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Last Updated on 11/11/2025 by Sarah Sarsby
Head positioning is critical not just for comfort, but to help with breathing, swallowing, vision, and communication. Occupational therapists must be able to navigate the clinical reasoning behind head support selection, including the impact of tone, asymmetry, and movement patterns, to ensure customers have the right one to match their specific needs.
This feature from Wendy Busby, Clinical Trainer at Sunrise Medical, a BHTA member company, will discuss how occupational therapists can balance stability with dynamic movement to support user engagement and independence.
Proper head positioning is a vital part of ensuring effective postural care for a patient. The right position will maintain spinal alignment, protect the skin, improve a patient’s visual field and support other essential functions such as respiration and swallowing. Moreover, it enhances a patient’s quality of life.
Head support is not an accessory but a fundamental part of the whole seating and positioning system. Finding the right head support is essential, but where should you start?
Before ordering any head support equipment, a mat evaluation should be carried out to determine the best postural alignment and support for the pelvis, trunk, and the rest of the body first. This process should then determine the available range of movement of the head and neck. Assessment should also look at other factors which will indicate a patients’ individual needs, such as how their head position affects their daily functional ability, visual field, and essential body functions. Effective head supports should aid management of excessive drooling, difficulty breathing, and reduction of pain wherever possible.
Simulating different head positions with your hands will help you to find the correct position. It will enable you to determine active movements, the amount and force of support required, and the location and size of the supports needed, both laterally and anteriorly.
Once you have confirmed the best head position with your hands, you can review the equipment options available and choose the items that will meet the posture of the patient and provide the most appropriate level of support. If needed, you can consult with other members of the multidisciplinary team (MDT) to ensure the equipment can be mounted on all the different seating that the patient uses, or check it can be replicated on them.
It is always important to consider the individual needs of a patient. For example, for patients with flexible asymmetries, consider corrective postures that allow for alignment of trunk and head, in conjunction with a suitable back support and cushion. Equally, for individuals with non-reducible asymmetries, you will need to respect the posture while providing support to prevent further deterioration. You should take into account how easy the equipment is to manage for the patient and the carer. For example, is it easy to remove if it must be out of the way for transfers in and out for the chair. Aesthetics are also an important factor for many patients, whether a head support is too bulky, uses too many accessories, or is simply unattractive.
Common symptoms which indicate that a patient’s head positioning needs to be assessed can include their head facing down, hyperextension of the neck and excessive drooling. It is best practice to analyse the cause of these symptoms to further support the patient. These could be linked to poor neck strength, pelvic misalignment, or even visual impairments.
Patients with progressive conditions might need additional support over time. Therefore, choosing a modular system with compatible hardware is necessary for longer-term support.
Proper postural care, including head positioning is just as important as finding the right wheelchair or scooter for a patient. As with all aspects of patient care, it is unique to the individual, and the right postural support can prevent future potential issues.
One of the key focuses of the government’s 10-year NHS restructure plan is around prioritising prevention over treatment, and the same approach should be taken with postural care.
The correct postural management, including head support, can help to prevent longer-term problems, such as issues with digestion and respiration, ski,n and spinal problems, as well as restricted movement.
The right training is integral to providing the best postural care.
Sunrise Medical, an adaptive wheelchair manufacturer, is offering free training courses on patient posture and seating care for NHS professionals.
These courses incorporate clinical guidance for professionals, as well as product training to demonstrate how innovative seating solutions can be integrated into patient care and enhance mobility, dignity and support.
The JAY Seating Masterclass will be taking place across 14 locations from 4 November to 12 March. The course will cover complex postures in seating and show ways professionals can get the most out of the available JAY cushions and JAY3 backrest. These solutions were designed to stabilise the pelvis, protect the skin, and position the body with seat width options ranging from 200mm to 760mm.
Sunrise Medical will also provide practical guidance on selecting and configuring solutions to meet a variety of postural needs.
To find out more about training opportunities and further guidance around postural care, visit sunrisemedical.co.uk/education-in-motion
Interested in contributing a view, guidance, or thought-leadership piece to the website? BHTA members should contact marketing@bhta.com to get involved.