Presentation at the Israeli Amota for Childe Development in 2014 (click on image to link to their site)

Postural Care

By Dalia Zwick PT PhD



How posture goes wrong:

Body Shape Distortion in Cerebral Palsy

Distortions in posture and impaired movement are key challenges in the care of both children and adults with cerebral palsy.  During early development, a child with CP inevitably stays in limited lying postures for long durations, due to difficulty changing positions.  This often results in habitual asymmetrical posture that continues to cause distortions at the hip, pelvis, spine, knees and feet.  These distortions are further influenced by factors such as abnormal reflexes, muscle tone (high or low), joint ligament type (loose or stiff), the force of gravity, and motor impairment, which might be asymmetrical as well. The resultant body distortion sequla was appropriately identified in an original article (1976): “Position as a cause of deformity in children with cerebral palsy.”  

The purpose of this presentation is to further explore the mechanism within the “position leading to distortion” hypothesis.  The presenter will elaborate on how and where distortions can be predicted, prevented and cared for by supported supine lying.   To counteract asymmetrical postural distortions, it is proposed that therapeutic night positioning can be an effective intervention.  The positioning technique is part of an educational initiative called Postural Care.  Postural Care involves educating therapists, families and caregivers to safely and humanely apply therapeutic positioning.  Postural Care highlights the benefit of relaxation and elongation of the body via gravity and targeted prop support. 

The latest evidence-based literature on postural care interventions will be reviewed.  Currently Postural Care programs are being successfully introduced in the US, Canada, Australia and at other locations.


The presenter is a Physical Therapist trained in Postural Care.


1. Mutch L., Alberman E., Hagberg B., Kodama K., Perat MV. (1992) Cerebral palsy epidemiology: where are we now and where are we are going Dev Med Child Neurol 34: 547–555.


2. Sato H1, Iwasaki T, Yokoyama M, Inoue T.  (2013) Monitoring of body position and motion in children with severe cerebral palsy for 24 hours. Disabil Rehabil [Epub ahead of print]  


3. Porter D1, Michael S, Kirkwood C. (2008) Is there a relationship between preferred posture and positioning in early life and the direction of subsequent asymmetrical postural deformity in non ambulant people with cerebral palsy? Child: Care, Health and Development, Vol. 34, No. 5. (September 2008), pp. 635-641.


4. Fulford GE, Brown JK. Position as a cause of deformity in children with cerebral palsy. Dev Med Child Neurol 1976; 18: 305–14.


5. Sarah Hill, John Goldsmith, (2010) "Biomechanics and prevention of body shape distortion", Tizard Learning Disability Review, Vol. 15 Iss: 2, pp.15 –


6. Piper, M. C., & Darrah, J. (1994). Motor assessment of the developing infant. Philadelphia: Saunders.  Page110


7. Learning Disability Physical Therapy Treatment and Management A Collaborative Approach (2nd ed. ed., pp. 180-198). (2007). Practical Treatment and Management Postural Care. West Sussex: John Wiley & Sons, Ltd.


8. Goldsmith, E., Golding, R.M., Garstang, R.A. and Macrae, A.W. (1992). A technique to measure windswept deformity. Physiotherapy, 4(78), 235-42.

9. Windward and leeward. (2014, February 16). Wikipedia. Retrieved March 13, 2014, from


10. Scrutton, D. (2008), Position as a cause of deformity in children with cerebral palsy (1976). Developmental Medicine & Child Neurology, 50: 404. 

How posture goes wrong: Body Shape Distortion in Cerebral Palsy

Distortions of posture and impaired movement are key challenges in the care of children and adults with cerebral palsy. 

The purpose of this blog is to further explore the mechanism within the “position leading to distortion” hypothesis.  The post is a review of an article that elaborates on how and where distortions can be predicted, prevented and cared for by supported supine lying. 

To counteract asymmetrical postural distortions it is proposed by some that therapeutic night positioning is an effective intervention.  The article will suggest similarities between alignment of the body in the supported supine lying positioning, for postural care and in the supported yoga posture of Savasana.  These positions gain benefit of relaxation and elongation of the body via gravity and prop support at key bodily regions.

Click here to read the full article.



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Physical Therapists and Yoga Teachers Collaboration.

Why Collaborate?

