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Thread: Any clever ideas for adaptive equipment when recovering from a pressure sore?

  1. #1
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    Any clever ideas for adaptive equipment when recovering from a pressure sore?

    Current situation - our son sustained his SCI almost 11 years ago (pretty much on his 4th birthday). Hasn’t required a stay in hospital since then, and has been very active. Due to a change to his cushion configuration, and complacency on our part, he has developed a stage 2 or 3 pressure sore, about 50mm in diameter. Can’t believe that we (ie all 3 of us in the family) managed to let that happen, but that’s where we’re at. He was admitted to hospital in the middle of this week, but is now home.

    Obviously he’s not able to put pressure on the sore area, so he’s limited to:
    - lying on his back, with his knee elevated (the sore is near the top of his leg, so it’s off the mattress).
    - lying on his right side, so the sore (on his left leg) is elevated. He doesn’t like this position (it’s uncomfortable) as he has always slept on his left side probably due to his scoliosis.
    - lying on his left side, with his hips twisted a bit to elevate the sore from the mattress.
    - lying on his front, but he find that very uncomfortable as his legs don’t straighten properly at his hips any more, from all his time in his chair.

    He’s coping pretty well at the moment, but I’m seeking any advice on any adaptive equipment that might be of use to him, either in getting him comfortable somehow on his front (a bean bag perhaps?), or for enabling him to use his laptop (loves his games, but it’s also needed for schoolwork) while on his back, or side, or front. At the moment I’m trying a projector on the ceiling while he’s on his back, but I don’t really want him totally in the dark for the next couple of months!

    Any ideas?
    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

  2. #2
    If his pressure injury is indeed over the ischium, he should not be on his back the with HOB (head of bed) elevated more than 30 degrees, especially with the knee gatch up. Knee gatch can increase his risk for getting a DVT too, which is much higher when on bed rest.

    Is he on a specialty mattress such as a low air loss mattress? That would be ideal.

    This is a good time for him to work on learning to prone (lay on his stomach) and get his knee and hip contractures stretched out. He needs to be properly positioned for this, with his genitals and bony areas (hips, knees, feet) bridged with pillows or pieces of foam. Is he getting home nursing or PT? They could show him how to do this and build up time proning as he stretches out and gets used to it.

    When laying on his side, his pelvis should not be tilted more than 30 degrees from the surface of the bed, as this puts excessive pressure on the trochanters.

    Is he using a laptop or desktop computer? Does he have voice recognition software? What is his level of SCI? This is a bed table for a laptop that might work for him:

    https://www.amazon.com/FCD-Portable-.../dp/B074N9N8HY



    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  3. #3
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    Quote Originally Posted by SCI-Nurse View Post
    If his pressure injury is indeed over the ischium, he should not be on his back the with HOB (head of bed) elevated more than 30 degrees, especially with the knee gatch up. Knee gatch can increase his risk for getting a DVT too, which is much higher when on bed rest.

    Is he on a specialty mattress such as a low air loss mattress? That would be ideal.

    This is a good time for him to work on learning to prone (lay on his stomach) and get his knee and hip contractures stretched out. He needs to be properly positioned for this, with his genitals and bony areas (hips, knees, feet) bridged with pillows or pieces of foam. Is he getting home nursing or PT? They could show him how to do this and build up time proning as he stretches out and gets used to it.

    When laying on his side, his pelvis should not be tilted more than 30 degrees from the surface of the bed, as this puts excessive pressure on the trochanters.

    Is he using a laptop or desktop computer? Does he have voice recognition software? What is his level of SCI? This is a bed table for a laptop that might work for him:

    https://www.amazon.com/FCD-Portable-.../dp/B074N9N8HY



    (KLD)
    Thanks KLD.

    His bed head isn?t elevated at all (he uses one pillow). He is on a pulsing air mattress topper (which seems better than the pulsing air mattress that he was on in the hospital). And he has pressure stocking for DVT minimisation. He is getting home nursing for dressing changes, and we will arrange for home PT.

