15. Pressury injury

Flashcards about pressure injuries, spasticity, contracture, risk assessment, prevention and management in spinal cord injury.

What is a pressure injury?

A localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear.

underlying tissue dies as a result of loss of blood flow to the area

What are the different stages of prssure injuries?

1. non-blachable erythema

2. partial thickness skin loss

3. full thickness skin loss

4. full thickness tissue loss

What are the causes of pressure injuries?

Pressure, shearing, friction, and microclimate.

What are common sites for pressure injuries during spine, side-lying and sitting respectively?

Occiput, scapulae, sacrum, heels, olecranons (supine); Greater trochanter, malleoli, head of fibula (side-lying); Ischial tuberosities, sacrum (sitting).

Why are people with SCI susceptible to pressure injuries?

Motor impairments, sensory impairments, moisture, aging, circulatory problems, co-morbidities (e.g., diabetes), poor nutrition, and poor equipment.

What are strategies for pressure injury prevention?

Skin checks (as part of routine managment), repositioning techniques (to relieve pressure), and pressure redistribution surfaces.

How often should skin checks be performed for individuals at risk of pressure injuries?

At least twice daily as part of routine management.

Besides keeping skin clean and dry, what else contributes to good skin health?

Good hydration and nutrition.

For people with SCI, how long and how often should pressure relief be performed when sitting?

At least 2 minutes every 15-30 minutes.

What should they do to relieve pressure and restore blood flow while sitting?

leaning forwards or on the side while stting, preferable to a lift

How to reposition in a power wheelchair?

tilt in space greater than 45 degrees is optimal for pressure relief

How long and how often should a person reposition in bed?

At least every 2 hours for 2 minutes

If side lying is preferred sleeping position, what position should they use?

30 degree side lying position should be used

What are some preferred wheelchair cushion types for pressure redistribution?

Foam, gel, and air cushions.

What is the primary purpose of mobility aids?

Enable people to access their environment/community.

What are the main types of mobility aids discussed?

Manual wheelchairs, power wheelchairs, and scooters.

What are the key requirements and considerations for using a manual wheelchair?

Requires reasonable UL function, good sitting balance, and independent/assisted transfers.

What are the key benefits of using a powered wheelchair?

Accommodates severe motor/sensory impairments and requires less sitting balance.

What is spasticity?

“Motor disorder characterized by a velocity-dependent increase in tonic stretch reflexes (muscle tone) with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex”.

In individuals with SCI, at which level of lesion is spasticity likely to occur?

Lesions T12 and above.

What are some triggers for spasticity/spasms?

Movement, touch, pressure, and pain.

What are the negative effects of spasticity?

Can interfere with function, stimulate neuropathic pain, cause postural deformity, and potentially damage skin.

What are the potential positive effects of spasticity?

Deliberate use for function, maintenance of muscle bulk, circulation, and padding bony prominences.

What are the long-term strategies for reducing spasticity?

Medication (baclofen, benzodiazepines, dantrolene), Botox injections, and physiotherapy.

What are the key muscles at risk of contracture for people with SCI?

Biceps, long finger flexors, hip flexors, hamstrings, gastrocs.