Abstract
Purpose of Review
The purpose of this review was to (1) assess the factors related to the occurrence of pressure injuries in people with a spinal cord injury (SCI), (2) review methods of pressure injury prevention, and (3) examine compensatory technologies developed to promote in-seat movement to reduce the risk of pressure injuries.
Recent Findings
Risk factors for seating-related pressure injuries are well documented, yet ulceration remains a daily concern for individuals with SCI. While prompts and alarms have been shown to be effective at increasing in-seat movement, the devices thus far were not designed for long-term use. Wheelchair users will benefit from continued development of novel technologies designed to help them self-manage pressure injury prevention.
Summary
Optimized feedback about pressure and movement will help wheelchair users with SCI perform more effective movements to relieve pressure, perform movements more frequently and consistently, and maintain effective and frequent movement behaviors over time while feedback is available.
Similar content being viewed by others
References
National Spinal Cord Injury Statistical Center. Annual Statistical Report--2015 Complete Public Version. Birmingham, Alabama; 2015.
Cardenas DD et al. Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis. Arch Phys Med Rehabil. 2004;85(11):1757–63.
National Pressure Ulcer Advisory Panel. Governmental Agencies and Professional Organizations Support NPUAP Pressure Injury Staging System. 2016.
National Pressure Ulcer Advisory Panel. Prevention and treatment of pressure ulcers: quick reference guide, E.H. Ed. N.P.U.A. Panel, and P.P.P.U. Alliance, Editors. Perth, Australia: Cambridge Media; 2014
Staas Jr WE, Cioschi HM. Pressure sores: a multifaceted approach to prevention and treatment. West J Med. 1991;154(5):539–44.
Thietje R et al. How does knowledge about spinal cord injury-related complications develop in subjects with spinal cord injury? A descriptive analysis in 214 patients. Spinal Cord. 2011;49(1):43–8.
Consortium for Spinal Cord Medicine. Pressure ulcer prevention and treatment following injury: a clinical practice guideline for health-care providers. Paralyzed Veterans Association. 2014.
Chawla JC, Andrews B, Bar C. Using warning devices to improve pressure-relief training. Paraplegia. 1979;16(4):413–9.
Defloor T. The risk of pressure sores: a conceptual scheme. J Clin Nurs. 1999;8(2):206–16.
Kosiak M. Etiology of decubitus ulcers. Archives of Physical Medicine & Rehabilitation. 1961;42:19–29.
Linder-Ganz E et al. Real-time finite element monitoring of sub-dermal tissue stresses in individuals with spinal cord injury: toward prevention of pressure ulcers. Ann Biomed Eng. 2009;37(2):387–400.
Linder-Ganz E et al. How do normals move during prolonged wheelchair- sitting? Technol Health Care. 2007;15(3):195–202.
Mayo Clinic. Mayo Clinic guide to living with a spinal cord injury. New York, New York: Demos Medical Publishing; 2009.
Reenalda J et al. Analysis of healthy sitting behavior: interface pressure distribution and subcutaneous tissue oxygenation. J Rehabil Res Dev. 2009;46(5):577–86.
Chenu O et al. TexiCare: an innovative embedded device for pressure ulcer prevention. Preliminary results with a paraplegic volunteer. Journal of Tissue Viability. 2013;22(3):83–90.
Yang YS et al. Remote monitoring of sitting behaviors for community-dwelling manual wheelchair users with spinal cord injury. Spinal Cord. 2009;47(1):67–71.
Stockton L, Parker D. Pressure relief behaviour and the prevention of pressure ulcers in wheelchair users in the community. Journal of Tissue Viability. 2002;12(3):84–99.
Coleman S et al. Patient risk factors for pressure ulcer development: systematic review. Int J Nurs Stud. 2013;50(7):974–1003.
Krause JS, Broderick L. Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset. Archives of Physical Medicine & Rehabilitation. 2004;85(8):1257–64.
Raghavan P et al. Prevalence of pressure sores in a community sample of spinal injury patients. Clin Rehabil. 2003;17(8):879–84.
Stinson M, Gillan C, Porter-Armstrong A. A literature review of pressure ulcer prevention: weight shift activity, cost of pressure care and role of the occupational therapist. Br J Occup Ther. 2013;76(4):169–78.
Sonenblum SE et al. Effects of wheelchair cushions and pressure relief maneuvers on ischial interface pressure and blood flow in people with spinal cord injury. Archives of Physical Medicine & Rehabilitation. 2014;95(7):1350–7.
Sonenblum SE, Sprigle S. Distinct tilting behaviours with power tilt-in-space systems. Disability & Rehabilitation: Assistive Technology. 2011;6(6):526–35.
