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Awareness of the risk of spinal-cord damage in moving an unconscious person with a suspected neck injury into the “lateral recovery position,” coupled with the even greater risk of inadequate airway management if the person is not moved, has resulted in a suggested modification to the lateral recovery position for use in this circumstance.
It is proposed that the modification to the lateral recovery position reduces movement of the neck. In this modification, one of the patient's arms is raised above the head (in full abduction) to support the head and neck. The position is called the “HAINES modified recovery position.” HAINES is an acronym for High Arm IN Endangered Spine.
Neck movements in two healthy volunteers were measured by the use of video-image analysis and radiographic studies when the volunteers were rolled from the supine position to both the lateral recovery position and the HAINES modified recovery position.
For both subjects, the total degree of lateral flexion of the cervical spine in the HAINES modified recovery position was less than half of that measured during use of the lateral recovery position (while an open airway was maintained in each).
An unconscious person with a suspected neck injury should be positioned in the HAINES modified recovery position. There is less neck movement (and less degree of lateral angulation) than when the lateral recovery position is used, and, therefore, HAINES use carries less risk of spinal-cord damage.
The physiotherapist has a range of responsibilities in functional psychiatric disorders. In addition to treating the physical conditions encountered in an aging population and those more specific to this group of patients, the physiotherapist is responsible for the education of patients, their family, carers and fellow staff members. As a member of the multidisciplinary team, the physiotherapist contributes a sophisticated understanding of normal and abnormal movement and the means of therapeutic intervention for movement problems to the treatment program.
Role of the physiotherapist
In the management of all psychiatric disorders a mature approach is required to assist patients with lack of motivation, cognitive problems and a variety of functional deficits. Physiotherapists undertaking the management of patients with functional psychiatric disorders should possess comprehensive knowledge and skills in cardiothoracic, neurological and musculoskeletal physiotherapy and in techniques of behavioral management. They must understand the normal psychophysiology of aging and the effects of superimposed pathology.
Patients are seen in the context of all the factors impinging on their lives and all health professionals should be aware of the integration between mind and body. Moon (1988) argues that the increasing knowledge in mental health should be absorbed into physiotherapy so that ‘all treatment approaches acknowledge the intrinsic unity between the mind and the body’. This is supported by Katona (1991) who reports that depression is found more often in the elderly with poor physical health than in the physically healthy.
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