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Thread: Question re: pressure sores

  1. #1
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    Question re: pressure sores

    Hi all:

    I am married to Don a T11 complete (5-2005) who had been using a J2 deep contour cushion. I had noticed a red area adjacent to his sacrum on the left side which was still white to pressure but irritated. I had been massaging his J2 gel everyday to no avail.
    He underwent rehab at Craig and they never did mapping on his butt and just put him in a J2 deep cushion. His PT did not have a clue as far as I am concerned. I emailed her and asked about a Roho enhancer and she stated that the J2 was fine for him. I have since put him in a Stimulite contour cushion with good results.
    I am an ophthalmologist so I concentrate on the other end of the body but I knew that the J2 was not working. I have been moisturizing the butt every morning and evening and that helps too.
    He goes back to Craig in March for his re-eval and I was wondering if I should request that a mapping be done? He most definitely needs help with his positioning and his positioning has vastly improved since having him on the Stimulite... his posture on the J2 was terrible... listing to the left (left side more injured than the right)... I just reallt think he was headed for major trouble and I don't think he's out of the woods yet. I would also like to have a nother PT work with him for the re-eval. Don is 61 years old and is not really great about his weight shifts but has recently gotten better about this.

    Any feedback on this situation would be appreciated.

    Sieg

  2. #2
    Sacral pressure is more likely to occur with laying down than with sitting, unless he is sitting with a lot of pelvic tilt (sacral sitting). Is this the case?

    When he is in bed is he using a hospital bed and elevating his head? Does he lay on his back for long periods in bed? Often sacral pressure from sitting is associated with the wrong wheelchair back more than with a cushion unless the person is a sacral sitter. Is he using a special back for his chair? Massaging the jel is less important in a Jay cushion than redistributing it to assure that most of the jel is under the ischiums prior to sitting.

    I am very surprised that you were told that interface pressure studies were not recommended for him at Craig. The clinical practice guidelines on the prevention of pressure ulcers in persons with SCI strongly recommend this as part of the initial rehab and annual evaluation, esp. if there are skin changes, weight loss or gain, or othe problems.

    Application of products to the epidermis (the dead part of the skin) do little to help prevent pressure ulcers, and massage should never be done to red areas. Weight shifts are important and should ideally be done every 15 minutes while sitting. What technique is he using for this?

    (KLD)

  3. #3
    Senior Member smokey's Avatar
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    I swear by ROHO air cushions. I think they are the greatest. Did you try one of these?

  4. #4
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    Yes... we tried the roho enhancer but I don't think we adjusted the air pressure correctly and Don was afraid of bottoming out on the roho... so we went with the stimulite.... At his re-eval in March I will have the PT address the roho... all I know is that the Jay 2 deep was not working.

    Sieg

  5. #5
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    thanks to the list SCI nurse for the comments.

    Yes... Don lies on his back on the bed (flat on his back) every nite for a couple of hours and then when he goes to sleep he is positioned on either side. We have a select comfort bed with a tempurpedic overlay which works well. He does his weight shifts in his chair every half hour by push ups with his arms. One of the bad things he does is to want to get on our couch and sit up on it for a couple of hours every day which I think is really bad for his skin.

    How does we let him on the couch without doing any harm to his butt?

  6. #6
    Regular furniture is often a culprit for pressure ulcers. It looks and feels soft, but often the foam or other stuffing actually gets harder when compressed. With the area you describe, he should be on the sofa only on his back or prone, and he should only be in these positions in bed as well.

    (KLD)

  7. #7
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    Thanks for the feedback... so let me see...Don can be on the sofa but only lying down... can he be on his back (flat) on the bed too?... He has to sit up in bed to IC and to eat if he wants dinner in the bedroom but then he lies down again... can I have him use a wedge that elevates him 30 degrees so he can use his laptop and/or read and/or watch tv?? I know that when he is positioned for sleep on either side that the red area gets better...

    Thanks for any information!

  8. #8
    From what you describe, he should not be on his back at all. Sitting at over 30 degrees will add shear to the existing pressure and make it even worse. He would be better to sit fully upright in his chair, as long as he is not sacral sitting, to laying partially reclined in bed or on a sofa.

    (KLD)

  9. #9
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    So... If he does get on the sofa... can he be fully reclined? I know that he will not stay in his chair... so if he is on the bed should he be prone?

  10. #10
    Prone would be best, but be sure his knees and hips are bridged with pillows or pieces of foam in this position, and that his feet are off the end of the bed.

    (KLD)

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