Taking the Pressure Off

United Spinal Association teamed up with the Northern New Jersey Spinal Cord Injury System (NNJSCIS) to present the first in a projected series of consumer-oriented, one-day medical seminars, Life After Spinal Cord Injury: A Dialogue About Maintaining Health, on Friday, June 17, 2005, at the Kessler Institute for Rehabilitation in West Orange, New Jersey. Addressing key medical issues affecting people with spinal cord injury and disease (SCI/D), specifically pressure ulcers and wheelchair seating, the seminar was a vehicle for communication between medical professionals who led the presentations and people with SCI/D.

In an effort to spur greater dialogue about maintaining health after SCI/D, the first session, which addressed the Treatment & Prevention of Pressure Sores, was presented by Trevor Dyson-Hudson, MD, SCI Researcher at the Kessler Medical Rehabilitation Research and Education Corporation and George Dietrick, MD, Director of Wound Care Service at the Bronx VA Medical Center.

Pressure ulcers are a major complication of SCI and have a significant effect on general health and quality of life. It was revealed that 25% of the total lifetime cost for a person with SCI/D goes to treating pressure ulcers.

“Having spent 21 years in a wheelchair, I have encountered two flap procedures for pressure sores,” said 40-year-old Lisa D’Annunzio, who was injured in September 1984 and is a T-12-L-1 paraplegic. “The morning’s topic about pressure sores opened my eyes to the physiological aspects of my body. I never realized that the type of skin changes is different in me as compared to an able-bodied person. It’s good to have things like this reinforced.”

According to Dietrick, the cause of pressure ulcers is multidimensional. Pressure, shear, friction, moisture, and poor nutrition contribute directly to the physiological etiology of pressure ulcers. Other factors associated with the development of pressure ulcers include immobility and psychosocial factors, such as inadequate personal and financial resources and not knowing, or practicing, preventive behavior.

Steps to Stay Sore Free

While there is no technology yet to prevent pressure ulcers, Dietrick says that practicing the following preventive measures can help avoid serious pressure sores:

• Take care of your skin: Inspect your skin at least once a day, paying special attention to any reddened areas that remain after you have changed position and the pressure has been relieved. Prevent dry skin by using creams or oils, and avoid cold or dry air. Minimize moisture from urine or stool, perspiration, or wound drainage. Use pads that absorb moisture quickly and keep it away from your skin.

• Protect your skin from injury: Limit pressure over parts of your skin by changing position once every hour while you’re sitting, if possible, or have your caregiver change your position.

• Eat well: A balanced diet with protein and calories is very important. Healthy skin is less likely to be damaged.

• Lastly, be proactive: Take these preventive measures and seek immediate medical attention if redness persists.

Sharing his own personal story of undergoing pressure ulcer treatment, Trevor Dyson-Hudson also enforced the importance of quick medical treatment, showing photos of pressure ulcers that became so severe, bone was visible. Dyson-Hudson said that he was stubborn in seeking treatment right away and it wasn’t until he received medical attention that his pressure ulcers were finally treated.

The Right Chair

Limiting pressure on parts of your body while sitting in your chair is very important to prevent sores, and changing positions in your chair about every hour is essential. It’s also important to ensure that you have the right chair for your body type and injury or disease. Experts in wheelchair fitting and seating from the Kessler Institute for Rehabilitation discussed advances in wheelchairs and seating, giving a demonstration on the evolution of wheelchair technology and seating.

The most important first step in ensuring that your chair fits your needs is to look at your position in the wheelchair, said Mary Shea, MA, OTR, ATP. She says that you should be able to sit completely upright, with good postural alignment. With your head up and chest out, you should be able to raise both arms in front of you without losing balance, and when you put your arms down the tips of your fingers should be able to touch right below the axel of the wheels of your chair.

“Pushing a wheelchair is hard work,” Shea says. “Fortunately, there is a wide range of wheelchairs, cushions and back supports, as well as lighter weight wheelchair materials such as titanium that can help you get the support and the efficiency with mobility that you need.”

Through pressure mapping, a person can be evaluated to assess their own personal sensitivity and adjust the angles of a chair’s cushion. This would allow someone who may lean to the left to be able to sit upright and comfortably in their chair. Pressure mapping can also help power-wheelchair users determine how far back they must tilt their chairs to achieve effective pressure relief.

D’Annunzio, who joined United Spinal that afternoon, said that after 10 years of using the same wheelchair, the session inspired her to seek out a much-needed new chair. Armed with the knowledge of the most up-to-date technology, D’Annunzio says she is confident that she will be able to choose the best chair and cushions that suit her body and needs.

On display were power assist wheelchairs as well as the different types of power wheelchairs, cushions, and other accessories.

The keynote speaker was Steven Kirshblum, MD, associate medical director and director of SCI Services at the Kessler Institute for Rehabilitation. Additional sponsorship was provided by Kessler Medical Rehabilitation Research and Education Corporation (KMRREC), the Kessler Institute for Rehabilitation, Henry H. Kessler Foundation, and National Institute on Disability and Rehabilitation Research.

NNJSCIS was established as a model system of SCI care in 1990 by the National Institute on Disability and Rehabilitation Research (NIDRR). This project is a cooperative effort of KMRREC, Kessler Institute for Rehabilitation, and University of Medicine and Dentistry of New Jersey-New Jersey Medical School. NNJSCIS provides a comprehensive continuum of state-of-the-art care for persons with SCI and their families, from the time of injury through long-term follow-up in the community.

Jennifer M. Rodriguez is an assistant public affairs officer at United Spinal.