A stroke occurs when blood flow to a part of the brain is interrupted, often leading to weakness or paralysis on one side of the body. Proper positioning of a stroke patient is a fundamental component of both initial care and long-term recovery. Managing the body’s alignment helps to minimize the risk of developing painful complications and promotes the patient’s overall comfort and safety.
Foundational Goals of Patient Positioning
The guidelines for positioning a stroke patient are rooted in physical objectives that support the body’s recovery. Maintaining a neutral body alignment is a primary goal, which helps encourage normal muscle tone and prevent joint deformities or contractures. Correct positioning also reduces pressure on bony areas, preventing skin breakdown and pressure injuries.
Another goal is to actively increase the patient’s awareness of the affected side of the body, which can be diminished following a stroke. Regular changes in position are required for patients unable to move independently, promoting circulation and redistributing weight. Caregivers should adhere to a strict turning schedule, typically repositioning the patient at least every two hours. They must check the skin for any signs of redness or bruising before and after each change.
Techniques for Bed Positioning
When a patient is lying on their back (supine), the head should be positioned centrally, often with a small towel roll or pillow to maintain neutral alignment. The head of the bed is typically elevated 25 to 30 degrees, which helps reduce the risk of aspiration and supports breathing. The affected arm should be supported by a pillow, positioned slightly away from the body to prevent the shoulder from being pulled out of its socket.
For the lower body, a pillow or foam wedge can be placed alongside the affected thigh to prevent the hip and leg from rolling outward (external rotation). The affected foot should be kept in a neutral position, avoiding sustained pointing downward, which can lead to foot drop. Positioning the patient on their side is encouraged to vary pressure points and provide sensory input to the affected side.
When lying on the affected side, the shoulder should be gently brought forward, and the affected arm should be extended straight out, supported by a pillow to prevent compression. Pillows should be placed behind the patient’s back to stabilize the trunk and prevent rolling backward, and a separate pillow is placed between the knees. If the patient is lying on the unaffected side, the affected arm should still be supported by several pillows in front of the body, and the affected leg should be supported on pillows and positioned slightly forward.
Optimizing Seated and Upright Postures
When a stroke patient is moved out of bed, their posture must be managed to maximize stability and function. The patient’s hips should be situated as far back in the seat as possible to prevent slouching and maintain pelvic stability. The ideal seated posture involves the hips, knees, and ankles all bent at right angles. Proper foot support is important to maintain circulation and prevent the feet from dangling, which can increase the risk of foot drop. The affected arm should be supported on a pillow, a lap tray, or the armrest to prevent the shoulder from hanging or being pulled downward.
For patients with swallowing difficulties (dysphagia), the optimal posture for feeding may vary from the standard upright position. While the head is typically kept in a neutral, midline position, a slightly reclined posture (around 45 to 60 degrees from upright) can reduce the risk of aspiration. This reclined position helps the food bolus move along the back wall of the throat due to gravity. Regardless of the exact angle, the patient’s head and trunk must be stable to ensure safe and effective swallowing.
Managing the Affected Limbs and Spasticity
Attention to the weakened limbs is necessary to prevent long-term complications, such as spasticity. For the affected arm, support is paramount to prevent shoulder subluxation, a partial dislocation that occurs when the arm’s weight pulls the joint apart. Pillows should be used in bed and while sitting to keep the arm supported, and a specialized sling may be used during transfers or when standing.
The hand and wrist should be positioned to avoid a clenched fist or a flexed wrist, which are common patterns of contracture after a stroke. Positioning the hand in a functional, open posture, perhaps with a soft object or splint in the palm, helps gently stretch the flexor muscles. It is important to manage the affected leg to maintain its length and flexibility. The leg should be positioned to prevent the hip from rotating outward or inward, and the ankle should be kept neutral to counteract the tendency toward foot drop.
When moving or transferring the patient, avoid pulling or dragging the affected limbs, as this can cause injury to the fragile joints and soft tissues. Repositioning the affected limbs frequently helps to interrupt abnormal muscle tone patterns and encourages better sensory awareness.