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Pressure Relief

Pressure Relief

Venezuela’s Jesus Aguilar raises his wheelchair after crashing just before the finish line during the men’s 800m T53 round 1 at the London 2012 Paralympic Games on September 4, 2012. 

Proper management and prevention of pressure ulcers make a big differencefor people with spinal-cord injuries.

Pressure ulcers are a serious and scary matter and, unfortunately, very common in people with spinal-cord injuries (SCI).
Various studies have found that more than half of all people with SCI and upward of 80% of veterans with SCI end up with a pressure ulcer sometime in their lives. There are many reasons to be concerned about them.

They are a common cause of rehospitalization; about 34% of spinal-cord-injured individuals undergo three or more hospitalizations during their lifetimes due to pressure ulcers.

Transferring without lifting your backside off the surface can damage your skin and lead to a pressure ulcer.
The sores can change a person’s life in many negative ways, including loss of income because of the need to be on bed rest, increased care costs, the negative health effects of prolonged bed rest and inactivity, and loss of usual activities and sources of life satisfaction. There’s a lot of personal suffering with dealing with a chronic ulcer, and it certainly can lead to depression.
About 7–8% of deaths in the SCI population are related to a pressure ulcer. These deaths most likely result from sepsis, an infection that spreads throughout the body in the blood and tissues.

Risk Factors
There are many reasons why a person with SCI is at high risk for pressure ulcers. SCI-related risk factors include:- Paralysis and sensory impairment. If you are unable to feel things normally, you won’t know if something is irritating your skin.

– Changes in collagen metabolism (the way your skin and connective tissues build new tissue and heal) caused by SCI mean it can take five times longer to heal below the level of injury.

– Muscle atrophy (shrinkage) can leave the bony areas on your backside (or other areas) less padded, so there is less protection over these areas.

– Altered circulation can reduce the blood supply to tissues. This increases your risk for skin problems and slows the healing process if you do develop a pressure ulcer.

Additional Risk Factors
– Low testosterone, which is more common in men with SCI than those without
– Diabetes, fevers or other illnesses
– Malnutrition
– Smoking (contributes to peripheral vascular disease, which makes it more difficult to heal a wound and more likely to develop a wound)

– Aging
(1) Skin gets thinner as one ages and tends to be less tolerant to trauma and shearing (dragging or rubbing) forces.
(2) People tend to lose some strength as they age. When you aren’t as strong, you might be more likely to drag your bottom across a surface and injure your skin.

By Deborah Crane, MD, MPH, and Beth Hall, RN, CWS, BS

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