experiencing elevated contact pressures or the ulcer does not show evidence of

Experiencing elevated contact pressures or the ulcer

This preview shows page 74 - 76 out of 104 pages.

(experiencing elevated contact pressures), or the ulcer does not show evidence of healing, an active support surface should be used. Active support surfaces are options for individuals with category/stage II pressure ulcers on multiple turning surfaces and a failure to heal on a reactive support surface. Similarly, the presence of a large category/stage III or IV pressure ulcer or a recent tissue graft for ulcer repair may also suggest the use of an active support surface (Charles et al., 1995; Day and Leonard, 1993). ADDITIONAL CONSIDERATIONS The individual circumstances of the person with a pressure ulcer must be considered in the prescription of a specialized bed or support surface as these devices may impact the ability to perform functional activities or affect the ability to provide core assistance. For example, it is often more difficult for someone with a higher level SCI to perform bed mobility or transfers on a active support surface than on a reactive one that may limit his or her functional independence and even require him or her to have additional help that might not have been needed on certain firmer reactive support surfaces. Any of these devices may not be appropriate in all home settings due to such factors as weight or operating costs. Wheelchair Seating and Positioning 23. Prescribe wheelchairs and seating systems specific to the individual that allow that individual to redistribute pressure sufficiently to prevent the development of pressure ulcers. Obtain specific body measurements for optimal selection of seating system dimensions (postural alignment, weight distribution, balance, stability, and pressure redistribution capabilities). Prescribe a power weight-shifting wheelchair system for individuals who are unable to independently perform an effective pressure relief. Use wheelchair tilt-in-space and/or recline devices effective enough to offload tissue pressure. Use standing wheelchairs to remobilize individuals with existing pelvic pressure ulcers.
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CLINICAL PRACTICE GUIDELINE 59 Full-time wheelchair users with pressure ulcers located on a sitting surface should limit sitting time and use a gel or air surface that provides pressure redistribution Maintain an offloaded position from the seating surface for at least 1 to 2 minutes every 30 minutes. (Scientific evidence–I, II, III, IV, IV; Grade of recommendation–A; Strength of panel opinion–Strong) An effective wheelchair and seating system can help promote skin health, sitting balance stability, symmetrical posture, greater upper limb use, and enhanced functional performance. Wheelchair features that optimize independence in performing pressure redistribution, transferring, and propelling, as well as providing optimal postural support and minimizing the risk of developing pressure ulcers, are recommended (Garber and Krouskop, 1997). An individual physical and functional assessment by a clinician with specific expertise in all these areas and in complex mobility equipment is necessary to achieve the best outcomes (Beer, 1984; Lowthian, 1993; Rosenthal et al., 1996; Coggrave & Rose,
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