The Two Types of Posturing

At a trauma, I am known to focus on the airway and the airway alone. Although, once the airway is stabilized and I am bagging. Or once the airway is stabilized and I have the patient on a ventilator. I have time to assess the entire patient. Or, you hear what the doctors and nurses are saying about the patient. And often times you hear about posturing.  "The patient is posturing." 

I have always known that posturing is a sign of brain injury. But I never really put much thought into what posturing really is or what it represents. That is, until today. Yesterday we had a trauma that involved a young man. We intubated him, stabilized him as best we could, and sent him packing via helecopter to a trauma center. 

Today the nurses were talking about posturing. And they noted that there are two kinds of posturing. One type was the good kind, meaning there was hope. The other kind was the bad kind and meant that there was little hope the person would come out o

Decorticate. This is where the legs become stiff and rigid. The feet are stiff and pointed downward towards the ground or the end of the bed. The hands are flexed upward and inwards as though holding onto the chest. . (1)

Decerebrate. The arms and legs are held straight out. The toes are pointed downward. The fingers are curled up. The head and neck are arched backward.  (2)

Both are signs of severe trauma. But decerebrate is generally considered the worse kind. It means there is damage below the red nucleus of the brain. This is a section of the brain in the middle. Decorticate is a less common type of posturing. But it is associated with better survival rates. (3)

References.

1.  "Decerebrate Posturing," Mayo Clinic, https://my.clevelandclinic.org/health/symptoms/24969-decorticate-posturing#:~:text=What%20is%20decorticate%20posturing%3F,body%20to%20reflexively%20tense%20up., accessed 7/2/2023
2. "Decerebrate Posturing," Medline Plus, https://medlineplus.gov/ency/article/003299.htm#:~:text=Decerebrate%20posture%20is%20an%20abnormal,severe%20damage%20to%20the%20brain., accessed 7/2/20231
3. Denslow, Elizabeth, "Posturing After Brain Injury: Types and Recovery Outlook," Flint Rehab, August 21, 2021, https://www.flintrehab.com/posturing-brain-injury/#:~:text=Although%20rarer%20than%20decerebrate%20posturing,or%20right)%20than%20decerebrate%20posturing., accessed 7/2/2023