Are you weight shifting long enough?

Jeff B · 11-25-2003, 10:20 AM

I just found this abstract:

A specialist seating assessment clinic: changing pressure relief practice

M J Coggrave1 and L S Rose1

1The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks, UK

Correspondence to: MJ Coggrave, The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks HP21 8AL, UK

Abstract

Study design: Description of a clinical service, evaluation of pressure relief practices.

Objectives: To describe a specialist seating assessment clinic and a change in clinical practice arising from its work.

Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, UK.

Methods: Retrospective review of the ischial transcutaneous oxygen measurements of 50 newly injured and chronic spinal cord-injured (SCI) individuals seen in a specialist seating assessment clinic. Tissue oxygenation was measured in the sitting position (loaded) and during pressure relief (unloaded).

Results: Mean duration of pressure relief required to raise tissue oxygen to unloaded levels was 1 min 51 s (range 42 s¾3 min 30 s).

Conclusion: These results confirmed the clinical perception that brief pressure lifts of 15-30 s are ineffective in raising transcutaneous oxygen tension (TcPO2) to the unloaded level for most individuals. Sustaining the traditional pressure relief by lifting up from the seat for the necessary extended duration is neither practical nor desirable for the majority of clients. It was found that alternative methods of pressure relief were more easily sustainable and very efficient.

Spinal Cord (2003) 41, 692-695. doi:10.1038/sj.sc.3101527

I try to tilt in my powerchair for about 1 minute every 15 minutes. In my manual chair I do a lift every five minutes or so, but can only hold myself up 10-30 seconds. I haven't had any skin problems since I started using these methods but I'm always worried about this bony butt.

Does anyone here have access to the whole article? There is mention that "alternative methods of pressure relief were more easily sustainable and very efficient" but no specifics in the abstract (I know that leaning forward, which is a commonly recommended method of pressure relief actually gives extremely high pressures under my ischias). No mention is given on whether cushion type effected "loaded levels" either.

crags · 11-25-2003, 12:13 PM

interesting...

one of the most educational things for me occured when i had a seat pressure mapping done. i could see on the screen the hot spots under the ischia or pelvic rear bones. then i did a lift up to see what lift was required to change the color to unloaded. to my surprise the color changed with much less of a lift than i was previously doing.

knowing this i now lift up less (in height, not frequency), save my shoulders and am able to hold it longer. it was about 1/3 the lift i was previously doing

Jeff B · 11-25-2003, 01:44 PM

Before I did pressure mapping I did not feel safe using my manual chair for long because I was not able to do a good lift. Once I saw that even the small lift I could do reduced the pressure I started using the manual chair more, which led to better strength for my lifts. However, I doubt that my triceps will ever get strong enough to hold me up for the almost 2 minutes recommended by the study.

611 · 11-25-2003, 04:53 PM

Do some type of shift every 5 minutes.Many wounds start with transfer scratches and break open with prolonged sitting.

andrew · 11-26-2003, 01:45 AM

I am lent forward 5-6 times a day for 1-2 minutes. Pressure mapping has shown this reduces pressure on my butt.
Andrew

Welcome to the party pal!
Bruce Willis, Diehard

TD · 11-26-2003, 03:11 PM

My wife calls me her weeble ("Weebles wobble but they don't fall down" copyright for some toy manufacturer back in the 70s or 80s) because I have no ab muscles and wiggle a lot while trying to sit up. This changes the pressure spots on my roho almost constantly. I haven't had a pressure problem since going to the high rise (4 inch) version and only do the occasional pressure release lift to get comfortable. 8 plus years and counting and the last time I was in the VA SCI clinic they told me I had excellent skin on my tush.

Lifting isn't the only way to relieve the pressure on your butt, side to side and forward to back helps too so wiggle around, get antsie and smile...people will wonder what you're up to.

