Effects of Wheelchair Cushions and Pressure Relief Maneuvers on Ischial Interface Pressure and Blood Flow in People With Spinal Cord Injury pdf

Despite extensive research, pressure ulcers are one of the most common secondary complications after spinal cord injury (SCI), affecting >50% of people during their lifetime.A pressure ulcer is localized damage of the skin and underlying tissue caused by pressure, shear, friction, or a combination of these factors.Sustained pressure causes cell death by means of tissue ischemia, cell deformation, and poor drainage of waste products.

Despite prevention efforts, pressure ulcers continue to be a problem impacting individuals’ health and quality of life and incurring enormous health care costs. The 2 common forms of prevention include pressure relief and wheelchair cushions. Clinical practice guidelines dictate performing a complete pressure relief lasting 30 seconds every 30 minutes; however, evidence supporting this practice is limited. Furthermore, multiple studies have shown that a push-up type pressure relief should last at least 1.5 to 4 minutes for a full recovery of the tissue oxygenation. This evidence suggests that pressure relief (as currently taught) is inadequate. Unfortunately, a prolonged push-up exposes people to detrimental shoulder positions and may not be achievable by many persons because of insufficient upper extremity strength and function. Forward and sideward leans may be good pressure relief alternatives to push-ups because these maneuvers do not require people to lift their entire body weight. Therefore, using forward and sideways leans should increase the number of people capable of performing a pressure relief and may also increase the duration and frequency of pressure reliefs.