An exploration of comfort and discomfort amongst children and young people with severe physical, learning and communication difficulties who depend on postural management equipment

Lyons, Elizabeth (2013) An exploration of comfort and discomfort amongst children and young people with severe physical, learning and communication difficulties who depend on postural management equipment. Doctoral thesis, Northumbria University.

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Abstract

The natural response to the intrusive bodily sensation of discomfort is positional change. The purpose of this study was to explore how children and young people with profound physical, learning and communication difficulties, largely dependent on others to gauge their need for positional change, have their comfort needs met when using postural management equipment.

Thirteen qualitative case studies were undertaken. Nine of the participants attended a special needs education primary or secondary school, two were in transition to school and two attended day services. All participants had a neurodevelopmental disability, with each being the focus of one case study. Parents, teachers, therapists and key support staff were interviewed, and the school or day centre routines of the children and young people were observed, with selective video recording. Single case and cross case analyses were undertaken.

The findings showed threats to comfort include the restrictive nature of various accessories, hastiness of care tasks producing positioning errors and the procedural stretching of tissues prior to application. Opportunities for lessening discomfort included scheduled daily routines and time out of postural management equipment. Equipment use for the children and young people in this study was intrinsically coupled with care giving. Attentive caregivers read the behavioural expressions of the children and young people and reassuringly responded, safeguarding them from discomforting experiences. This maximised each individual‘s adaptive functioning, without compromising the benefits of postural support.

This study highlights that the same item of equipment can be both comfortable and uncomfortable. Given the social and interactional world in which the children and young people live and learn, and the complex nature of their difficulties, it is others who must accept responsibility for ensuring their optimal level of comfort.

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