Hi Maggie!
All great questions!
For the supine position, there can be many reasons. First, the supine position can put a patient at a risk for increase in intracranial pressure due to reduced venous outflow from the brain, especially if the head and neck are not in midline. The can also be an aspiration risk if their is an impaired cough/gag reflex. At times, a supine position can promote abnormal posturing – like an extensor posture. A true supine posture can also be a very overstimulating position for patients, too. So for all of these reasons, supine is typically avoided.
Semi-prone is a modified sidelying position. This position facilitates a more flexed posture and inhibits that extensor tone. It can support a more midline posture of the head and improve secretion management and airway safety for patients. It can also be an overall more calming and pleasant sensory position for patients.
You’re also right to think that all of this can be helpful with bed sores too. But it is also all helpful in terms of neuroprotective positioning.
For the passive range of motion question, I think the main thing here is that there is limited evidence to show that a PT doing passive range of motion exercises is helpful, rather the use of splints and serial casting is what is helpful for maintaining/gaining range of motion. You doing passive range of motion for 5-10 minutes is not doing anything, only long term static stretching devices are doing this (similar thought as to why we don’t stretch kids with CP, we aren’t doing anything, only long term bracing/serial casting is actually making changes). If anything, our stretching may be agitating and causing more harm than good. So, avoid this and focus on more function based activities with these patients if possible.
I hope this helps! Let me know if you have any other questions!
Jessica