Rehab: Pressure Ulcers

Pressure Ulcers & Related OT Interventions

Types & Stages of Pressure Injuries

Stage 1: (skin is intact) pressure injuries are not open wounds.

Stage 2: (partial-thickness skin loss) pressure injuries are open wounds

Stage 3: (Full-thickness skin loss with visible fat) pressure injuries extend through the skin into deeper tissue and fat but do not reach muscle, tendon, or bone.

Stage 4: Full-thickness tissue loss with exposed muscle, tendon, or bone.

OT Evaluation & Interventions for Pressure Ulcers

Key Focus Areas:

Pain: Ensure adequate control for participation in functional activities.
Communication: Use plain language; collaborate with interdisciplinary team (IP).
Education: Train patient/caregiver on risk factors, prevention, skin inspection.

Moisture: Limit clothing layers, promote continence, use breathable materials.
Nutrition: Encourage self-feeding, hydration, and optimal food intake.
Positioning: Assess support surfaces, create a positioning schedule, consider daily roles and demands.
Repositioning/Transfers: Minimize friction; use lifting devices; teach effective weight shifting.
Support Surfaces: Promote posture, accommodate deformities, and optimize pressure distribution.

Medical Management

  • Fluids & Edema Control

  • Hydrotherapy (Whirlpool): Loosens dead tissue for debridement.

  • Surgical Interventions: Skin grafting.

  • Vacuum-Assisted Closure (Wound-Vac): Applies negative pressure to aid healing.

  • Nutrition: Supports metabolic demands of healing.

Acute Care & Post-Surgical OT Phase

Evaluation (within 24–48 hours):

  • Functional status

  • ROM & strength

  • Activity/mobility tolerance

  • Psychological status

  • Support system

  • Anticipated discharge plan

  • (For children: developmental level)

Interventions:

  1. Positioning: Prevent contractures; ensure optimal functional alignment.

  2. Splinting:

    • Pre-/post-operative use

    • Maintain anti-deformity position (e.g., intrinsic-plus for hands)

  3. ADLs: Adaptive methods and tools for self-care independence.

  4. Therapeutic Exercise & Activity: Maintain mobility and strength.

  5. Education: On precautions, positioning, wound care, and activity tolerance.

Functional Interventions

Adaptive Equipment & Techniques:

  • Build-up handles for utensils, toothbrushes, writing tools (use cylindrical tubing).

  • Pad walker handles with washcloths/tape for improved grip.

  • Use Coban/compression gloves to keep dressings clean.

  • Train grasp/manipulation for ADL tools (urinal, toothpaste, writing tools).

  • Use light-resistance TheraPutty (inside medical glove) for grip/pinch strengthening.

  • Posture & Movement: Normalize guarded/slow movements.

  • Quality of Movement: Prevent compensatory or maladaptive motions.

  • Pain, Anxiety, Fear: Use calming or distraction techniques.

Rehabilitation Phase (Sub-Acute & Outpatient)

Evaluation:

  • Functional status

  • ROM & strength

  • Splint condition (re-mold or replace as needed)

  • Activity/mobility tolerance

  • Psychological status

  • Support system

  • Anticipated discharge plan

OT Interventions:

  • Splint management (re-fit, re-mold as healing progresses)

  • ADL retraining

  • Therapeutic exercise and activity

  • Patient/caregiver education

  • Scar Massage

  • Goal re-assessment

  • Compression therapy

  • Edema management

Home Exercise & Ongoing Care

  • Wound Care & Positioning

  • Skin & Scar Care

  • Self-Care Training: Promote safe independence in daily routines.

  • Splints/Orthotics: Clean, maintain schedule for wearing.

  • Pressure Garments: Follow strict wearing schedule.

  • Exercise Program: Maintain mobility and prevent stiffness.

Scar Management

Compression Garments:

  • Custom-measured by OT; ordered from manufacturer.

  • Fitted 3 weeks post-wound healing.

  • Worn 22–23 hours/day, off for ≤30 minutes at a time.

  • Continued use for 12–18 months for optimal results.

Topical Agents: Used to soften and protect healing skin and scars.