If possible, the patient is placed in a prone position for 15 to 30 minutes several times a
day. A small pillow or a support is placed under the pelvis, extending from the level of
the umbilicus to the upper third of the thigh (Fig. 62-4). This position helps to promote
hyperextension of the hip joints, which is essential for normal gait and helps prevent
knee and hip flexion contractures. The prone position also helps to drain bronchial
secretions and prevents contractural deformities of the shoulders and knees. During
positioning, it is important to reduce pressure and change position frequently to prevent
pressure ulcers.
Establishing an Exercise Program
The affected extremities are exercised passively and put through a full range of motion
four or five times a day to maintain joint mobility, regain motor control, prevent
contractures in the paralyzed extremity, prevent further deterioration of the
neuromuscular system, and enhance circulation. Exercise is helpful in preventing
venous stasis, which may predispose the patient to thrombosis and pulmonary embolus.
Repetition of an activity forms new pathways in the CNS and therefore encourages new
patterns of motion. At first, the extremities are usually flaccid. If tightness occurs in
any area, the range-of-motion exercises should be performed more frequently (see
Chapter 11).
The patient is observed for signs and symptoms that may indicate pulmonary embolus
or excessive cardiac workload during exercise; these include shortness of breath, chest
pain, cyanosis, and increasing pulse rate with exercise. Frequent short periods of
exercise always are preferable to longer periods at infrequent intervals. Regularity in
exercise is most important. Improvement in muscle strength and maintenance of range
of motion can be achieved only through daily exercise.
The patient is encouraged and reminded to exercise the unaffected side at intervals
throughout the day. It is helpful to develop a written schedule to remind the patient of
the exercise activities. The nurse supervises and supports the patient during these
activities. The patient can be taught to put the unaffected leg under the affected one to
assist in moving it when turning and exercising. Flexibility, strengthening,
coordination, endurance, and balancing exercises prepare the patient for ambulation.