Module 8 - Pressure Management
The Big Picture - setting the overall goal
1. Seating and wheeled mobility is customised to the client's body size and shape to optimise weight distribution and postural alignment.
2. Seating and wheeled mobility system supports and maintains the client's functional ability to self-manage pressure issues. It includes:
- enabling client to independently perform an effective weight shift, and
- providing adequate training of equipment usage and user guides, so that the system and pressure care products can be operated and maintained by client or carer.
According to "Pressure ulcer prevention and treatment following spinal cord injury" produced by the Consortium for Spinal Cord Medicine, the recommendations on wheelchair positioning in relation to pressure management are as follows:
Recommendation 30: Prescribe wheelchairs and seating systems according to individualized anthropometric, ergonomic and functional principles.
- Obtain specific body measurements for optimal selection of seating system dimensions
- Measure the effects of posture and deformity on interface pressure distribution
- Prescribe a power weight-shifting wheelchair system for individuals who are unable to independently perform an effective weight shift
- Use clinical judgment as well as objective data in determining the compatibility of the individual's shape with the seating system.
(Scientific evidence: II, III, V; Grade of recommendation: B, C; Strength of panel opinion: Strong)
Recommendation 31: Evaluate the individual's postural alignment, weight distribution, balance, stability and pressure reduction capabilities to establish a proper sitting schedule.
Read more on "Pressure ulcer prevention and treatment following spinal cord injury", published by Paralyzed Veterans of America - August 2000 (reviewed 2005).
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.
Click to see video " Pressure management in seating and wheeled mobility".
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 not recommanded as it forms a circle of high pressure around the wound and can reduce blood flow to the wound.