Individuals with spinal cord injuries are at high risk for developing pressure sores. These wounds, which form on the body just from being immobile, can be fatal if not treated quickly and sufficiently.
Up to 80% of individuals with SCI will have a pressure sore during their lifetime, and 30% will have more than one.
But 95% of these wounds are preventable.
How does a pressure sore form?
A pressure sore (also called pressure ulcer, decubitus ulcer, or bedsore) is an area of the skin or underlying muscle and bone that is damaged due to loss of blood flow to the area.
Blood flow is lost when there is too much pressure on the skin for too long: Sitting too long without shifting weight, lying too long without turning, and not having padding in bed and in wheelchairs (to protect bony areas of the body, such as the heels) can cause pressure sores.
When you have an SCI muscles shrink (atrophy). The natural cushion over the bony areas dissipates and there’s more pressure on the thin skin layers. People with paralysis also experience decreased circulation due to the lack of muscle movement which results in a reduction in nutrients and oxygen healing the skin.
How can pressure sores be avoided?
Pressure relief
When sitting in your wheelchair you should do pressure reliefs every 15 to 30 minutes for a duration of at least 30 to 90 seconds. Just tilt or recline the wheelchair if possible. Some people require more relief than others. In bed, use an alternating pressure air mattress and float your heels by hanging them off a pillow; alternatively you can wear protective boots at night.
Skin inspection
Check your skin, or have your caregiver check daily. Look for changes in skin color (redness or darkening), blisters, bruises, or cracked, scraped or dry skin. Check bony areas like the sacrum (lower back), coccyx (tailbone), heel of the foot, ischium (the base of the buttocks, hip, elbow, knee, ankle and bony areas of foot (from tight-fitting shoes) and the back of the head.
Have someone press down on the mark and note whether or not the skin blanches (turns white after a second after pressing). If it doesn’t, the wound may already be deep.
Proper padding
Use a rotating air mattress in bed and a wheelchair seat with air cells, gel or foam. Depending on weight and skin tolerance you may need to be turned in bed every every 2 to 6 hours.
You should have a seating evaluation for a wheelchair in which a therapist will place a pressure map above your cushion and under your buttocks to see where your pressure-sensitive areas are so they can alter the wheelchair seat or back and show you how to relieve pressure on the vulnerable areas.
Dehydration and nutrition
To keep the skin strong, drink enough water every day and avoid caffeinated drinks, which are dehydrating and may trigger bladder spasms. Eat a balanced diet that includes adequate protein, fruits and vegetables (fresh if possible). Good nutrition helps the body tissue rebuild and fight infection.
If you think you might be getting a pressure sore:
If you see a pressure wound forming, consult a wound specialist immediately. Your primary care physician can refer you. Stay under the close guidance of a medical professional, using the recommended products and heeding their warnings about maintaining pressure relief.
It’s important to catch and treat wounds quickly, because they can progress very rapidly. Bad pressure wounds may be deep down to the bone, require extensive bed rest and even surgeries to repair.
Pressure sores can be life threatening. Infections can develop and spread to the blood, heart and bone. Amputations can be necessary and Prolonged bedrest causes more health complications. Treatment can get incredibly expensive, too.
That’s why it’s so important to catch a pressure sore right away. They may take only days to form but months to heal.
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