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Orthotics & Seating
Positioning Supports
A surgeon's perspective on positioning supports — what 24-hour postural management involves, why it matters for people with complex needs, and why it is led by therapists and orthotists.
Positioning supports are the equipment and strategies used to help people with complex physical needs maintain good, comfortable and safe positions throughout the day and night — in lying, sitting and standing. For people with significant neurological conditions or complex disability, this "postural management" is an important part of protecting comfort, function and, over time, body shape. As a spinal surgeon I sometimes care for such patients and understand how posture relates to the spine, but positioning supports and postural management programmes are led by physiotherapists, occupational therapists and orthotists — not by me. This page gives an honest, evidence-based overview from a surgeon's perspective.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
What positioning supports are
Positioning supports include a range of equipment used across the day and night to help maintain good posture: supportive seating, sleep or night-time positioning systems, standing support, and various cushions and supports. Together these form what is often called 24-hour postural management — a coordinated approach to how a person is supported in all positions. The aim is to keep them comfortable and well-supported, help maintain body symmetry and function, and reduce the risk of problems that can develop when someone spends long periods in poor positions.
Why postural management matters
For people with severe movement disorders, staying in the same position for long periods and being unable to reposition themselves can, over time, contribute to discomfort, asymmetry and changes in body shape, including of the spine and hips. The idea behind postural management is to support good positions throughout the 24-hour cycle in the hope of maintaining comfort and function and reducing these risks. It is particularly relevant in conditions such as cerebral palsy and other complex neurodisability. As a surgeon, I recognise how this connects to spinal shape, which is why I take an interest in it.
Who leads it
Postural management and positioning supports are led by physiotherapists, occupational therapists and orthotists with expertise in this area, often working as a team around the person and their family. They assess needs, provide and set up the equipment, and review it as things change, balancing support with comfort and practicality for daily life. My role, where I am involved in a patient's spinal care, is to understand their postural management and to communicate with the team — not to prescribe or run it. I defer to their expertise here.
What the evidence shows
The evidence on postural management is developing and, honestly, still limited in places. Systematic reviews of 24-hour postural management and of night-time positioning in cerebral palsy and similar conditions find some supportive evidence for benefits such as maintaining posture and comfort, while consistently noting that the quality and quantity of evidence is limited and that more research is needed. Guidance and consensus therefore support individualised postural management as part of care while acknowledging the uncertainty. This is why programmes are tailored by the therapy team to the individual.
What to expect
If positioning supports or a postural management programme are being considered, they are assessed, provided and reviewed by physiotherapists, occupational therapists and orthotists, tailored to the individual. Where I am involved in someone's spinal care, I will support and communicate with that team so that postural management and spinal treatment work together, but the programme itself sits with the therapy and orthotics specialists.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Mr Madi is a spinal surgeon; positioning supports and postural management are led by physiotherapists, occupational therapists and orthotists. Every patient is different, and the suitability, benefits and risks of positioning supports depend upon an individual's diagnosis, general health and personal circumstances. Decisions should always be made following consultation with your treating spinal surgeon, physiotherapist, occupational therapist, orthotist or healthcare professional.
Evidence & further reading
- —Osborne N, et al. Twenty-four-hour postural management: a systematic review. 2025. (PMID 40337627)
- —Gericke T. Postural management for children with cerebral palsy: consensus statement. Dev Med Child Neurol 2006. (PMID 16542509)
- —Livingstone R, Paleg G. Practice considerations for the introduction and use of power mobility and postural management. 2022. (PMID 35275575)
- —Gough M. Continuous postural management and the prevention of deformity in children with cerebral palsy. Dev Med Child Neurol 2009. (PMID 19191843)
- —Angsupaisal M, et al. Adaptive seating systems in children with cerebral palsy: systematic review. Dev Med Child Neurol 2015. (PMID 29295638)
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Every patient is different. The information on this page is a starting point — Mr Madi will tailor any plan to your specific imaging, symptoms and goals.