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Thread: How can I be bony and overweight at the same time?

  1. #1
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    How can I be bony and overweight at the same time?

    I?m a C5 that is 18 yrs. post- injury. Over the years I?ve lost much muscle mass in my upper body, while getting wider hips and a bigger stomach. ..kind of like an hourglass figure w/all the sand at the bottom 😊.

    Recently my husband has noticed that my right posterior bone (the main one that I sit on) is pretty close to the surface, as is my tailbone.

    This is of concern to both of us, and he?s encouraged me to do frequent weight shifts, lying flat to distribute the weight more evenly.

    Does this happen frequently w/other SCI injured people, is my husband correct, and what else can I do? Thanks!
    "courage is fear that has said its prayers"

  2. #2
    Loss of muscle mass and lack of core strength weaken your overall body stability over time.
    Your gluteus maximus is the muscle of your buttocks - you have lost that muscle mass and you have very little fat tissue based on how you described your skin. Bony prominences need to be protected with appropriate seating and yes pressure reduction-wight shifts -as you described.

    pbr
    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
    Loss of muscle mass and lack of core strength weaken your overall body stability over time.
    Your gluteus maximus is the muscle of your buttocks - you have lost that muscle mass and you have very little fat tissue based on how you described your skin. Bony prominences need to be protected with appropriate seating and yes pressure reduction-wight shifts -as you described.

    pbr
    what angle of tilt/recline is recommended, and how long/often for the shifts? general guidelines?
    "courage is fear that has said its prayers"

  4. #4
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    Quote Originally Posted by jennypenny View Post
    what angle of tilt/recline is recommended, and how long/often for the shifts? general guidelines?
    From the document: RESNA Position on the Application of Tilt, Recline, and Elevating Legrests for Wheelchairs (pages 8 and 9)
    Rehabilitation Engineering & Assistive Technology Society of North America (RESNA)

    http://www.rstce.pitt.edu/rstce_reso...at_Legrest.pdf


    Power Features for Pressure Relief
    Tilt and recline features provide the most pressure relief when used in combination.

    One study (Vaisbuch et al., 2000) found significantly lower maximum pressure in the combined position of 25
    ? of tilt with 110? of recline in subjects with SB. A study in subjects without impairments (Aissaoui, Lacoste, & Dansereau, 2001) showed that 45? of tilt with 120? of recline provided a 40% load reduction. A study on 2 subjects with tetraplegia (Pellow, 1999) showed a trend toward interface pressure reduction with combination of 45? of tilt and 150? of recline.


    Tilt alone may also confer some advantage for pressure relief. Significant ischial pressure relief has been shown at 65? of tilt (Henderson et al., 1994) and lower shear forces noted even at 25? (Hobson, 1992). However, one study showed that 15? or less provides no advantage in terms of pressure reduction (Aissaoui, Lacoste et al., 2001) however may have benefits for postural stability. Power Lateral and Rotational tilt can be beneficial in adding more degrees of freedom to the maneuvers available.

    When effects of elevating legrests on posture were studied in subjects without impairments (Stinson, Porter-Armstrong, & Eakin, 2003) it was found that 120? of recline in combination with elevation of legs can significantly reduce seating interface pressure. When used alone, recline tends to reduce normal force but increase shear (Hobson, 1992), especially when individuals recline to 110 and 120? (Aissaoui, Lacoste et al., 2001). Care must be taken with sole prescription of recline because when used in isolation it may put a client at risk for skin breakdown, especially if the client does not know how to use it properly. Additionally, return to upright position after recline can also increase normal forces at the ischial tuberosities (Gilsdorf, Patterson, Fisher, & Appel, 1990), so clinicians often recommend using tilt before return to upright to minimize shear. Elevating legrests may also help in alleviating ischial and foot support pressure (Aissaoui, Heydar, Dansereau, & Lacoste, 2000) and can help reduce shear along the entire seating surface (Carlson, Payette, & Vervena, 1995). The aforementioned ?shear reducing? recline systems (Pfaff, 1993) are thought to reduce shear forces, but at the time of this publication, the only evidence to support this is anecdotal. Yet, their utility is especially important clinically when they allow the user to remain in contact with the seat back for positioning purposes.

    Simply providing these power features when they are medically necessary may not be adequate; training and follow-up is important. One survey study (Lacoste et al., 2003) showed that although 97.5% of individuals who had tilt and recline used these features every day, less than 35% used these features primarily for pressure relief but rather also to reduce pain and promote comfort. The majority of individuals used angles that were inadequate for pressure relief. There is also insufficient research that documents the appropriate duration and frequency of use of these features but clinicians sometimes estimate a duration of 30 seconds with a frequency of 15-30 minutes or 60 seconds every 60 minutes to be a conservative estimate given the research on wheelchair pushups and clinical practice guidelines published for SCI (Coggrave & Rose, 2003; "Paralyzed Veterans of America. Pressure ulcer prevention and treatment following spinal cord injury: a clinical practice guideline for health care professionals," 2000; Vaisbuch et al., 2000). This evidence substantiates the need for follow up visits with clients for extended biofeedback and training.



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