Pressure sores are common amongst those with limited mobility. This article aims to discuss the risks associated with pressure sores, preventative measures and solutions including specialist seating.
Risk of pressure injuries
Both skin and muscle need oxygen to function healthily. Being seated for longer than a few hours is known to increase the risk of pressure injuries because it reduces blood flow and consequently, oxygen to tissues.
Signs of pressure sores
A person's lack of sensation or reduced ability to change position can also heighten the risk of skin breakdown. When blood flow is restricted via compression (through sitting, bony prominences or asymmetrical loading), increased moisture (as a result of reduced thermoregulation and/or sweating) and shear (through sliding, spasms or vibration through a chair), redness may occur on the skin. This is the body trying to reoxygenate the affected area. Redness that doesn’t go away within half an hour is the first sign of a pressure sore.
Severity of pressure injuries range from uncomfortable redness that doesn’t go away all the way through open wounds that can prove to be fatal. In the later stages of pressure sores, total offloading (through bedrest) is usually the main course of action. This can be frustrating and extremely limiting to those afflicted.
Prevention of pressure sores and solutions
Daily activities to promote skin integrity and prevent development of pressure sores include:
Incorporating pressure reliving materials into seating
Having a routine for offloading pressure by lifting up out of or re-adjusting position in a chair to allow blood flow back to those vulnerable body prominences
Distributing pressure through offloading
Depending on skin integrity and individual movement, preventative offloading should occur at minimum every 1-3 hours.
A tilt in space wheelchair can be used to redistribute pressure from the bottom to the back without the need to transfer and is particularly useful tool for people who have difficulty adjusting their own position to offload and wish to do so independently or whilst out and about.
Seating solutions and cushions for pressure sores
Seating is another tool we can use to prevent pressure injuries. Pressure = Force/Area. If we assume that the force (in the case of seating, this would be the weight of the occupant) is fixed, the best route to affecting pressure is to look at the contact surface area.
On this basis, the golden rule of pressure relief in seating is to maximise the body surface area in contact with the seat which in turn means that the peak pressure exerted through any given point is reduced. The two main ways to do this within a cushion are through shape and materials.