Preventing Pressure Ulcers Among Wheelchair Users

Why It Is Important To Do This Review

Pressure ulcers commonly occur amongst wheelchair users, therefore identification of strategies which reduce recovery time is important . Bed rest may or may not be an effective treatment for pressure ulcers in wheelchair users the balance of benefits and risks associated with bed rest must be assessed systematically. Although there have been many reports of bed rest as a modality for pressure ulcer management, many of these reports appear to have been underpinned by anecdotal evidence, or have been subjected to little critical scrutiny , so overall, the precise impact of bed rest is unclear. Therefore, it was important to search and appraise the literature systematically in order to determine the impact of bed rest on the management of pressure ulcers in wheelchair users.

Xsensors Wheelchair Pressure Mapping System

Wheelchair users continue to experience a higher number of pressure injuriesdespite how wheelchairs and cushions have continued to adapt and improve over time.

At XSENSOR, weve combined global innovation with scientific expertise to create interface pressure management technologies that help to measure pressure points and provide the most benefit when used proactively. By working to mitigate and prevent pressure development, we enable healthcare professionals to provide preventative care and patients to live more comfortable, healthy lives in their wheelchairs.

Our advanced pressure imaging system for wheelchair seatingForeSite SSis the market leader. This technology is medically certified but also requires minimal training, which makes it ideal for busy medical professionals and their patients.

Combining top-tier sensor accuracy and clear, high-resolution images with smart, easy-to-use software, the ForeSite SS system helps clinicians ensure their clients have comfortable and effective wheelchair seating that also monitors skin pressure. This helps to prevent sores from developing, alleviates painful, dangerous injuries and ultimately offers better patient care for wheelchair patients.

Pressure Relief Behaviour And The Prevention Of Pressure Ulcers In Wheelchair Users In The Community

This study aims to provide an insight into wheelchair users’ preventative health behaviours with respect to pressure-relief behaviour, perceived risk and attribution of responsibility for preventative health measures. Wheelchair users who are dependent upon a wheelchair for their indoor and outdoor mobility have a long-term risk of developing a pressure ulcer. In an attempt to lessen the risk they need to perform pressure- relieving movements frequently. The Department of Health’ currently advises wheelchair users to perform a pressure-relieving movement every 15 minutes. Many wheelchair users responding to this largescale survey reported that although they were physically capable of performing pressure-relieving movements without help, they either did not do them or did not adhere to current advice. Of those who responded, 20.8% moved only once an hour and a further 54.7% moved less often than once an hour. This study is part of a wider study investigating the preventative health behaviours of wheelchair users.

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Express Comfort Contoured Gel Foam Wheelchair Cushion

The Express Comfort Contoured Gel Foam Wheelchair Cushion by the Comfort Company offers a cooling sensation, which not only improves someoneâs comfort but it allows the skin to breathe better while seated. The gel is one of the most sought-after materials for pressure relief cushions, since people find them to be optimally durable and accommodating.

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Preventing Pressure Ulcers Among Wheelchair Users: Preliminary Comments On The Development Of A Self

The prevalence of pressure ulcers among permanent wheelchair users remains high. While many risk factors for pressure ulcer development in this group have been identified only a minority of these have been evaluated scientifically and it is generally acknowledged that existing risk assessment tools are inadequate for predicting risk in seated persons who use a wheelchair for mobility. A 2-year prospective study is underway to design a new self administered pressure ulcer risk indicator to be used by non-ambulant wheelchair users. and their carers in conjunction with professionals. This instrument will be designed as a result of triangulation of methods.

A systematic review of available evidence

Latest professional opinion

A qualitative study exploring the issues from the perspective of seated persons with a history of pressure ulcers undertaken by one of the authors

A 2-year prospective study identifying key risk factors in a sample of 160 seated persons.

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Who Gets Pressure Sores

Pressure injuries can happen to anyone who spends too much time sitting or lying down in one place. People who are most susceptible to pressure injuries include those that are:

• In bed or sitting most of the day with little movement
• Without full bowel or bladder control
• Chronically experiencing decreased feeling in certain areas of the body
• Are often stuck in one position for long periods of time

Pressure Relief Exercises For Wheelchair Users

Relieving pressure from a certain part of the body requires dispersing that pressure to another part of the body. Ideally, this pressure should be spread across a persons body as evenly as possible to lessen the chance of pressure sores developing.

One of the best pressure injury prevention & relief techniques for wheelchair users is to regularly carry out specific pressure relieving movements.

It is important to ensure that wheelchair wheels are locked, and any belts are undone before attempting any exercises.

Here are some popular exercises to try:

• The push-up Use the wheelchair armrests to push up out of the seat with your arms. You should straighten your arms fully so that your elbows are locked. Then ensure that the buttocks and lower back are fully out of the seat.
• The forward lean Lean forward as far as you can imagine that you are trying to rest your chest on your knees! This movement is particularly good for relieving pressure on the coccyx.
• Leaning side-to-side Whilst seated, shift your body weight onto your left side to lift your right side out of your seat. Then repeat on the other side. Like the push-up, this movement relieves pressure from the buttocks and the lower back. Because this is a more subtle movement its easier to perform whilst youre out and about.

