The Seating Interface For The Individual With SCI: Minimizing Risk and Maximizing Function

Transcription

1 The Seating Interface For The Individual With SCI: Minimizing Risk and Maximizing Function

2 Disclosure of PI- RRTC Grant James S. Krause, PhD, Holly Wise, PhD; PT, and Emily Johnson, MHA have disclosed a research grant with the NaIonal InsItute of Disability and RehabilitaIon Research The contents of this presentaion were developed with support from an educaional grant from the Department of EducaIon, NIDRR grant number H133B However, those contents do not necessarily represent the policy of the Department of EducaIon, and you should not assume endorsement by the Federal Government.

3 AccreditaIon The Medical University of South Carolina is accredited by the Accredita:on Council for Con:nuing Medical Educa:on (ACCME) to provide con:nuing medical educa:on for physicians. The Medical University of South Carolina designates this live ac:vity for a maximum of 1.0 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their par:cipa:on in the ac:vity. In accordance with the ACCME Essen:als &Standards, anyone involved in planning or presen:ng this educa:onal ac:vity will be required to disclose any relevant financial rela:onships with commercial interests in the healthcare industry. This informa:on is listed below. Speakers who incorporate informa:on about off- label or inves:ga:onal use of drugs or devices will be asked to disclose that informa:on at the beginning of their presenta:on. The Center for Professional Development is an approved provider of the con:nuing nursing educa:on by the South Carolina Nurses Associa:on an accredited approver by the American Nurses Creden:aling Center s Commission on Accredita:on

4 Disclosure of Presenter Dr. Sara Kraft, PT, DPT, NCS, ATP has disclosed a research grant with the United States Department of Education.

5 Learning Objectives After this presentation you should be able to Understand the mechanisms of pressure ulcers from the seated position Identify when a client is at high risk for pressure ulcers Identify 3 reasons to use a wheelchair cushion Select which type of cushion interface would be most appropriate for specific clients

6 What is a Pressure Ulcer? A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be made clear. - NPUAP(National Pressure Ulcer Advisory Panel.)

7 Intrinsic Factors Diminished sensation Muscle atrophy paralysis spasticity helps Immobility pressure distribution/reduction and relief help Poor circulation elevation of the legs above the heart helps Incontinence proper bowel and bladder programs help Poor nutritional status Increase in calories (especially protein) helps Systemic disease such as diabetes, cancer

8 Extrinsic Factors Pressure Moisture Cut - scratch Shearing - friction Scarring Bug bite, pimple Cellulitis - edema

9 Common Causes of Shear or Friction Unstable/unbalanced posture Sliding Transfers Tires Tub/shower tracts Bath benches Slide boards (best to call transfer board) Vehicle seats

10 Most Common Areas of Pressure Sores on People with SCI Sacrum from the bed or chair Heel Usually from the bed Ischium Usually from the chair Foot (bony areas like the ankle) Usually from the bed Trochanter Usually from the bed

11 Other Areas Can Include Elbows, forearms Bed or chair Scapula Bed or chair Back of thighs Usually the chair Bottom of feet Usually the chair Hands Usually the bed Back of head Usually the bed

12 Prevention of Secondary Complications is Always Best Identify at risk individuals Braden scale, Norton scale Level of Risk Protect against extrinsic factors Education Cost savings to patient and system

13 Low Risk Sensation intact When the client feels the need able to move freely for pressure relief they do so.

14 Moderate Risk Sensation intact Providing self pressure relief position change takes some effort Unlikely to perform pressure relief as often as needed Tend to push the limit on sitting tolerance

15 Moderate Risk Impaired or absent sensation Ability to do pressure relief with ease Performs pressure relief often

16 High Risk Sensation intact Unable to perform sufficient pressure relief Has a current sore or a history of a sore, very bony, or multiple risk factors

17 High Risk Sensation impaired or absent Unable to perform pressure relief Does not perform pressure relief Has a current sore or history of sore, very bony, or multiple risks

18 Guidelines to Prevent Pressure, Friction & Shear in the Wheelchair. Perform Pressure relief q/15 min x 1min 40 sec Independently NO DONUTS Use pressure and shear reducing materials Accommodate/reduce deformities Position to prevent shearing Maximize surface contact area - contour Increase load on non bony areas - pressure distribution

19 What are the Goals For the Seating Interface for People Provide comfort With SCI? Distribute pressure and promote skin protection Postural support Encourage optimal function

20 Comfort What is comfortable to one person is not always comfortable to another-trial cushions are a must! The longer a client can sit on a cushion the better they will be able to determine the comfort level. Balance comfort with function

21

22 Pressure Distribution One of the main goals of wheelchair cushions is skin protection via pressure distribution. The main goal is to off-load the at risk bony prominences (sacrum and ischium)by loading the longer bones (femurs)

23 Foam Liquid Air Cushion Materials and Pressure Distribution

24 Foam Advantages Lightweight Can cut to size Stable base to transfer from Good postural support Disadvantages Poor Pressure relief Poor Shear reduction Uses: Low risk clients Primarily used for comfort or positioning

25 Advantages Liquids (gel or water) Adjusts to body movements so decreased shear Gel can be positioned under at risk bony prominences to decrease pressure Disadvantages Heavy Can be very hot for clients and cause perspiration Can make transfers more difficult Uses Shear reduction and pressure reduction for moderate to high risk clients

26 Advantages Lightweight Air Good pressure distribution Good shear reduction Disadvantages Maintenance Poor postural stability Difficulty with transfers Uses High risk clients for pressure and shear reduction, s/p flap or other Wound issues

27 Hybrids (foam/air or foam/gel) Combination of either of the 2 materials to give both the postural support and pelvic positioning.

28 Postural Support Ideal Pelvic posture Neutral alignment: head balanced over spine, spine balanced over pelvis Neutral pelvis: ASIS and PSIS are level Natural spinal curves Shoulders slightly posterior to pelvis Head in neutral position with eyes (gaze) forward Equal weight bearing through ischial tuberosities PATIENT IS FUNCTIONAL!!!

29 Postural Support Where does the postural support come from Cushion properties mentioned before Contour of the foam base in hybrid cushions

30 Flat versus contour In general a contoured cushion provides more postural support than a flat cushion. The amount of contour should match the clients postural needs.

31 Encourage Optimal Function The posture that is supported should be one that optimizes function.

32 Questions?

33 Contact Information Sara Kraft

34 Information on becoming a seating and mobility specialist Rehabilitation Engineering and Assistive Technology Society of North America ( RESNA) Assistive Technology Practitioner For more information