"And so it begins."

firewheels · 12-18-2003, 04:52 PM

Quote:

Originally posted by Jeff B:

I just found this abstract:

A specialist seating assessment clinic: changing pressure relief practice

M J Coggrave and L S Rose
[snip]
Spinal Cord (2003) 41, 692-695. doi:10.1038/sj.sc.3101527
[snip]

Does anyone here have access to the whole article? There is mention that "alternative methods of pressure relief were more easily sustainable and very efficient" but no specifics in the abstract[...]No mention is given on whether cushion type effected "loaded levels" either.

The article is available for $30 at http://www.nature.com/sj/subscribe/purchase.html, Just enter the title in the search bar. I dunno if I'll order it, particularly as there are reprint conditions, so I don't know if we could share it here. Perhaps someone with a sub to _Spinal Cord_ could read and summarize it for us.

The conclusion mentioned in the abstract is depressing, after all the time I've spent habituating myself to 10-sec pushups twice an hour! It's also a little mystifying, as IME such a pushup regimen *does* help. - f

firewheels · 06-12-2004, 04:58 PM

Good grief, I act as if we're going to live forever. 'Way back at the end of last year I shelled out for the article, intending to post a summary here. Gods only know what intervened, but here finally is the summary. I hope that some folks will find this useful, late as it is.

The pressure-relief study was part of a longer article devoted to Stoke Mandeville's seating clinic and their use blood-oxygen partial-pressure monitors in addition to the usual strain-gauge devices to evaluate seating arrangements. The conclusion of the pressure-relief study was that while 15-30 s pushups were effective in lowering oxygen partial presssure in 13% of their sample, they were ineffective for the majority, for whom other methods (forward lean, side lean, and tilt-back) did give the desired reduction, with repositioning times ranging from around 0.5 m to 3.5 m.. What I take from it is that one needs to do *some sort* of repositioning, the particular technique being dependent on one's abilities and stamina. Pushups aren't the only option, and one shouldn't feel guilty if one can't do them, as long as one does some sort of repositioning at intervals.

I think the following extract is short enough so that there's no copyright problem. If there is a problem, my apologies. - fw

Extract from "A specialist seating assessment clinic: changing pressure relief practice", MJ Coggrave and LS Rose, The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks, UK

[...] Our experience in the clinic suggests that the traditional pressure relief lift lasting 15-30 s is ineffective as a means of pressure relief as tissue oxygen levels are unable to recover to the unloaded level within this time. [...] A small retrospective project was undertaken to review the initial assessments of 50 newly injured and chronic SCI individuals seen in the clinic for a full assessment. The following information was recorded: age, level of injury, Frankel Grade, unloaded TcPO2 [blood oxygen partial pressure] and duration of pressure relief required for loaded TcPO2 to recover to unloaded levels. The records of four patients were excluded due to incomplete data.

Sample

Age Range 20-83 years, median 41 years
Duration of injury Range 5 weeks - 50 years, median 12 weeks
Level of injury Cervical=19
T1-6=9
T7-12=13
L1 and below=4
Nontraumatic=1
Frankel grade A=18
B=5
C=16
D=2
N/K=5
Gender Females 13, Males 33

Findings

[T]he mean duration of pressure relief required to raise tissue oxygen to unloaded levels was 1 min 51 s (range 42 s - 3 min 30 s). These results con.rmed the perception that brief pressure lifts of 15-30 s are ineffective in raising TcPO2 to the unloaded level for each individual. Sustaining the traditional pressure relief by lifting up from the seat for the extended duration is neither practical nor desirable for the majority of clients due to strain on upper limb joints, and sometimes other constraining health conditions. However, we have found that alternative methods of pressure relief are more easily sustainable and very efficient [...:]

Forward lean: Leaning forward with elbows or chest on knees, with or without assistance, effectively relieves pressure from the ischial tuberosities and requires no effort to maintain. Some independent patients also indicated that this was a less-obtrusive method of pressure relief than the traditional lift and was therefore more acceptable to them.

