Posture matters. We learn this from an early age when commands of "sit up straight!" and "don't slouch!" are constant companions in the classroom and at the dinner table. In the office, we're constantly reminded not to slump over the keyboard, and driving courses advise an upright position as the safest and ergonomically best.
The fact is, though, that the ghost of poor posture plagues most of us all our lives, but nowhere is it such an issue as when an individual must live in a wheelchair. Whether it's a temporary or permanent way of life, confinement to a wheelchair has serious postural implications.
These change with the condition, of course. The needs of wheelchair occupants vary depending on whether they're suffering from a congenital disorder or, healing from a spinal injury, dealing with paralysis, or being forced to a sitting position while a broken femur mends. What all conditions have in common, though, is that they place serious pressure on both internal and external structures.
Among the most serious repercussions of improper wheelchair seating are pressure sores.
In today's post, let's examine what these are, how posture impacts pressure sores, why repositioning matters, and how you can assure proper patient placement from now on. Hospitals, equipment suppliers, and clinics all need better tools to help meet these needs, but the good news is that there is a solution.
Pressure sores are what they sound like, sores that arise from areas of high pressure. These occur when bony protuberances are pressed against hard surfaces, catching the muscle and skin in between. When this happens too long, it can cause inflammation and eventually rupture the skin.
A pressure sore, also known as a pressure ulcer or bed sore, may present as:
While pressure sores typically get worse over time, moving from superficial to deeper layers of skin, they can sometimes appear quite abruptly. They are especially common on the sit bones and tailbone, spine and shoulders, arms, and elbows in wheelchair users.
As will be no surprise to occupational and physical therapists, pressure sores most commonly develop when posture is incorrect, and wheelchair occupants cannot alleviate pressure. Over time, this can lead to:
The good news is that relieving pressure using a clinical approach to wheelchair seating can significantly decrease the incidence and severity of pressure sores.
Positioning is a critical component of managing and preventing pressure sores. It becomes especially important when the patient lacks sensation and, therefore, cannot report on areas of irritation or pain before they get out of control. That makes it even more critical to ensure proper seating before anything happens.
In general, though, there are several steps any clinician can take. These include:
In summary, proper positioning is achievable. However, problems remain.
Among the most common wheelchair seating challenges are:
Plus, while putting patients in the proper position can contribute to pressure injury prevention, it isn't a matter of guesswork. You need cold, hard facts to make the right clinical decisions. Otherwise, your seat cushion evaluation and selection rely on gut instinct. While that might carry an experienced therapist quite a distance, it can't replace data.
That's where pressure mapping comes in.
Pressure injury prevention starts with knowing where areas of high pressure are. How can you address the issue if you don't remember which bony protuberance may cause problems, which areas are chafed, and which cushions aren't getting the job done? You can't, which is why you need pressure mapping equipment.
By laying a simple sensor-based mat over the wheelchair surface and then inviting a patient to sit down, you can see in seconds where the areas of high and low pressure are, even when the patient can't tell you themselves.
The right equipment can scan the patient's pressure distribution across various chair parts and create a map demonstrating high, medium, and low-pressure areas. The clinician can create a treatment plan using the resulting images and data. This will assist with:
No one needs to tell you how important it is for clinicians to provide a safe and comfortable environment, whatever the duration of wheelchair use. Correct wheelchair seating posture assures better healing of acute injuries, just as it helps maximize quality of life for chronic conditions. Get in touch to learn more today.