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State Spinal Cord Injury Service

Spinal Seating Modules

Keep the big picture in mind

The wheelchair cushion is the usual suspect responsible for causing pressure injuries for wheelchair users. However there are many other possible causes (other equipment, non-wheelchair seating, etc.) as well as risk factors that contribute to pressure injury development. Rarely will a single cause be identified as the sole factor. A comprehensive pressure risk assessment should be implementing for each client. A comprehensive pressure risk assessment should be implemented for each client.

Commonly used pressure risk assessment tools (such as the Norton , Braden and Waterlow scales) lack sufficient sensitivity to be useful in the context of spinal cord injury pressure management because any individual with SCI is rated at ‘very high risk of pressure injury’. The ‘Spinal Cord Injury Pressure Ulcer Scale’ (SCIPUS) is an alternative scale that has been specifically designed for individuals with SCI in the acute or rehabilitation phases of treatment.1

It is therefore important to utilise a team approach to pressure risk management along with additional investigations to select suitable interventions and implement prevention strategies. The Pressure Management Assessment Tool (PMAT) is particularly useful in collating a range of information and identifies functional aspects of pressure injury development from a 24 hour perspective.2

Please note

The PMAT is protected by copyright law. You are welcome to use, copy, and distribute the PMAT as long as the following conditions are met:

  • You may not alter, transform, or build upon the PMAT without the author’s written permission
  • You must provide credit and cite copyright information when using the PMAT
  • You may not publish or use the PMAT for any commercial purposes without the author's written permission

The author of the PMAT may contact you at a future date to seek feedback regarding use of the PMAT to help inform future developments.


  1. Salzberg, C. A., D. W. Byrne, et al. (1996). "A new pressure ulcer risk assessment scale for individuals with spinal cord injury." Am J Phys Med Rehabil 75(2): 96-104.
  2. Pressure Management Assessment Tool (PMAT)
  3. Presentation covering the development and implementation of the Pressure Management Assessment Tool (PMAT): Development and Implementation of a Comprehensive Clinical Evaluation for Managing Pressure from a 24 Hour Perspective , Jennifer Birt, Health Sciences Centre, Winnipeg 2012