush.
 
✅         Look for early signs of gum disease
 
              - gums that bleed easily
              - persistent bad breath
              - trouble chewing
 
✅          Drink tap water after meals
 
✅           Look for any changes in the mouth or behaviour when brushing teeth or at meal times                
✅           Take care to remove all plaque on and between the teeth and at the gum line.
 
✅            Clean dentures and remove overnight
 
✅             Book appointments at the time of day that is best for the person.          
 
✅              Visit the dentist regularly, sooner if any changes in the mouth or behaviour are noted.
 
 
Adapted from the University of Adelaide Colgate Dental Education Programs “Dental care for people with disabilities information for carers”.