Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 23

CLINICAL PRACTICE GUIDELINE

pressure mapping, discussion of home and
community environments, exposure to seating
and mobility options, actual trial of various
systems, education of the person with SCI and
his or her caregivers, and collaboration of the
therapeutic seating team with a knowledgeable
complex medical equipment supplier, preferably
those with the assistive technology professional
(ATP) designation.
Ongoing assessments of the compatibility
of each individual and his or her equipment are
important as people change over time (Garber
and Krouskop, 1997; Chen et al., 2005). Routine
maintenance and replacement of parts reduce the
possibility that poor equipment conditions will
contribute to pressure ulcers. The very equipment
that has been selected to prevent pressure ulcers
may contribute to them if it is inappropriate,
inadequate, or poorly maintained.

Exercise
7. Implement an ongoing exercise regimen to
promote maintenance of skin integrity and
prevent contractures.
(Scientific evidence-III, V; Grade of recommendation-C;
Strength of panel opinion-Strong)

Maintaining physical endurance, mobility,
and joint range-of-motion is an appropriate goal
for most individuals (Bergstrom et al., 1992).
Immobility can adversely affect pulmonary
function, joint range of motion as well as muscle
strength and bulk. For individuals confined to bed
while they are being treated medically for
pressure ulcers, facilities may have protocols for
providing these patients with appropriate
exercises. Physical and occupational therapists
often are asked to intervene to prevent the
serious loss of function and independence that
results from imposed bed-rest. After pressure
ulcer surgical intervention, the rehabilitation
team, including the plastic surgeon, will modify
range-of-motion recommendations to prevent
dehiscence of the wound (Lewis, 1994). Facilityspecific protocols introducing range of motion of
the hips, are implemented when the patient is
cleared by. In addition, sitting on toilet seats can
put extreme on comprised or newly healed tissues
over the ischial tuberosities.
Participation in athletic activities have been
associated with less pressure ulcer development
in individuals with SCI of comparable age,
severity of spinal cord injury, and pre-injury
health. (Stotts, 1986).

Nutrition
8. Assess nutritional status, including dietary
intake, anthropometric measurements,
biochemical parameters (prealbumin, total
protein, albumin, hemoglobin, hematocrit,
and total lymphocyte count) fasting blood
sugar, liver function panel, folate, and
vitamin B12.
(Scientific evidence-II, III, IV V; Grade of
,
recommendation-B; Strength of panel opinion-Strong)

Although there is consensus that malnutrition
is a major risk factor related to the development
of pressure ulcers as well as the prolonged
healing of pressure ulcers in individuals with SCI
(Maklebust and Magnan, 1994; Vidal and Sarrias,
1991; Wagner et al., 1996), there is no universal
agreement of the definition of malnutrition. The
Academy of Nutrition and Dietetics and the
American Society for Parenteral and Enteral
Nutrition (A.S.P
.E.N.) has recommended two or
more of the following characteristics for the
diagnosis of malnutrition:
(1) Insufficient energy intake,
(2) weight loss,
(3) loss of muscle mass,
(4) loss of subcutaneous fat,
(5) localized or generalized fluid accumulation
that may sometimes mask weight loss, and
(6) diminished functional status as measured
by hand grip strength (White, J.V 2012).
.,
Although malnutrition and overall nutritional
status have been correlated with the development
and healing of pressure ulcers (Ek et al., 1991;
Strauss and Margolis, 1996), no single biomarker,
biochemical parameter or otherwise, of nutrition
has been identified as a strong predictor related
to prevention or healing of pressure ulcers. Serial
measurements of multiple biomarkers of
nutritional status to assess trends over time may
be the most fruitful method for estimating
baseline nutritional status and assessing the
response to a nutritional intervention.
Recommended evaluations should be interpreted
collectively, with consideration given to possible
non-nutritional factors, such as age, gender,
economic, psychosocial issues, over- or underhydration, drug-nutrient interactions, physiologic
stress, infection, and concurrent illnesses. This
comprehensive assessment and monitoring of
nutritional status can lead to appropriate
interventions for both prevention and healing of
pressure ulcers.

Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury

Table of Contents for the Digital Edition of Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury