Confronted with the question of when to pressure map, the answer might seem
obvious: Consider using pressure mapping when you’re concerned about pressure!
To today’s seating & mobility professionals, that often means bringing
pressure mapping into the client evaluation to assess how pressure is being
distributed as the client is sitting in a wheelchair. Pressure mapping is also
commonly brought into play when clinicians and providers are considering new
equipment — a new seat cushion, mobility vehicle, support surface, etc.
— and want to compare pressure distribution when a client is using one
product vs. another.
But pressure mapping — which produces visual, color-coded images (and
measurements) to represent, for instance, pressure distribution as a client
sits on a wheelchair cushion — can be a valuable resource in other scenarios
“Other” Pressure Mapping Applications
Consider these other potential pressure mapping applications:
- To examine other seating surfaces. When a wheelchair user has pressure
problems, the seating system often becomes the prime suspect. But your investigation
shouldn’t end there. It’s important to assess your client’s
daily routine and environment, and to scrutinize other seating surfaces he/she
is in contact with. For instance, does your client sit on the living room
floor to watch TV? Does he have a long commute in a car, bus or train? Is
he sitting on a shower or bathtub chair while bathing? Does he use a commode?
Does he also use a sports chair? Is he sitting up in bed for any length of
- Even if he’s been pressure mapped while lying in bed and the results
have been good, sitting up in bed can be a completely different story. Pressure
mapping other seating surfaces can point out other sources of pressure problems.
- To provide feedback and education. Clients may faithfully do push-ups in
their ultralight chairs, but are they shifting enough of their weight to truly
attain pressure relief? Are clients using tilt and recline systems tilting
or reclining far enough to redistribute their weight properly?
Pressure mapping results can help clients learn to do more effective push-ups
or leaning weight shifts and can help clients and clinicians to determine how
far back to tilt or recline — or if both tilt and recline are necessary
to get the best results. “Pressure maps,” said Douglas A. Hobson,
Ph.D., as part of a Rehabilitation Engineering & Research Center (RERC)
on Wheeled Mobility presentation, “can give the wheelchair user an idea
of what upperbody movements are required in order to provide significant pressure
relief to buttock tissues.”
As the ISO Working Group Clinical Use Guidelines (see sidebar) explain, “Seeing
one’s own pressure distribution and peak areas drives home the message
of the importance of pressure management. It is also a very valuable tool to
demonstrate the effectiveness of pressure relief techniques.” The color-coded
representations produced during pressure mapping are generally easy for clients
to learn to interpret. For example, Red means danger!
- To assess other positions and other parts of the body. Seating & mobility
professionals may focus first on seating surfaces, sacral areas and ischial
tuberosities, but skin breakdown can also happen to the back of the head,
the elbows and heels while lying down, for instance. If the client practices
a standing regimen, how does the pressure distribution of his feet look?
Focusing on Client Immobility
While pressure mapping may most readily be considered while working with complex
rehab clients, a wide range of clinicians and researchers now agree that immobility
is a major or perhaps the number one risk factor for pressure ulcers.
Yes, loss of sensation — along with poor nutrition, changes in cognition,
frequent moisture, poor hygiene, previous pressure sore history, and many other
factors — also contribute to the likelihood that a client will suffer
skin breakdown. But as Angela Morrow, RN, said: “People at the greatest
risk of developing pressure ulcers are those who are immobile.” Daniel
Silverman, M.D. and author for the Multiple Sclerosis Foundation, concurred:
“Contrary to popular belief, it is not MS, but immobility, that creates
an increased risk for pressure sores.”
Logically, then, pressure mapping tools could help any client who has difficulty repositioning himself or herself completely and frequently enough to avoid
pressure problems. That includes some clients who don’t immediately come
to mind, such as active paraplegics or clients who have sensation. But if immobility
is the starting point and pressure mapping one of the tools that can help prevent
skin breakdown, its use may be indicated far more often than commonly thought.
ISO Working Group Clinical Use Guidelines
The guidelines, which can only be edited by registered users, includes definitions of different types of pressure, different pressure map technologies,
map calibration and map care and hygiene. Then the guidelines walk through the
data acquisition process and includes advice on postural and skin evaluations.
Pressure Mapping: What’s the Point?
This PowerPoint presentation, originally delivered at Heartland 2006, explains
what pressure mapping can and cannot accomplish, and gives hands-on advice on
how to both successfully complete a pressure mapping session and communicate
your findings to payors, referral sources, etc. The presentation also discusses
how pressure mapping can contribute to evidence-based practice and documentation/justification goals.