Proper Positioning for Stroke Patients

Proper Positioning for Stroke Patients

Use the guide below to educate family members and caregivers on the proper positioning for stroke patients.

Proper anatomical positioning for stroke patients is important not only to reduce the chances of shoulder subluxation, but also to promote body awareness. As a result, proper positioning encourages the use of the neglected extremity after the stroke. Furthermore, extremities positioned correctly in supine as well as in sitting position will enhance stroke recovery and help regain motor control more rapidly.

Educating Caregivers on Positioning for Stroke Patients

Providing education to caregivers regarding anatomical positioning will ensure correct body alignment for the patient, especially when the rehab team is not present in the facility or home. The following information can be printed and provided to family members and other caregivers as a reference. You can also copy the picture and place it in a resident's room for simple instruction.

Positions to Facilitate:

Upper Extremity

Lower Extremity
  • Scapula protraction
  • Hip in neutral or slightly abducted
  • Shoulder neutral or flexion of 90 degrees to improve body awareness, placing arm in front of the body
  • Knee extended
  • Elbow either straight or slightly bent (10 to 15 degrees of flexion)
  • Ankle in neutral
  • Wrist and fingers extended or lumbar grip
  • Toes extended

Positions to Avoid to Minimize Contractures:

Upper Extremity

Lower Extremity
  • Scapula retraction/elevation
  • Pelvic tilt
  • Shoulder abduction, external rotation
  • Hip extension, adduction, and internal rotation
  • Elbow flexion (slight flexion around 10 to 15 degrees is okay, but avoid 90 degrees or higher flexion)
  • Knee extension
  • Forearm supination
  • Ankle plantar flexion, inversion
  • Wrist and finger flexion
  • Toe plantar flexion

 Supine Position:

  • Pillow under the patient’s head (the head of the bed to be elevated to 25 to 30 degrees).
  • Pillow under the affected arm (may need two pillows to support the full arm from the shoulder to the fingers).
  • Pillow under both knees.

Side-Lying Position:

Upper Extremity

Lower Extremity
  • Make sure the affected shoulder is neutral and the scapula protected.
  • Affected hip is in neutral and knee is extended with ankle neutral or slightly dorsiflexed.
  • The elbow should be slightly bent and supported with a pillow.
  • Wrist and fingers should be in an extended position.

 

Below is a picture which shows an example of proper positioning for stroke patients using pillows in the side-lying position. (The bold color is the affected side.)

Proper Positioning for Stroke Patients

 Lying on Unaffected Side:

  • Pillow under the patient’s head (the head of the bed to be elevated to 25 to 30 degrees).
  • Affected shoulder/scapula protracted and supported with a pillow.
  • Elbow, wrist, and fingers of the affected side extended.
  • You can place the unaffected extremity on a pillow with the shoulder around 90 degrees abducted and elbow slightly flexed.
  • It is important to have the affected extremity (upper extremity) in front of the body. This will improve awareness in the stroke patient.

 Sitting Position:

In Bed

In Chair
  • You can use the same supine position, but elevate the head of the bed to around 80 to 90 degrees. Support the patient’s back with the placement of few pillows.
  • Support the affected shoulder with an arm tray or a bedside table. You can use a pillow on the arm tray to provide an extra cushion as well as to bring the shoulder in neutral. (This will avoid shoulder depression that can otherwise happen by only using an arm tray.)

 

Examples of adaptive equipment to support the hemiplegic side are:

  • Arm tray
  • Foot box
  • Lateral support around the lower back or on the footrest area of a wheelchair
  • Foot pedal
  • Lateral pads around thigh areas
  • Adjustable headrest
  • Facial pad (for cervical dystonia)
  • Wedges to support weaker areas and facilitate upright sitting

 

Learn More:

 

References:

  1. Jong LD, Nieuwboer A, Aufdemkampe G. Contracture preventive positioning of the hemiplegic arm in subacute stroke patients: a pilot randomized controlled Clinical Rehabilitation. 2006; 20 (8).
  2. Ada L, Goddard E, McCully J, Stavrinos T, Bampton J. Thrifty Minutes of Positioning Reduces the Development of Shoulder External, Rotation Contracture After Stroke: A Randomized Controlled Arch Phys Med Rehabilitation 2005; 86: 230 - 234.
  3. Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD; on behalf of the American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. 2016;47:e98–e169. DOI: 10.1161/STR.0000000000000098.
  4. Luzia G, Corinne J, Gilberto B, Robert T, Fred M. Motor Imagery training improves precision of an upper limb movement in patients with NeuroRehabilitation. 2015; 36 (2):157-166.
  5. Davis One- side Neglect: Improving Awareness to speed Recovery. Stroke Connection Magazine. 2003.
  6. Pollock A, Farmer SE, Brady MC, Langhorne P, Mead GE, Mehrholz J, Wijck FV. Interventions for improving upper limb function after Cochrane Reviews. 2013; DOI: 10.1002/14651858.CD010820.
  7. Rowat What do nurses and therapists think about the positioning of stroke patients? Journal of Advanced Nursing. 2001; 34 (6): 795-803.
This article was written by Bijal Shah, Clinical Educator

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