Module 8 - Pressure Management
Identifying seating issues for pressure management
Pressure issues are identified during the referral and interview process in Module 2 and skin check in Module 3:
- where are the risk areas/pressure ulcers?
- what is the stage of ulcer?
- how frequent are the ulcers?
- how did the ulcers occur?
Further investigations are conducted through assessment of posture, balance and function (Module 3), body dimension (Module 4) and evaluation of current seating and mobility system (Module 5) to identify:
- issues with wheelchair/seating products or set-up not matching client's body size and shape to maximise support surface and even distribution of pressure
- issues with postural asymmetry leading to uneven weight distribution
- issues with postural instability for functional tasks leading to shear/friction forces
- issues with damaged and worn support surfaces leading to possible trauma, injury or ineffective pressure distribution/postural support and/or
- issues with client's ability to weight shift or correctly maintain pressure care equipment in current system.
Key principles to address pressure issues in seating and wheeled mobility systems:
1. The greater the contact area of the support surface, the lesser the pressure exerted at the skin's surface by the body weight (Pressure = Force/Area of contact)
2. A symmetrical posture promotes even weight distribution on the support surface
3. A stable posture reduces undesirable movement of the skeleton on the support surface and thus minimises shear
4. Pressure management in the seating and wheeled mobility system should be individualised to the client's functional ability for effective weight shift and pressure care management.
Specialised seating services also utilise custom design and fabricated products to "off load" pressure or redirect forces from skin areas of concern. These products include Contour foam cushion/Perth cushion/Isch-dish cushion, spinal process 'cut-outs'/'channelling'. The design principles involved with these fabricated cushions require expert assessment and evaluation. Changes from fabricated products to commercial products should be made in consultation with the Spinal Seating Services.
The use of a "doughnut cushion" for the treatment of pressure ulcer is discouraged as it forms a circle of high pressure around the wound and can reduce blood flow to the wound.
Click to see video " Pressure management in seating and wheeled mobility".