The purpose of these exercises is to shift your body weight around in the wheelchair, relieving pressure from the areas where it is most commonly felt.

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Pressure Sores In Wheelchair Users

For people who use wheelchairs, the risk of developing pressure sores is real. This is because sitting in a wheelchair for long periods can put a lot of pressure on specific body parts. Did you know that an estimated 85% of people who use wheelchairs will experience a pressure sore at some point in their lives? In this blog post, we will discuss why pressure sores in wheelchair users happen, and we will also provide some tips on how to prevent them from happening!

If you are a wheelchair user, there are a few things that you can do to prevent pressure sores from developing. First of all, it is essential to make sure that you are sitting in your wheelchair correctly.

This means that your bottom should be back in the seat, and your knees should be at a 90-degree angle. You also want to make sure that you are not sitting on any wrinkles in the fabric of your wheelchair seat, as this can create additional pressure points.

Additionally, it is important to change positions while sitting in your wheelchair regularly. Every 20 minutes or so, try to shift your weight around a bit to distribute the pressure on your body evenly. Finally, make sure to practice.

Description Of The Condition

A pressure ulcer is defined as a “localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers the primary of which is impaired mobility” . Pressure is the amount of force acting on a unit of area . Shear forces occur in soft tissue when these tissues are stretched, which happens when the bony structures move but the skin is stationary . Pressure ulcers commonly occur in individuals who have reduced activity and/or mobility and so are exposed to prolonged periods of exposure to sustained pressure/shear forces . Elderly with reduced activity/mobility, people with spinal cord injury and those who are sedated following trauma or surgery are at increased risk of pressure ulcer development , however, potentially any person of any age could develop a pressure ulcer if he/she were exposed to the causative factors, that is, sustained unrelieved pressure and shear .

Pressure ulcers vary in severity. One of the most widely recognised systems for categorising pressure ulcers is the National Pressure Ulcer Advisory Panel system, which is summarised below .

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Practices For Reducing Pressure Sores On Buttocks

When a person spends a lot of time sitting in a wheelchair, they are more susceptible to developing injuryespecially on an area of intense pressure like the buttocks. However, those sitting in wheelchairs can also develop pressure sores on the backs of their thighs, their lower back and the folds of their knees. Certain practices can help to reduce injuries from occurring.

Keep skin clean and dry: Moist skin creates an atmosphere where a sore can develop quickly, so keeping the skin dry when in a wheelchair can help. Regular bathing is another important preventive skin care measure, as bacteria increases the risk of infection in a developing sore.

Implement softer seating: Sitting in a wheelchair consistently can become uncomfortable, and excess pressure increases the risk of developing a pressure injury on the buttocks. Consider adding a seat cushion or gel cover to the wheelchair seat to soften the surface and help relieve the pressure.

Reposition consistently: Oftentimes, those in wheelchairs are partially immobile but that doesnt mean movement isnt possible. Whether by implementing a repositioning schedule or intentionally getting out of the chair when possible, consistent repositioning is essential for relieving pressure.

B Searching For The Evidence: Literature Search Strategies For Identification Of Relevant Studies To Answer The Key Questions

Literature Sources

We will search Ovid MEDLINE®, CINAHL®, EBM Reviews, including the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, and Health Technology Assessments.

Additional literature will be identified by reviewing the reference lists of articles and from recommendations from the TEP and peer reviewers.

Device manufacturers will have the opportunity to submit data for this review by using the portal for submitting scientific information packets on the Effective Health Care Program Web site .

Dual Review

Pre-established criteria will be used to determine eligibility for inclusion and exclusion of abstracts. To ensure accuracy, all excluded abstracts will be dual reviewed. All citations deemed appropriate for inclusion by at least one of the reviewers will be retrieved.

Each full-text article will be independently reviewed for eligibility by two team members. Any disagreements will be resolved by consensus.

Note: The comprehensive search strategies are available in the Appendix.

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Treatment For Pressure Sores

There are a variety of treatments available to manage pressure sores and promote healing, depending on the severity of the pressure sore. These include:

• regular position changes
• special mattresses and beds that reduce pressure
• being aware of the importance of maintaining healthy diet and nutrition
• dressings to keep the sore moist and the surrounding skin dry. There is no advantage of one type of dressing over another.
• saline gauze dressing may be used if ointments or other dressings are unavailable.
• light packing of any empty skin spaces with dressings to help prevent infection
• regular cleaning with appropriate solutions, depending on the stage of the sore
• there is no advantage of one particular type of antiseptic or antibiotic treatment over another
• specific drugs and chemicals applied to the area, if an infection persists
• surgery to remove the damaged tissue that involves thorough debridement of the wound, the removal of underlying or exposed bone, and filling the empty space
• operations to close the wound, using skin grafts if necessary
• continuing supportive lifestyle habits such as eating a healthy and nutritious diet, as suggested by the nutritional staff.