Side to side: For individuals unable to lean forward, leaning first to one side then the other is again effective in relieving pressure from the ischial tuberosities.

Tilt back: For a small group of individuals for whom these changes in position are unsuitable, for instance due to ventilator dependence or pain, tilting the whole seating unit back can relieve pressure sufficiently for TcPO2 to rise. The degree of tilt required to provide effective pressure relief is 65 deg. or greater. This can be achieved using a 'tilt in space' wheelchair or manually in other chairs. Where this method is conducted manually, it is recommended that the assistant is seated behind the patient.

[...] The traditional pressure lift was recommended for only 13% of this sample where recovery of TcPO2 in response to pressure relief was particularly rapid and the individual was both suff- ciently able and preferred this option. Other methods of pressure relief included 'tilt back' as described above. This method was used by a ventilator-dependent individual. This man was sensory incomplete and regular pressure relief enabled him to increase his time up in his chair by improving his level of comfort.

greta · 06-13-2004, 11:11 PM

I have a question regarding the "forward lean". When I am undressed and lean forward I can reach under my right IT--where my scoliosis creates the greatest pressure--and sure enough, no pressure at all.

When I have my pants on however, and do the forward lean and reach under my right IT, once again, clearance from the seating surface, but I notice this tightens my pants over the area. If I do the side lean, my pants stay loose and I always make sure there are no wrinkles or seams on that area.

This is not a tight pants issue; I have been roaming around in men's flannel pajama bottoms--very stylish--since my colostomy surgery a while back.

So...my question is:
Would the forward lean to relieve pressure be negated my the change in clothing tension created by it? I assume the study mentioned was not done on naked folk. I am just speaking from my own experience and wondering if anyone has info regarding my question.

If you can, try reaching under there with and without pants on during a forward lean and see what you think. I look "forward" to hearing about it.

SCI-Nurse · 06-14-2004, 12:55 AM

Greta, the lean forward weight shift is an excellent method for those unable to do push ups. The tension of your clothing against your skin is negliable in this position compared to the pressure of your buttocks on the wheelchair cushion or seat.

(KLD)

11-25-2003, 10:20 AM	#1
Jeff B Senior Member Join Date: Sep 2003 Location: Ontario, Canada Posts: 1,290	Are you weight shifting long enough? I just found this abstract: A specialist seating assessment clinic: changing pressure relief practice M J Coggrave1 and L S Rose1 1The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks, UK Correspondence to: MJ Coggrave, The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks HP21 8AL, UK Abstract Study design: Description of a clinical service, evaluation of pressure relief practices. Objectives: To describe a specialist seating assessment clinic and a change in clinical practice arising from its work. Setting: National Spinal Injuries Centre, Stoke Mandeville Hospital, UK. Methods: Retrospective review of the ischial transcutaneous oxygen measurements of 50 newly injured and chronic spinal cord-injured (SCI) individuals seen in a specialist seating assessment clinic. Tissue oxygenation was measured in the sitting position (loaded) and during pressure relief (unloaded). Results: Mean duration of pressure relief required to raise tissue oxygen to unloaded levels was 1 min 51 s (range 42 s¾3 min 30 s). Conclusion: These results confirmed the clinical perception that brief pressure lifts of 15-30 s are ineffective in raising transcutaneous oxygen tension (TcPO2) to the unloaded level for most individuals. Sustaining the traditional pressure relief by lifting up from the seat for the necessary extended duration is neither practical nor desirable for the majority of clients. It was found that alternative methods of pressure relief were more easily sustainable and very efficient. Spinal Cord (2003) 41, 692-695. doi:10.1038/sj.sc.3101527 I try to tilt in my powerchair for about 1 minute every 15 minutes. In my manual chair I do a lift every five minutes or so, but can only hold myself up 10-30 seconds. I haven't had any skin problems since I started using these methods but I'm always worried about this bony butt. Does anyone here have access to the whole article? There is mention that "alternative methods of pressure relief were more easily sustainable and very efficient" but no specifics in the abstract (I know that leaning forward, which is a commonly recommended method of pressure relief actually gives extremely high pressures under my ischias). No mention is given on whether cushion type effected "loaded levels" either.

