Pressure sores.

georgewm

I am not able to walk any distance and so use a powerchair. But the problem with this is that after half an hour or so it gets really uncomfortable and pain in my lower back starts and I am plagued with pressure sores. I have experimented with numerous different cushions at great expense and would welcome any advice from people with similar experience. In particular has anyone got any experience using Roho air cushions. I am fairly confident that they would be helpful, but they are expensive. I am concerned that they may be prone to punctures. In treating my pressure sores, the District Nurse provided me with an air mattress and an air cushion for my recliner chair which works well and helps with the pain so an air cushion on the powerchair May be the solution and better than foam or gel cushions. I would appreciate it very much if anyone with similar problems would let me have their solutions. Thank you.

janer1967

Hi and welcome I am a power chair user too but dont sit in it for that long so dont have any issues with pressure sores thought I do out an additional cushion in from my manual chair if going out for a long time

Maybe a mobility shop could help they may have samples for you to try Im not really sure who else could help but there are lots of wheelchair users on here so hopefully they may have some guidance for you

Tori_Scope

Hi @georgewm! I know that Jane has given you some advice above, but I've tagged your post as 'unanswered' in case it helps any other powerchair users to find your post. 

georgewm

Thank you:janer1967 for replying to my post. Much appreciated. And thanks Tori. One of the negatives of using SCOPE is the amount of stuff and difficulty navigating through it all. Considering the number of people who use this site I should have far better response. The simple fact is that my Post hasn’t been read. 

The content of this site should be greatly simplified, reduced in size with a redesigned index. So I sincerely hope that a Senior Member of SCOPE reads this post and. Acts on the content.

Cher_Alumni

@georgewm Thank you for your comments and apologies you didn't get a better response.  I'll feedback your thoughts to the team and I hope you find a solution to help with your pressure sores soon.  

Richard_Scope

Hi @georgewm
I'm a full-time wheelchair user myself and it can get uncomfortable there's no doubt about that. 

1)    Perform Pressure Relief Exercises

One of the best pressure relief techniques for wheelchair users is to regularly carry out specific pressure relieving movements. Here are some popular exercises to try:

Please remember to check that your wheels are locked, and any belts are undone before attempting any exercises.

• The push-up – Use the wheelchair armrests (or wheels if you don’t have any) to push up out of the seat with your arms. You should straighten your arms fully so that your elbows are locked. Then ensure that the buttocks and lower back are fully out of the seat.
• The forward lean – Lean forward as far as you can – imagine that you are trying to rest your chest on your knees! This movement is particularly good for relieving pressure on the coccyx.
• Leaning side-to-side – Whilst seated, shift your body weight onto your left side to lift your right side out of your seat. Then repeat on the other side. Like the push-up, this movement relieves pressure from the buttocks and the lower back. However, because this is a more subtle movement it’s great to perform whilst you’re out and about!

The purpose of these exercises is to shift your body weight around in the wheelchair, relieving pressure from the areas where it is most commonly felt.

General advice suggests performing each movement for 15 seconds for every 15 minutes of wheelchair use. So, if you had been sat in your wheelchair for 30 minutes, you would exercise for 30 seconds. But we always recommend speaking to your doctor or physio first to find out what is best for you.

Any of the three movements mentioned above can be performed independently, or with assistance, depending on individual mobility levels.

Pros and Cons

Pros	Cons
No specialist equipment required	Requires some degree of mobility, or someone who is available to assist the user frequently
Only a short period of time is required to complete the exercises	Wheelchair users may feel uncomfortable performing the exercises in public
Encourages regular movement in those using a wheelchair as part of a recovery programme	Requires the cognitive abilities to remember to perform the movements at regular intervals

 

2)    Use pressure relief aids

Unfortunately, not all wheelchair users are able to perform pressure-relieving exercises. That’s one of the reasons why pressure relief aids like wheelchair cushions and heel pads are another great option.

What is a pressure cushion?

A pressure relief cushion is one of those items that really does ‘do what it says on the tin’. They provide a layer of cushioning – made from foam, gel or air – which acts as a barrier between the user and their wheelchair, relieving pressure from the areas of the body that typically come into the most contact with the chair.

This pressure relief cushion has a moulded shape to help it contour the body

Choosing a pressure relief cushion

An important factor when choosing a pressure cushion for wheelchair users is ensuring there is a close contour against the user’s body. This maximises surface area to help reduce pressure.

