Promoting function through supportive positioning – ABI Week

For individuals recovering from a brain injury, what constitutes a "good day" can vary enormously. Functional abilities, comfort levels, fatigue and cognitive clarity may change significantly from one day to the next. That unpredictability is part of the lived experience for many patients with acquired brain injury (ABI) and a core focus of this year’s Action for Brain Injury Week.

Supportive positioning is one of the most fundamental aspects of neurorehabilitation. Done well, it is shown to support functional performance, reduce secondary complications, and support physical and psychological wellbeing.

Why positioning matters

Positioning isn't just a matter of comfort, it’s a clinical strategy to optimise tone and alignment, facilitate task performance, reduce the risk of pressure injuries and contractures, support respiratory, digestive, and sensory function, and enhance engagement in therapy.

The British Society of Rehabilitation Medicine (BSRM) guidelines emphasise early, consistent, and personalised postural management from the acute stage through long-term care. Inconsistencies in posture and alignment can compound issues such as hypertonus, pain, fatigue, and functional asymmetries.

Postural needs change

After ABI, day-to-day function is typically inconsistent. As the BSRM and studies like Hassett et al. have shown, individuals can experience fluctuations in tone, awareness, fatigue and tolerance. That means positioning strategies should be responsive and dynamic, rather than fixed.

For example, a person who sits upright independently on a good day may require lateral supports, pelvic belts or footrests to maintain symmetry and prevent sliding on a more difficult and fatigued day. Factors such as time of day, level of tiredness, fluctuating tone, engagement, and recent activity all influence what "good positioning" looks like in the moment.

General principles of supportive positioning

• Align to enable - Position for midline orientation, neutral joint alignment, and weight distribution that allows the individual to participate in activity.
• Position with purpose - Think beyond "getting someone upright". Are they positioned to communicate? To eat? To access technology? To rest and recovery
• Prepare the environment - Ensure chairs, beds, trays, and supports match the person's size and need. Consider transfer aids and carer access too.
• Promote consistency - Document strategies clearly. Use visual guides, photos, or checklists if needed. Consistency can reduce the risk of regression.
• Review regularly - Posture should be reassessed frequently, as even small changes in function or presentation can demand a new approach

Positioning across contexts

Environmental context plays a pivotal role in how effective a positioning strategy will be. Whether someone is lying in bed, seated upright, or participating in therapy, the setting must be matched to their needs and tolerance on that day.

In bed, thoughtful positioning with pillows, wedges, or modular systems can help maintain joint alignment. For some, prone or side-lying positions, when clinically safe, might offer sensory and postural benefits.

In seated positions, the goal is to achieve both stability and functional engagement. Specialist seating with tilt-in-space functions, dynamic backrests, contoured cushions, and lateral or pelvic supports can be tailored to reduce effort and maximise comfort, especially on low-energy days.

During therapy sessions, positioning should enable optimal task performance. Supported standing frames, semi-reclined postures for endurance tasks, or active sitting for fine motor work all play a part. The goal is to meet the person where they are, while enabling progression.

Even at rest, positioning should be intentional. Restorative positioning helps avoid sensory overload, mitigates fatigue, and provides necessary breaks without risking regression in posture or comfort.

Spotlight on specialist equipment

Partnering with equipment providers enables therapists to select bespoke systems that adapt to day-to-day variation.

Tools such as tilt-in-space wheelchairs, modular seating with lateral and pelvic supports, pressure-redistributing cushions, adjustable height furniture, and headrests or trays can transform both comfort and participation. But success depends on proper setup and regular review.

On a good day... And on a harder one

On a good day, positioning can extend a person’s capacity to participate, communicate, and function. On a harder day, it becomes a safety net - maintaining comfort, preventing harm, and offering the opportunity for rest without regression.

For professionals supporting individuals with ABI, thoughtful positioning is an everyday intervention with long-term impact.

AJM Choice is committed to clinically led, person-centred mobility solutions for individuals living with acquired brain injury. To learn more or explore our equipment partners, visit ajmchoice.com.