Postural Care in Australia: Postural Care Provision for Adults with Multiple Disabilities

Ahead of our conference, we’re finding out about another keynote speaker and workshop facilitator at Elijah’s First International Conference: The Living University of Postural Care. Bas Jansen is a postural care tutor-manager and seating specialist who will be looking at ‘Postural Care in Australia’ in his keynote speech and exploring how the principles of postural care and night-time positioning can be applied to seating in what promises to be an excellent workshop.

It’s my life! A person-centred postural care pathway

Bas Jansen and Sarah Clayton will be running a joint workshop, during which they will explore how gravity influences the body and how the principles of postural care for people who are laying down can be applied to seating to help individuals sit as straight and comfortably as possible.

Twenty-four-hour postural care is a well-recognised approach within complex health and many practitioners aspire to deliver a cohesive and effective service to protect body shape. As part of a comprehensive postural care pathway, assessment is an essential component. Currently, within the UK, many practitioners are limited in the assessment they are able to offer due to the nature of the system they work within. For example, wheelchair service practitioners would be unable to provide assessment or equipment for the lying posture despite the obvious influence of this on the likely success of the seating intervention being proposed.

This workshop will explore the relationship between assessment of the lying position and the seated position. Bas and Sarah will consider with the attendees how assessment should be individualised and person-centred and how safeguarding of the individual is essential to the assessment process. Assessment will also be discussed in relation to the use of the Goldsmith Indices of Body Symmetry.

Bas Jansen’s keynote speech: “Postural Care in Australia”

In his keynote speech, ‘Postural Care in Australia: Postural care provision for adults with multiple disabilities’, Bas Jansen will be sharing his experiences as a postural care tutor-manager and seating specialist, as well as providing some fantastic examples of the difference this work is making.

Bas works with adults with multiple disabilities, typically a combination of severe physical and learning disabilities. Bas points out that very little has been done to explore the benefits of postural care and night-time positioning for adults. Most of the research focuses on children but, in Bas’s opinion, postural care should be a lifelong provision that helps increase comfort and sleep and reduces problems associated with reflux, breathing difficulties and pressure

A physically able person moves between 30 and 50 times a night, naturally protecting the body from the damage caused by gravity. However, someone with mobility problems laying in one position for a long time is exposed to the forces of gravity that push down on them. .  Over time, this can lead to body shape distortions, including dislocated hips, chest distortions and scoliosis.

Bas has found that postural care can gradually halt or even begin to reverse body shape distortion by harnessing gravity as a therapeutic force. By trying to nurture and facilitate a more symmetrical posture when a person with multiple disabilities is laying down, gravity can gradually stretch and lengthen the muscles, improve body shape and reduce the risk of secondary complications.

In his keynote speech, Bas will be exploring why and how the focus of postural care training needs to shift to the ‘first circle of support’, i.e. the family, friends and carers closest to the person with the disability.

When families are trained, because they are a constant presence in the person’s life, they only need to be trained once, whereas paid carers may need more intervention simply because people move on to new roles.

When parents and carers understand how the body shape distorts, they are more likely to engage with straight forward postural care interventions that can be adapted to the individual needs of the person with multiple disabilities, figuring out how to provide optimal postural care even when the person can’t safely lay on their back and supported side lying might be indicated because of seizures, reflux, vomiting or breathing problems, for example.

There are major blocks to postural care becoming consistently available. The medical world takes an evidence-based approach but research tends to focus on post-surgical complications and outcomes rather than data and evidence to support the benefits and value of preventative postural care. For the medical world, anecdotal evidence is often not enough to create change. And yet, as Bas will show at the conference, anecdotal evidence exists.

On the plus side, families tend to get on board the idea of postural care quite quickly because it makes sense to them and what they have witnessed of body shape distortion first hand. Bas is focused on spreading a health prevention message, even if the empirical data isn’t there yet.  Sometimes professionals are nervous about giving postural care responsibility back to families but, when families and carers work from the same information and are on the same page, they become a powerful force for change.

Introducing Bas Jansen

Bas Jansen is a postural care tutor/manager and seating specialist. He completed his training as a physiotherapist in the Netherlands, working with people with multiple disabilities where a high level of resources were available. The people he worked with tended to live in ‘care villages’ where they had access on an almost daily basis to a team of carers, occupational therapists, physiotherapists and much more. Although there was lots of positive human contact, Bas noted that there was a lot of repetitive work without a lot of gain. People were being offered 24-hour postural care but it was missing a crucial element, which Bas later found through Liz and John Goldsmith’s work on night-time positioning.

Bas’s next move was to the UK where is worked on various hospital wards. It was during this time that he met his wife and the couple eventually moved to Perth, Western Australia, where they and their three beautiful children are still based.

Bas has been a tutor-manager of postural care since 2008 and has provided training to many personal assistants (paid carers), parents and therapists. He has mainly worked with adults with severe physical and intellectual disabilities.

Bas describes it as “rewarding, exciting and a privilege to assist families with the prevention of body shape distortions, and demonstrate that this seemingly intractable problem is not necessarily inevitable.”

While continuing his work with adults, Bas is also increasingly working with parents to support their children, as early intervention or prevention of body shape distortion – by empowering the families – is most effective.

Over the past ten or so years, Bas has been training care staff in postural care. He initially started with a small, sceptical group of carers, showing them the benefits of postural care and empowering them to be in charge, as well as making an effort to celebrate their successes. The carers began to see how they can make a difference in helping people to live longer and enjoy a better quality of life.

conference brochure imageLast year, Bas started training postural care tutors locally, which will ensure that the amount of tutors will grow and the service provision to the most vulnerable will improve. He is now involved in a new consultancy position through which he plans to develop this side of his work further.


To book your place on the It’s my life! A person-centred postural care pathway workshop, visit our booking page

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