Sprigle S, Maurer C, Soneblum SE. Load redistribution in variable position wheelchairs in people with spinal cord injury. J Spinal Cord Med. 2010;33(1):58–64.
Hobson DA, Tooms RE. Seated lumbar/pelvic alignment: a comparison between spinal cord-injured and noninjured groups. Spine. 1992;17(3):293–8.
Burns SP, Betz, Kendra L. Seating pressures with conventional and dynamic wheelchair cushions in tetraplegia. Arch Phys Med Rehabil. 1999;80(5):566–71.
Fordyce WE, Simons BC. Automated training system for wheelchair pushups. Public Health Rep. 1968;83(6):527–8.
Roemer R, Lee H, Meisel H. Warning device for the prevention of ischaemic ulcers in quadriplegics. Medical & Biological Engineering. 1976;14(5):580–1.
Temes WC, Harder P. Pressure relief training device. Phys Ther. 1977;57(10):1152–3.
Patterson RP, Fisher SV. Pressure and temperature patterns under the ischial tuberosities. Bulletin of prosthetics research. 1980;10-34:5.
Werner P, Perkash I. Warning mat to signal air seat cushion failure. Arch Phys Med Rehabil. 1982;63(4):188–90.
Fisher SV, Patterson P. Long term pressure recordings under the ischial tuberosities of tetraplegics. Paraplegia. 1983;21(2):99–106.
Cumming WT et al. Microprocessor-based weight shift monitors for paraplegic patients. Arch Phys Med Rehabil. 1986;67(3):172–4.
Grip JC, Merbitz CT. Wheelchair-based mobile measurement of behavior for pressure sore prevention. Comput Methods Prog Biomed. 1986;22(1):137–44.
Bain DS, Ferguson-Pell M. Remote monitoring of sitting behavior of people with spinal cord injury. Journal of Rehabilitation Research & Development. 2002;39(4):513–20.
Wilson, J.W., et al. Mobile wireless activity monitoring to prevent pressure sores in wheelchair users. In: RESNA 27th International Annual Confence. Orlando, Florida. 2004.
Brizzi, K., et al. Improving quality of life: design of an automated pressure relief timer for pressure sore prevention. In: RESNA Annual Conference. 2008.
Eneling, M., et al. A pressure-controlled alarm and monitoring device for pressure ulcer prophylaxis in patients with traumatic spinal cord injury. In: IFMBE Proceedings. 2009.
Verbunt M, Bartneck C. Sensing senses: tactile feedback for the prevention of decubitus ulcers. Applied Psychophysiology and Biofeedback. 2010;35(3):243–50.
Malament IR, Dunn ME, Davis R. Pressure sores: an operant conditioning approach to prevention. Archives of Physical Medicine & Rehabilitation. 1975;56(4):161–4.
Carr S, Wilson B. Promotion of pressure-relief exercising in a spinal injury patient: a multiple baseline across settings design. Behavioural Psycotherapy. 1983;11(4):329–36.
Merbitz CT et al. Wheelchair push-ups: measuring pressure relief frequency. Archives of Physical Medicine & Rehabilitation. 1985;66(7):433–8.
White GW, Mathews RM, Fawcett SB. Reducing risk of pressure sores: effects of watch prompts and alarm avoidance on wheelchair push-ups. J Appl Behav Anal. 1989;22(3):287–95.
Bridle M, Yasenchak P, Nidiffer B. Selecting a pressure-relief training device. Am J Occup Ther. 1992;46(2):168–70.
Yang YS et al. Effects of audio feedback on sitting behaviors of community-dwelling manual wheelchair users with spinal cord injuries. Assist Technol. 2010;22(2):79–86.
Wu YK et al. Evaluating the usability of a smartphone virtual seating coach application for powered wheelchair users. Med Eng Phys. 2016;38(6):569–75.
Acknowledgements
This publication was made possible by funding the National Institutes of Health (R21 AG050640-01).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Tamara L. Vos-Draper and Melissa M. B. Morrow declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Funding
This publication was made possible by funding the National Institutes of Health (R21 AG050640–01).
Additional information
This article is part of the Topical Collection on Rehabilitation Technology
Rights and permissions
About this article
Cite this article
Vos-Draper, T.L., Morrow, M.M.B. Seating-Related Pressure Injury Prevention in Spinal Cord Injury: a Review of Compensatory Technologies to Improve In-Seat Movement Behavior. Curr Phys Med Rehabil Rep 4, 320–328 (2016). https://doi.org/10.1007/s40141-016-0140-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40141-016-0140-7