Document Type


Publication/Presentation Date

February 2020


BACKGROUND Nighttime postural care (NTPC), an intervention using sleep-systems to position the body symmetrically during sleep, is particularly suited for children with severe Cerebral Palsy (CP); however, its impact yields mixed conclusions (Wynn & Wickham, 2009; Gericke, 2006).This variation may be due to the types of assessments used and lack of effective caregiver training.AIM of DISSERTATION 1) examine sleep-based measures used in previous NTPC research and 2) investigate the "sleep care positioning training program’s" (Lesson A), an online NTPC training program, feasibility to educate caregivers.METHOD Completed studies include: 1) systematic literature review of NTPC sleep-based measures and 2) randomized control trial, comparing caregiver competence pre and post educational intervention. Investigators randomized 38 participants into groups (Lesson A or Lesson B) to complete differently formatted 2-hour online training (interactive video-based or self-guided web-links) on topics of NTPC evidence, risk monitoring, sleep-system types and set up, positioning methods, and outcome measures.RESULTS 1). Systematic review revealed no sleep-based measures used in past NTPC intervention research are fully suitable as outcome measures for children with severe CP. 2) Randomized trial showed Lesson A group had significantly greater change in self-rated competence for NTPC implementation (0.46 points [SE 0.17], p = 0.0078). Subjective themes describe Lesson A as a better lesson matching my learning style and Lesson B as overwhelming, not knowing what I was supposed to learn. Post-training, Lesson A and B groups correctly completed 11.85 [SE 0.83] and 12.60 [SE 0.84] of 16 positioning-tasks, not differing significantly (average difference 0.75 items [SE 0.54], p = 0.17). Professionals performed significantly better than non-professionals (F(1,92.34) = 16.62, p < 0.0001). Commonly missed tasks include “placing head/neck in neutral” and “snugging up parts”, with more error variation among Lesson B group.INTERPRETATION 1) To capture meaningful change and understand NTPC’s impact on sleep, combined use of the Sleep Disturbance Scale for Children-R and triaxial actigraph may be recommended for children with severe CP. 2) Sleep care positioning education caused increased perceived competence for health professionals and non-professionals. Post online-training caregivers accurately completed most sleep-system positioning tasks. Lesson A better prepares NTPC caregivers.* The Sleep Care Positioning Training Program, revised version of Lesson A, can be found at