Pros And Cons Of Gel Cushions For Wheelchair

Gel wheelchair cushions are usually designed to have vicious gel pouches that are attached to a high-density foam base thus, they are meant to provide exceptional pressure distribution allowing the cushion surface to conform to its user.

Their gel bladders make for body temperature regulation and enhance blood circulation.

If you are in need of wheelchair cushions with the following needs, then the gel wheelchair is for you.

• Regulation of body temperature and prevention of sweaty skin
• Enhanced posture and sitting stability
• Provision of exceptional pressure relief
• Requires low maintenance

However, gel wheelchair cushions are not ideal for those searching for cushions with the following characteristics.

• Not susceptible to ruptures

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If You Use A Wheelchair

Make sure your wheelchair is the right size for you.

• Have your doctor or physical therapist check the fit once or twice a year.
• If you gain weight, ask your doctor or physical therapist to check how you fit your wheelchair.
• If you feel pressure anywhere, have your doctor or physical therapist check your wheelchair.

Sit on a foam or gel seat cushion that fits your wheelchair. Natural sheepskin pads are also helpful to reduce pressure on the skin. DO NOT sit on a donut-shaped cushions.

You or your caregiver should shift your weight in your wheelchair every 15 to 20 minutes. This will take pressure off certain areas and maintain blood flow:

• Lean to one side, then lean to the other side

If you transfer yourself , lift your body up with your arms. DO NOT drag yourself. If you are having trouble transferring into your wheelchair, ask a physical therapist to teach you the proper technique.

If your caregiver transfers you, make sure they know the proper way to move you.

Review Of Key Questions

For all EPC reviews, KQs were reviewed and refined as needed by the EPC with input from Key Informants and the TEP to assure that the questions are specific and explicit about what information is being reviewed. In addition, for Comparative Effectiveness reviews, the KQs were posted for public comment and finalized by the EPC after review of the comments.

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When You Are In Bed

Use a foam mattress or one that is filled with gel or air. Place pads under your bottom to absorb wetness to help keep your skin dry.

Use a soft pillow or a piece of soft foam between parts of your body that press against each other or against your mattress.

When you are lying on your side, put a pillow or foam between your knees and ankles.

When you are lying on your back, put a pillow or foam:

• Under your heels. Or, place a pillow under your calves to lift up your heels, another way to relieve pressure on your heels.
• Under your tailbone area.
• Under your shoulders and shoulder blades.
• Under your elbows.

Other tips are:

• DO NOT put pillows under your knees. It puts pressure on your heels.
• Never drag yourself to change your position or get in or out of bed. Dragging causes skin breakdown. Get help if you need moving in bed or getting in or out of bed.
• If someone else moves you, they should lift you or use a draw sheet to move you.
• Change your position every 1 to 2 hours to keep the pressure off any one spot.
• Sheets and clothing should be dry and smooth, with no wrinkles.
• Remove any objects such as pins, pencils or pens, or coins from your bed.
• DO NOT raise the head of your bed to more than a 30 degree angle. Being flatter keeps your body from sliding down. Sliding may harm your skin.
• Check your skin often for any areas of skin breakdown.

Padding Positioning And Turning In Bed

• Use a regular schedule of turning at night. Depending on weight and skin tolerance, your turning schedule may vary from every 2 to every 6 hours. Ask your health care provider for advice about a turning schedule. When turning and moving in bed, lift rather than slide across sheets.
• Use pillows and foam pads to protect bony areas. No two skin surfaces should rest against each other!
• Unless your doctor tells you to do it, avoid elevating the head of your bed, which can put too much pressure on your buttocks and lower back areas.
• For individuals at the highest risk for pressure sores, your health care provider may prescribe a special mattress, mattress overlay or bed for long-term use.

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What Type Of Cushion Is Best For Pressure Sores

While memory foam and gel cushions are among the best materials for wheelchair cushions, the latter has a slight advantage. Gel cushions alleviate or prevent skin redness, provide support, and help distribute your weight more effectively. A combination of the two types of cushions is also great. Of course, this doesnt mean you should ignore memory foam, which is durable. Sometimes its necessary to try different options before determining what works for you and meets your needs the most.

What Cushion Should Be Used For Residents With Impaired Skin Or At High Risk For Skin Breakdown

The best cushion for this purpose is an air cell cushion, which offers outstanding pressure redistribution and protection against wounds and pressure ulcers. In a nutshell, an air cushion is a type of fluid cushion that relies on compressed air as the lubrication medium. These cushions are beneficial for persons at high risk for skin breakdown and may aid in reducing the risk of developing pressure sores.

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