    Yes, we will work on getting him straighter and on his front, but he?s only going to be able to do that for short periods initially - I?ve just tried lying on my front on a bean bag and it?s not very comfortable, and I?m a front sleeper!

    Laptop, with separate mouse. I saw those bed tables, but to me they will only work if you can sit up, which isn?t the case. I did wonder about attaching the laptop to the underneath of a similar table, so that the laptop is above him, but then I thought the projector-on-the-ceiling idea would be easier.

    He?s T6 complete. Doesn?t use voice recognition software and I doubt that work work with his current games, although that may be a good option with schoolwork, so I?ll look into that.
    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

  4. #4
    Compression stockings do little if anything to prevent DVT in people with SCI in high risk situations. Low molecular weight heparin injections would be much more effective.

    A mattress topper that is alternating pressure provides little if any real pressure reduction compared to either a low air loss mattress or a air fluidized mattress.

    Look at the pictures of the computer table I posted above. There is one of a person using it laying flat on their back in bed.

    I wouldn't use a bean bag for proning, either to building proning tolerance or for maintenance. Pillows or foam rubber cut to size works better. We used to then put a weight on the low back area for some time to help with slowly stretching out hip flexion contractures.



    (KLD)
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    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  5. #5
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    Quote Originally Posted by SCI-Nurse View Post
    Compression stockings do little if anything to prevent DVT in people with SCI in high risk situations. Low molecular weight heparin injections would be much more effective.

    A mattress topper that is alternating pressure provides little if any real pressure reduction compared to either a low air loss mattress or a air fluidized mattress.

    Look at the pictures of the computer table I posted above. There is one of a person using it laying flat on their back in bed.

    I wouldn't use a bean bag for proning, either to building proning tolerance or for maintenance. Pillows or foam rubber cut to size works better. We used to then put a weight on the low back area for some time to help with slowly stretching out hip flexion contractures.

    (KLD)
    Thanks again KLD.

    I hadn’t see the photo of the person laying flat...apologies...that does seem like a very good option. Shame they don’t send them to Australia, so I’ll just have to make one!

    The mattress he is using is this one https://www.axismedical.com.au/produ...s-overlay.html. They called it a topper at the hospital. The description at the bottom right does say it has “low air loss”, although the way I interpret the text, I’m not sure whether it’s saying that is an optional function? I’m not sure how you can tell what you’ve got if that is the case....

    I did wonder about the compression stocking, so thanks for your input there. And for the bean bag view...we’ve actually just tried one, for comfort more than proning...it seems ok, but definitely not ideal.
    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

  6. #6
    Such a tough situation! We are both paralyzed, my husband SCI, paralyzed 48 years, me since childhood Polio. As long as I've known him he has inspected his rear, laying down in bed with a mirror propped up, each day after morning routine and showering. At one time he had the beginning of a pressure sore after we took a long trip and he drove for too many hours (never did that again). This happened before more modern ways of handling skin sores and so he pretty much laid on his abdomen most of the day for about two months. Later, we found out about Duoderm and that worked quite well when a tiny sore appeared - it enabled him to continue working full time, and those small sores healed fairly quickly with laying down time after work.

    Skin care is so critical for SCI and I'm wondering if your son does a daily checking of his rear with a mirror. I can truly understand how a sore could go undetected as it can be difficult to spot trouble until it's too late. It seems the daily rear check-up is something he can do - unless I'm not clear on his physical ability; maybe he's doing it already? The mirror my husband uses is 8" X 6" and has a stand on it; all bedroom lights on. It's a quick, but important part of meeting the day that he's done now for almost 50 years. (We're both in our 70's).

    You will all get through this rough time! Very best to you.