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11-25-2003, 12:13 PM	#2
crags Senior Member Join Date: May 2002 Posts: 1,024	interesting... one of the most educational things for me occured when i had a seat pressure mapping done. i could see on the screen the hot spots under the ischia or pelvic rear bones. then i did a lift up to see what lift was required to change the color to unloaded. to my surprise the color changed with much less of a lift than i was previously doing. knowing this i now lift up less (in height, not frequency), save my shoulders and am able to hold it longer. it was about 1/3 the lift i was previously doing

11-25-2003, 01:44 PM	#3
Jeff B Senior Member Join Date: Sep 2003 Location: Ontario, Canada Posts: 1,290	Before I did pressure mapping I did not feel safe using my manual chair for long because I was not able to do a good lift. Once I saw that even the small lift I could do reduced the pressure I started using the manual chair more, which led to better strength for my lifts. However, I doubt that my triceps will ever get strong enough to hold me up for the almost 2 minutes recommended by the study.

11-25-2003, 04:53 PM	#4
611 Banned Join Date: Oct 2001 Posts: 559	Do some type of shift every 5 minutes.Many wounds start with transfer scratches and break open with prolonged sitting.

11-26-2003, 01:45 AM	#5
andrew Senior Member Join Date: Apr 2002 Location: Newcastle, Australia Posts: 741	I am lent forward 5-6 times a day for 1-2 minutes. Pressure mapping has shown this reduces pressure on my butt. Andrew Welcome to the party pal! Bruce Willis, Diehard

11-26-2003, 03:11 PM	#6
TD Senior Member Join Date: Aug 2001 Location: Phoenix, AZ, USA Posts: 649	My wife calls me her weeble ("Weebles wobble but they don't fall down" copyright for some toy manufacturer back in the 70s or 80s) because I have no ab muscles and wiggle a lot while trying to sit up. This changes the pressure spots on my roho almost constantly. I haven't had a pressure problem since going to the high rise (4 inch) version and only do the occasional pressure release lift to get comfortable. 8 plus years and counting and the last time I was in the VA SCI clinic they told me I had excellent skin on my tush. Lifting isn't the only way to relieve the pressure on your butt, side to side and forward to back helps too so wiggle around, get antsie and smile...people will wonder what you're up to. "And so it begins."

