Truly managing pressure injury risk requires a wide-angle lens that takes in everything a wheelchair rider does — and everywhere that rider sits — all day long.
“People think it was just that car ride over the weekend or sitting on a commode for too long that caused this pressure injury,” said Nicole LaBerge, PT, ATP, commercial product manager, Permobil Americas. “They think, ‘It happened in that half hour or hour, but now it’s going to be better within a week or two.”
When healing doesn’t happen, LaBerge said, wheelchair riders can get confused: “They’re thinking, ‘I’m doing all the things I’m supposed to do. I’m offloading, I’m reducing my shear. What else is there?’
While working in a wound clinic for five years, LaBerge observed the multidisciplinary approach that now shapes the way she views pressure injury risk.
“I was doing the seating and the positioning and all of the support surfaces, because we can’t forget about beds and commodes and toilet seats,” LaBerge said of her time at the wound clinic. “But then it was so important to also have that nurse practitioner or that physician saying, ‘OK, what are you doing for your protein intake, and what are you doing for your hydration? Are your blood sugars through the roof, and is that breaking down your cells while we’re trying to rebuild them?’ I think that’s the other part of this. With microclimate, truly the temperature and the moisture right between your skin and the support surface is a big factor. But it’s not the only one.”
Specifically for microclimate considerations, LaBerge learned to consider where her patients were living — were heat and high humidity common, for example? — as well as a patient’s incontinence level.
“I’ve had clients who would say, ‘I was constantly leaking, so I went with the surgery to get a suprapubic catheter.’ Well, that could still leak depending on their positioning or if they’re still sitting for a long time and they’re not good at regulating their own temperature. Maybe they got rid of urine incontinence, but now they’re sweating more because they’re sitting, and they’re not thinking about doing a position change or getting up to use the toilet or the commode.”
Managing pressure injury risk, therefore, is a constant exercise in assessing and reassessing how a wheelchair rider is sitting, moving, eating, hydrating, weight shifting, etc.
“I think it’s an overall checklist, but it’s a checklist every single time for that individual as well,” LaBerge said. “If they were really great for a couple months and now they’re starting to get skin breakdown, you can’t just go back to that one factor that caused it before. It’s looking at the whole situation again — their individual or personal environment as well as their external environment.
“Are they smoking? Are they drinking sugary drinks all day? Did they have a loss of income so now they’re not eating as healthy as they did before? I think sometimes we forget that something that worked for this person isn’t going to work for everybody. Every person is unique.”
Editor’s note: This is a sidebar to Managing Microclimate, a feature story in Mobility Management’s latest ebook digital edition. To access the rest of the issue, visit the Mobility Management website.
