Module 8:
Pressure management

Aim

This module provides information and strategies to manage pressure injuries within the context of a seating and wheeled mobility system prescribed for clients with a spinal cord injury (SCI).

Rationale

A high percentage of clients with SCI experience skin breakdown.  A priority goal of seating is to prevent the development of sitting acquired pressure injuries which frequently result in hospitalisation.

In a study of 253 people with SCI over a ten year period, pressure sores accounted for 6.6% of total readmissions, and 27.9% of re-hospitalisation bed days¹.

Apart from the cost to health care, pressure injuries have significant negative impact on the client’s physical, psychosocial and financial status. During the conservative or surgical management phase, a client’s ability to conduct work and self-care activities is reduced while the level of isolation and dependency may increase. Furthermore, extensive periods of bed rest can result in a reduction of cardiac respiratory fitness, physical deconditioning, development of postural asymmetry and contractures.

Outcomes

At the conclusion of this module, you will be able to:

• Understand  the terminology related to pressure and support surfaces
• Identify pressure related issues in seating and wheeled mobility
• Set seating goals to manage pressure
• List the key seating principles to address pressure issues, and
• Apply strategies to manage pressure in seating and wheeled mobility systems.

In this module

• Terms and definitions
• The importance of pressure management for SCI clients
  • What to do if the client has pressure injury located on a seating surface
• Keep the big picture in mind
• Be systematic: Identifying pressure issues in seating
  • Setting pressure management goals in the client’s context
• Recognizing key relationships between the client and wheelchair
  • Four key considerations
  • Keys to pressure management
    • Skeletal anatomy and seating pressure risks
    • Pressure management equipment: Pressure care cushions
    • Pressure management equipment: Configuration of seating and wheelchair
    • Weight-shift strategies
• Formulate trials
• Work as a team
• Persevere!!
• Key concepts in this module
• Case Study: Katherine
  • Case study questions
  • Case study answers