06-12-2004, 04:58 PM	#8
firewheels Senior Member Join Date: Aug 2001 Location: Massachusetts Posts: 168	Good grief, I act as if we're going to live forever. 'Way back at the end of last year I shelled out for the article, intending to post a summary here. Gods only know what intervened, but here finally is the summary. I hope that some folks will find this useful, late as it is. The pressure-relief study was part of a longer article devoted to Stoke Mandeville's seating clinic and their use blood-oxygen partial-pressure monitors in addition to the usual strain-gauge devices to evaluate seating arrangements. The conclusion of the pressure-relief study was that while 15-30 s pushups were effective in lowering oxygen partial presssure in 13% of their sample, they were ineffective for the majority, for whom other methods (forward lean, side lean, and tilt-back) did give the desired reduction, with repositioning times ranging from around 0.5 m to 3.5 m.. What I take from it is that one needs to do some sort of repositioning, the particular technique being dependent on one's abilities and stamina. Pushups aren't the only option, and one shouldn't feel guilty if one can't do them, as long as one does some sort of repositioning at intervals. I think the following extract is short enough so that there's no copyright problem. If there is a problem, my apologies. - fw Extract from "A specialist seating assessment clinic: changing pressure relief practice", MJ Coggrave and LS Rose, The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, Bucks, UK [...] Our experience in the clinic suggests that the traditional pressure relief lift lasting 15-30 s is ineffective as a means of pressure relief as tissue oxygen levels are unable to recover to the unloaded level within this time. [...] A small retrospective project was undertaken to review the initial assessments of 50 newly injured and chronic SCI individuals seen in the clinic for a full assessment. The following information was recorded: age, level of injury, Frankel Grade, unloaded TcPO2 [blood oxygen partial pressure] and duration of pressure relief required for loaded TcPO2 to recover to unloaded levels. The records of four patients were excluded due to incomplete data. Sample Age Range 20-83 years, median 41 years Duration of injury Range 5 weeks - 50 years, median 12 weeks Level of injury Cervical=19 T1-6=9 T7-12=13 L1 and below=4 Nontraumatic=1 Frankel grade A=18 B=5 C=16 D=2 N/K=5 Gender Females 13, Males 33 Findings [T]he mean duration of pressure relief required to raise tissue oxygen to unloaded levels was 1 min 51 s (range 42 s - 3 min 30 s). These results con.rmed the perception that brief pressure lifts of 15-30 s are ineffective in raising TcPO2 to the unloaded level for each individual. Sustaining the traditional pressure relief by lifting up from the seat for the extended duration is neither practical nor desirable for the majority of clients due to strain on upper limb joints, and sometimes other constraining health conditions. However, we have found that alternative methods of pressure relief are more easily sustainable and very efficient [...:] Forward lean: Leaning forward with elbows or chest on knees, with or without assistance, effectively relieves pressure from the ischial tuberosities and requires no effort to maintain. Some independent patients also indicated that this was a less-obtrusive method of pressure relief than the traditional lift and was therefore more acceptable to them. Side to side: For individuals unable to lean forward, leaning first to one side then the other is again effective in relieving pressure from the ischial tuberosities. Tilt back: For a small group of individuals for whom these changes in position are unsuitable, for instance due to ventilator dependence or pain, tilting the whole seating unit back can relieve pressure sufficiently for TcPO2 to rise. The degree of tilt required to provide effective pressure relief is 65 deg. or greater. This can be achieved using a 'tilt in space' wheelchair or manually in other chairs. Where this method is conducted manually, it is recommended that the assistant is seated behind the patient. [...] The traditional pressure lift was recommended for only 13% of this sample where recovery of TcPO2 in response to pressure relief was particularly rapid and the individual was both suff- ciently able and preferred this option. Other methods of pressure relief included 'tilt back' as described above. This method was used by a ventilator-dependent individual. This man was sensory incomplete and regular pressure relief enabled him to increase his time up in his chair by improving his level of comfort.

06-13-2004, 11:11 PM	#9
greta Senior Member Join Date: Jun 2004 Location: Utah Posts: 226	I have a question regarding the "forward lean". When I am undressed and lean forward I can reach under my right IT--where my scoliosis creates the greatest pressure--and sure enough, no pressure at all. When I have my pants on however, and do the forward lean and reach under my right IT, once again, clearance from the seating surface, but I notice this tightens my pants over the area. If I do the side lean, my pants stay loose and I always make sure there are no wrinkles or seams on that area. This is not a tight pants issue; I have been roaming around in men's flannel pajama bottoms--very stylish--since my colostomy surgery a while back. So...my question is: Would the forward lean to relieve pressure be negated my the change in clothing tension created by it? I assume the study mentioned was not done on naked folk. I am just speaking from my own experience and wondering if anyone has info regarding my question. If you can, try reaching under there with and without pants on during a forward lean and see what you think. I look "forward" to hearing about it.

06-14-2004, 12:55 AM	#10
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,515	Greta, the lean forward weight shift is an excellent method for those unable to do push ups. The tension of your clothing against your skin is negliable in this position compared to the pressure of your buttocks on the wheelchair cushion or seat. (KLD)