a. Requirements. Any position support device should meet the following
Promote good posture and conform to the part of the body being
Be firm enough to support the part, yet not cause undue pressure.
Be of sufficient size to support a part along its entire length.
Be clean and protected against moisture and body secretions.
b. Use of Support Devices. The reason for using a device should be explained
to the patient. He should be encouraged to participate to the extent possible in
maintaining good body alignment. Following is a description of the more common
(1) The Gatch bed. Raising and lowering the back and knee rests on the
adjustable Gatch bed provides support and allows for position changes, but there are
disadvantages that must be considered. When the back rest is elevated, the patient
tends to slide down in bed, with his body weight concentrated on the base of his spine.
This is undesirable. Elevation of the knee rest counteracts this to some extent, but
continued use of the knee rest causes undesirable pressure in the popliteal space
(behind the knee) and can lead to restrictions in the range movement of the knee and
hip. The Gatch bed should be used for variations in position and not as a substitute for
active movement of the patient.
(2) The footboard. When properly placed in relation to the patient's feet, the
footboard helps prevent foot drop (plantar flexion). The patient's feet should be
supported at right angles to the legs then he lies on his back. A padded board, a firm
pillow, or a blanket roll is braced between the end of the bed and the patient's feet.
Such a device also helps prevent the patient from sliding down in the bed, relieves the
pressure of bedding on the toes, and provides a resistant surface against which the
patient can push for exercise to maintain circulation and muscle tone. The board or
pillow roll should extend higher than the toes (figure 2-24).
(3) Pillows. These have multiple uses, but placement in relation to body
curves is essential. The standard-size pillow is often too large, but folded bath towels
placed in a pillowcase can be substituted when small, firm pillow support is
recommended. When the patient is supine or has the back rest elevated, the pillow
supporting the head should start well under the shoulders. (A common mistake is to
tuck the pillow behind the neck, forcing the head forward.) When pillows are used to
elevate a limb, they should be placed so that the entire limb is supported. Two or more
pillows may be required. It is important to remember that, unless otherwise ordered, the
foot or hand should be slightly higher than the rest of the limb. Arrange the pillows in
order to provide an inclined plane. In moving an injured arm or leg, place both hands