  7. #7

    Lapdesk

    I made a lapdesk that I use with my laptop...works well whether on my side, sitting up etc. I've made different versions over the years. I use a piece of plywood (sanded then clear coated) for the bottom, (have used a bamboo cutting board that's worked well also) a piece of foam covered with a piece of fabric to cover it and attached it to the bottom of the lapdesk.
    To attach the laptop to the desk, I use 3m dual lock vhb adhesive tape (have tried different kinds, this one works the best, got mine off of ebay) on each corner (it mates to itself, so there's no male or female sides) to attach it to the bottom of my laptop and to another to the on the desk, and press down.
    It's strong enough to hold the laptop to the desk even upside down, but yet you can pull the laptop off and with this tape, it leaves a little room for air circulation. I use a logitech M570 trackball wireless mouse...I've used this setup for years and it's worked like a charm for me. Will try and upload a pic later when I find my camera.

    http://sci.rutgers.edu/forum/album.php?albumid=1076
    Last edited by Moongazr; 06-10-2018 at 11:09 AM.

  8. #8
    I hadn’t see the photo of the person laying flat...apologies...that does seem like a very good option. Shame they don’t send them to Australia, so I’ll just have to make one!
    Pretty easy to find in Australia too:

    https://www.gumtree.com.au/s-ad/paci...ble/1185553663

    https://www.gumtree.com.au/s-ad/maro...ble/1186349064

    https://www.gumtree.com.au/s-ad/sydn...esk/1186224553

    https://www.amazon.com.au/gp/product...d_i=4913467051

    https://www.amazon.com.au/Portable-L...NKDXVM7RMPK5GC

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

  9. #9
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    Quote Originally Posted by triumph View Post
    Skin care is so critical for SCI and I'm wondering if your son does a daily checking of his rear with a mirror. I can truly understand how a sore could go undetected as it can be difficult to spot trouble until it's too late. It seems the daily rear check-up is something he can do - unless I'm not clear on his physical ability; maybe he's doing it already? The mirror my husband uses is 8" X 6" and has a stand on it; all bedroom lights on. It's a quick, but important part of meeting the day that he's done now for almost 50 years. (We're both in our 70's).

    You will all get through this rough time! Very best to you.
    Thanks Triumph. Yes, my son is more than capable of self-checking, but for many years my wife would do that when assisting him with changing clothes at night. Now that he’s fully self-sufficient, and become a bit more private as a teenager, we’ve told him that a check needs to be done, but that has obviously fallen on deaf/teenage ears! I used the word “complacency” below, and that’s what has happened, particularly as he has had no problems with his cushions before. (He did have a small sore several years ago, but that was due to a long international plane trip, in combination with some folded clothing...).

    But I’m pretty sure the lesson has been learnt by us all in this house...there will be plenty of checking and reminding going forward! And at least we know the cause of the sore (although the physiotherapist who made the cushion adjustment is in denial!)
    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

  10. #10
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    Quote Originally Posted by Moongazr View Post
    I made a lapdesk that I use with my laptop...works well whether on my side, sitting up etc. I've made different versions over the years. I use a piece of plywood (sanded then clear coated) for the bottom, (have used a bamboo cutting board that's worked well also) a piece of foam covered with a piece of fabric to cover it and attached it to the bottom of the lapdesk.
    To attach the laptop to the desk, I use 3m dual lock vhb adhesive tape (have tried different kinds, this one works the best, got mine off of ebay) on each corner (it mates to itself, so there's no male or female sides) to attach it to the bottom of my laptop and to another to the on the desk, and press down.
    It's strong enough to hold the laptop to the desk even upside down, but yet you can pull the laptop off and with this tape, it leaves a little room for air circulation. I use a logitech M570 trackball wireless mouse...I've used this setup for years and it's worked like a charm for me. Will try and upload a pic later when I find my camera.

    http://sci.rutgers.edu/forum/album.php?albumid=1076
    Thanks Moongazr - I think I know what you?ve described, but a photo would be great. It may well work better on the air mattress than one with struts.
    Gordon, father of son who became t6 paraplegic at the age of 4 in 2007 as a result of surgery to remove a spinal tumour.

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