Having studied with several different yoga disciplines over the years, I've discovered a fascinating world of knowledge that allows me to integrate yoga postures, breathing and other principles with my physical therapy treatment modalities. Through yoga studies, I've met dedicated people who use a different language to describe the same movements we deal with in physical therapy.

Many yoga teachers are able to instruct therapeutic exercises that are at times more beneficial, interesting and effective than the options physical therapists can offer. Physical therapists can learn from this group, and adapt and accommodate this knowledge to benefit patients under their care. Sharing our professional knowledge in anatomy, physiology and biomechanics can benefit both groups and the public at large.

Most experienced yoga teachers understand movement and movement dysfunction from experiential aspects. I've found that as a result, their level of understanding of posture and movement is often deeper than those of most PTs.

The collaborative model is not a new idea. Many physical therapists are already sharing their knowledge with yoga teachers and practitioners. Others are teaching yoga themselves, while still others strongly integrate their treatment philosophy with yoga principles.

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Understanding Body Image in Women with Disabilities can help tailor Rehab accordingly

Women with disabilities bring a range of experiences, attitudes and feelings about their bodies all of which shape the rehab process. The more we understand about a woman’s image of her own body with all the feelings and history underlying it the better we can tailor a therapy program that meets her physical and emotional needs.

Many women with disabilities who are referred to physical therapy have been in therapy before. This is particularly true for women who have been disabled since childhood. I have been a therapist for many years and have treated children in the past. I have often heard about positive childhood experiences, but also discovered that many women recalled negative childhood experiences of therapy. I was interested in hearing the recollections of these women to help me understand how childhood experiences might affect their attitudes toward physical therapy as adults. K, who has cerebral palsy and came to rehab to deal with back pain, says, "I had physical therapy when I was a child, and my emotional and physical memories about that time are mixed. Therapists used to own body. I remember myself as a child crying when they were stretching my legs with force. However, I also remember the smell of the vinyl from the exercise mat when I was allowed to be playful, crawl freely and explore my own bodily movements." L, who also has cerebral palsy, does not have any positive memories about therapy. "All I remember as a child is pain. The physical therapist was very nasty with me". In reaction to my need to rest, she would say "Oh, you are just lazy." When I said I was tired and unable to climb the stairs, she would say, "Yes you can," without any sympathy or supporting emotions to my own personal struggle. Therapists used to have [so much control over my desires and my body. Such histories teach me that women with disabilities must be equal partners in the rehab process. To that end, they must actively participate in setting goals and designing the program. In fact, this is the underlying philosophy in all the work I do. Each woman needs to feel in control of her body and what happens to it in the therapy room. To address these issues, I tell a woman beforehand how I will be moving or positioning her body and ask her permission. While she may experience some discomfort (it is inevitable with certain types of stretching), she is at least prepared for it. Therefore, the experience may not feel as invasive and unpleasant. Regardless of whether women with disabilities have had physical therapy before, certain parts of the body raise strong feelings and emotions in them. Such feelings need to be recognized and respected.

For example, the pelvis and hips are often the prime focus of therapy, particularly for women. Yet, they are quite interconnected with sexuality and personal hygiene, as well as walking and standing. Sometimes, the legs need to be placed apart at the hips, which can cause a heightened sense of exposure and vulnerability.

As a physical therapist, I advocate for body symmetry. But this sometimes is misinterpreted by a woman as one more demand for normalcy. It is not. Rather, asymmetry brings health-related consequences I seek to mitigate. For instance, asymmetrical postures in wheelchairs may lead to pain and scoliosis, among other things. Similarly, asymmetrical walking patterns may lead to uneven stress on joints, resulting in pain and premature arthritis.

  B describes some of the benefits of these positions.  "The accumulative experience of my disability sometimes drains me. There is physical discomfort, frustration and fear of the long-term effects on my reserves. It takes more determination to get anything done, which discourages me from doing more and creates an almost bottomless, insatiable sense of need. But the passive restorative postures restore my equilibrium and stretch me in many ways, which dissolve my inertia and replenish me."

Original article was published Advance for directors in Rehabilitation March 2003 VOL. 12 NO. 3

It had images Images:

By artist Ellen Clark

and by artist Melina

And line drawing by  Dalia Zwick

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