Education in Motion / Blog / April 2021 / Breaking the Cycle of Asymmetries Using 24-Hour Postural Management

Breaking the Cycle of Asymmetries Using 24-Hour Postural Management

For those of us who work with children with disabilities, we seem to intuitively know that if the child stays in one position too long, then the body will take the "shape" of that position, and if the position is not in good alignment, the child will begin to develop postural asymmetries. So, we try to create a program that offers alternative positioning throughout the day while supporting the child to prevent asymmetries.

The Cycle of Asymmetries

The Cycle of Asymmetries

Our goal is to break this cycle of asymmetries by using 24-hour postural management.

24-hour postural management is a planned program that considers all relevant positions a child uses throughout the day and intervenes to improve or maintain a body shape while promoting the child's function and development. It should then be incorporated into the child's everyday life at home, at school, and during social activities. The three core postural orientations are lying, sitting, and standing. However, postural management strategies should be applied across all activities from bathing to floor play to upright movement.

Healthy individuals can move freely in and out of lying, sitting, and standing for functional activities. When an individual has complex rehab needs, they are often unable to assume these positions, and therefore their functional ability has been compromised. Many times, an individual with complex rehab needs may be in a standing position for one hour, seated for 15 minutes, and lying down for seven hours in a given day. Because we know the effects of sitting for long periods of time, great attention has been given to seating systems. We know that good supportive seating provides an individual with a stable posture in sitting, creating a good foundation for function and promoting active participation in daily living.

Orientations for Positions

Lying orientation


  • Head in middle and comfortable
  • Spine straight, support on sides if needed
  • Hip and knees bent with lower back in neutral, support under knees if needed
  • Legs open and uncrossed, padding between knees if needed
  • Ankle in neutral, night resting splints if needed
  • Shoulders forward and supported
Sitting orientation


  • Head in middle and comfortable
  • Spine straight, support on sides if needed
  • Hip and knees bent with lower back in neutral, support under knees if needed
  • Legs opened and uncrossed, padding between knees if needed
  • Ankle in neutral, night resting splints if needed
  • Shoulders forward and supported
Standing orientation


  • Spine is straight
  • Hips facing the front
  • Neutral pelvis
  • Feet firmly on floor
  • Hips and knees aligned under pelvis
  • Upper extremities at sides or engaged in activity

Goal in all orientations is always a neutral body.

When the body is in an unsupported position, we know that gravity will negatively influence this position. These positions become habitual and eventually lead to obligatory positions and ultimately create non-reducible asymmetries. As the child ages, these harmful postures change the child's body shape. This often leads to the need for custom positioning equipment.

Let's also consider the amount of time someone with complex rehab needs may be in a standing position. Most times, it is inadequate, and therefore they spend the majority of their day in positions that result in loss of joint range of motion, shortened muscles, and muscle weakness. This ultimately causes changes to the spine and hips. It can also result in difficulties with respiration, digestion, and elimination, as well as reduced function and pain.

In 2020, Sunrise Medical welcomed the Leckey family to our family of seating and mobility complex rehab technology (CRT) products. Leckey products support the child's clinical needs to maintain posture, accessing the child's abilities to function on everyday tasks, and promoting comfort while using the equipment. This product line is specifically designed to achieve the clinical benefits of 24-hour postural management. These products can be your go-to line for the child with complex rehab needs and complements various products offered from the ZIPPIE line.

Leckey's full range of products can now offer a solution to those with all levels of ability from Mild to Moderate to Complex, and will take a child right through school to adulthood.

Leckey products provide positioning during all of the child's activities. These products are practical and fun while helping children with special needs participate in daily family life with optimal postural support.

A Day in the Life...

Morning (Getting ready)

  • Get dressed
  • Eat breakfast
  • Leave for school
Early Activity System

Early Activity System

Support for early intervention.

Squiggles Seating System

Squiggles Seating System

Postural needs for young children.

Daytime (School)

  • Circle time
  • Gym/playtime
  • Lunch
  • Leave for home
Everyday Activity Seat

Everyday Activity Seat

Basic positioning. Great for school activities.

Mygo Stander

Mygo Stander

3-in-1 stander for school-aged kids. Great for a school setting.

MyWay+ Gait Trainer

MyWay+ Gait Trainer

Core support from harness. Open front to allow for natural gait. Gait training from behind.

Afternoon (Family time)

  • Free time
  • Dinner
Mygo Seating System

Mygo Seating System

Optimal pediatric postural support. Grows with user. Adjustable height.

Squiggles+ Stander

Squiggles+ Stander

3-in-1 stander. Abducted standing.

Evening (Getting ready for bed)

  • Bath
  • Get dressed
  • Bed (sleep)
Advanced Bath Chair

Advance Bath Chair

Postural support while bathing. Multiple positioning.

Sleepform System

Sleep Systems

Postural support in an anti-gravity position.

When we evaluate our children with special needs, it is important that we not only look at their positioning for the time they are with us. We need to consider all aspects of their daily life: family/home, school, and entertainment. When we provide options for their positioning, we are not only improving their positioning, but also their social and communication opportunities. 24-hour positioning equipment is critical for a child's quality of life.

For more information on 24-hour postural management:

Linda Bollinger

Linda Bollinger, PT, DPT, ATP/SMS
Pediatric Sales Specialist
Sunrise Medical

Published: 4/19/2021

Related Products

Leckey Advance Bath Chair

LECKEY Advance Bath Chair

Bathing support - when things get slippery

Leckey Mygo Seating System

LECKEY Mygo Seating System

The optimum pediatric postural support seating system.

Leckey Squiggles+ Stander

LECKEY Squiggles+ Stander

Prone, upright, and supine standing in one product.


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