Pressure Ulcer Prevention and Treatment Following Spinal Cord Injury - 62

62

PRESSURE ULCER PREVENTION AND TREATMENT FOLLOWING SPINAL CORD INJURY

sagittal plane (80%) and frontal plane (20%).
These posture shifts caused an increase of 2.2%
in the subcutaneous tissue oxygen saturation
(SO2), suggesting increased tissue viability.
Pressure relieving and redistributing
maneuvers are a critical element of pressure
reduction (DeLateur et al., 1976). Historically,
pressure redistribution have been recommended
every 30 minutes for 30 seconds or every 60
minutes for 1 minute to allow reoxygenation of
the cutaneous tissues (Nixon, 1985). Research
has shown that the previously accepted duration
parameters may not be sufficient to allow for
raising transcutaneous oxygen tension to
unloaded levels and that a duration of almost 2
minutes may be required (Coggrave & Rose,
2003; Barnett & Shelton, 1997). Obesity may
reduce one's ability to perform adequate pressure
redistribution and safe transfers. Obesity
associated with excess rolls of soft tissue can lead
to the development of skin breakdown on other
parts of the body, due to these skin folds retaining
moisture and bacteria and causing pressure on
other areas.

Wheelchair Support Surfaces
24. Prescribe wheelchair seating systems for
each person with a spinal cord injury
individualized to anthropometric fit, to
provide optimal ergonomics, and to provide
maximal function.


Prescribe wheelchair seating
systems that-
* Redistribute pressure
* Minimize shear
* Provide comfort and stability
* Reduce heat and moisture
* Enhance functional activity



Inspect and maintain all wheelchair
cushions at regular scheduled intervals.



Replace wheelchair seating systems that
are no longer effective.

(Scientific evidence-II, III, IV V; Grade of
,
recommendation-B; Strength of panel opinion-Strong)

Interface pressures at the ischial tuberosities
are higher while sitting than lying down and must
be relieved frequently to prevent tissue injury.
When the pressure on the ulcer can be relieved
by either assisted or self-mobility, limited sitting
may be allowed (Bergstrom et al., 1994).
It may be necessary to prescribe a specific
wheelchair back support to minimize unequal

weight bearing or shearing over the pelvis from
an unstable trunk posture. Standard wheelchair
seat and back upholstery is made of materials
that tend to "sling and stretch" with use. Yarkony
and Chen (1996) state "one of the most common
problems arises from the basic wheelchair design,
since the basic sling seat and back can result in
pelvic obliquity and kyphotic posture, with
increased risk of pressure ulcers, deformity, and
discomfort." Postural management is a significant
determinant of proper seating of individuals.
Postural instability can result from absent or
weakened musculature, imbalanced muscle tone,
orthopedic deformities, sensory deficits, or
inadequately fitting support devices. Sitting
posture was found to influence ischial pressure,
and the final pressure distribution over the sitting
surface was dependent on lateral pelvic tilt
(Hobson, 1992; Koo et al., 1996). The use of
contoured back supports can minimize unequal
weight bearing, reduce shear forces on the pelvis,
and stabilize trunk posture. Proper selection of
seat and back supports can effectively solve
postural seating problems (Buschbacher et al.,
1996). Health-care professionals involved in the
recommendation of wheelchair back supports
should be knowledgeable about solving problems
related to postural seating difficulties
(Buschbacher et al., 1996).
Improving center of pressure weight shifts,
especially in the sagittal plane should be
incorporated into rehabilitation programs for
persons with SCI. Evidence suggests that impaired
dynamic sitting stability is associated with
pressure ulcer development (Karatas et al., 2008).
There are many commercially available,
custom-fabricated wheelchair seat cushions on
the market, but not one of them has pressure
ulcer prevention capacity for all individuals who
have sustained SCI (DeLateur et al., 1976;
Krouskop et al., 1983). The primary purpose of
cushion use is to reduce excessive pressure over
the bony prominences and thereby aid in the
prevention of pressure ulcer formation. The initial
cushion prescribed for an individual may not be
appropriate over the lifetime of the user (Garber,
1985; Krouskop et al., 1983) and should be
reassessed on a frequent basis for function, fit,
and condition. Cushion selection should be based
on a combination of clinical knowledge, pressure
mapping, skin tolerance history, history of
pressure ulcers, and other individual
characteristics. Factors to be considered during a
cushion evaluation include pressure-redistribution
and shear-reducing qualities, comfort, postural
support, functional activity level, ADL
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