Another thing to note is that cushions can also be categorised into three risk bands – low risk, medium risk, and high risk. A higher risk band means that the cushion is designed for a wheelchair user who is more likely to develop a pressure sore.

Gel, foam and air pressure relief cushions can all be categorised as either low, medium or high-risk cushions. It is not the material that determines the risk band, how effectively they relieve the pressure is the key.

However, alternating air cushions are typically considered the ultimate high-risk cushion. This is because they actually change pressure over time. Air is moved from cell to cell inside the cushion, so the pressure to builds up in one area before moving onto another area. Unfortunately, users often find them less comfortable than standard air, gel or foam pressure cushions. So, it is best to only use them when it is really necessary.

If you need help understanding the risk bands, or finding the right pressure relief cushion for you, please give us a call or visit us in the showroom. Someone from the Yorkshire Care team will always be happy to help!

What is a heel pad?

A heel pad is a specially designed piece of material that is strapped around the foot to protect against pressure sores. For wheelchair users, they are useful for protecting the lower part of the leg which comes into contact with the wheelchair frame.

These heel pads are multi-purpose, they can also be used to protect the elbows, arms, and palms

They are also sometimes referred to as heel cushions, as they are often used together with a pressure relief cushion. It is important to remember that the lower back and buttocks aren’t the only areas at risk of pressure sores in wheelchair users and therefore aren’t the only areas that need protection.

Pros and Cons

Pros	Cons
Relatively affordable and widely available online and in shops	Pressure cushions can cause a pressure ulcer if not used correctly
A wide range of aids are available to suit different wheelchair users needs	They can reduce some users’ ability to move around independently using their wheelchair.
They offer pain relief as well as being a preventative measure

3)     Get a Modified Wheelchair

If you have tried pressure relief exercises and aids but are still experiencing pressure ulcers, it may be that your wheelchair does not have the correct seat dimensions for you.

When we put together our specialist seating assessment guide, we found that if a care chair has a seat depth that is too high, then the user’s feet won’t be properly supported and 94% of their body weight will be going through their buttocks and thighs! That seriously increases the pressure levels in those areas.

These principles also apply to wheelchairs, so getting the seat properly sized is crucial for pressure relief and avoiding ulcers.

Tips for seat sizing

The key measurements to take are:

• Seat Height
• Seat Depth
• Seat Width
• Armrest Height
• Back Height

Do you remember that we said incorrectly using a pressure relief cushion can cause pressure sores? Well, that usually occurs due to using a pressure cushion in an incorrectly sized wheelchair.

A tape measure should be used to take the required measurements

Getting your seat sizing measurements correct is key. If the measurements are inaccurate then the user is at an increased risk of pressure sores, as well as poor posture and other issues. Plus, because pressure sores can start developing in just a few hours it is important that sizing is correct from day one.

To get peace of mind, you’re always welcome to visit the Yorkshire Care Equipment showroom. Our team are pros with a tape measure and have been creating custom-built wheelchairs for decades!

We can offer advice on whether your existing wheelchair is the right fit for you or take measurements to help you choose your new wheelchair.

Tilt-in-Space Wheelchairs

As well as modifying your wheelchair so that the dimensions are just right, you can get specially designed wheelchairs with built-in features for positioning, posture support, and pressure relief.

They are called tilt-in-space wheelchairs. What makes these wheelchairs perfect for pressure relief is their ability to tilt the whole chair whilst maintaining correct body positioning with hip and knee angles at 90 degrees. This tilting allows the user to reposition their body weight to stop pressure building up in one area, without compromising proper posture.

Different wheelchair models have different ranges of tilt. For example, the Ibis allows a 30-degree tilt adjustment which can be easily operated by both the user or their carer.

Here’s what the Ibis wheelchair looks like when tilted back

Summary

Pressure relief exercises, pressure relief aids and having a bespoke wheelchair that suits your needs are all excellent pressure relief techniques for wheelchair users. Where possible, using a combination of all three is an effective way to reduce the risk of pressure sores. However, not everyone can perform exercises and pressure relief aids cause discomfort for some. Therefore, our number one tip is to make sure your wheelchair has the correct sizing dimensions for you.

georgewm

Thank you very much for a really useful article. Extremely helpful. I have been considering roho cushions for a while but they are expensive, very expensive and you can’t try them out before buying. The risk is too high.