Bedsore—the unbearable pain of wheelchair users
Bedsores, more accurately called pressure sores or pressure ulcers, are areas of damaged skin and tissue that develop when sustained pressure cuts off circulation to vulnerable parts of one’s body, especially skin on the buttocks, hips and heels. Without adequate blood flow, the affected tissue dies. Bedsores that do not receive proper treatment can become fatal. Christopher Reeve, the famous American actor most known for his role as “Superman,” died of a bedsore infection. Anyone who is bedridden, uses a wheelchair, or is unable to change positions without help can develop bedsores. According to a relevant study, about 60% of long time wheelchair users have suffered from bedsores. On average it takes about USD $2,731 in medical expenses and 116 days to cure a bedsore; the purchase of bedsore preventing equipment is a wise investment.
To avoid bedsores, avoid prolonged pressure on any one part of the body. A proper seating cushion and pressure relief exercises every 15-30 minutes are important. Wheelchair users can participate in the following pressure release exercises according to their physical condition—push up to lift buttocks, lean to the left, right, then forwards for pressure release, and a change of seating position.
It’s all about the shape—important for pressure release and stabilized seating posture
A well-designed sofa is comfortable because of the way its shape fits one’s body. The buttocks are round, and when one sits on a flat surface, the shapes do not match; the area that supports the body’s weight is reduced and the increased pressure causes discomfort. Lacking of proper support, buttocks can slip to either sides or front, causing unstable seating position and undesirable posture. To avoid this problem, a well-trained professional staff should select a wheelchair with proper seating shape so as to reduce the pressure and improve the stability of the wheelchair user.
Common causes of bedsores
1. Pressure—often affects people who are paralyzed, comatose, and too weak to move their bodies by themselves.
2. Friction—buttocks slips constantly on wheelchair or lower part of body moves too much, causing friction.
3. Moisture-- skin may be exposed to prolonged contact with perspiration, urine, or feces.
4. Inadequate nutrition—malnutrition and an unbalanced diet
5. Diminished sensation or lack of feeling—insensitive to pressure or heat due to the lack of skin sensation
Pressure Release Exercise
1. Lift the body with both hands to release pressure from the buttocks.
While seated in a wheelchair, one should lift the body every 15-30 minutes for 15-30 seconds to allow the pressured skin to regain good blood circulation. This exercise is good for wheelchair users with good upper body control and strength, such as those who have spinal cord injuries (waist level or lower) and poliomyelitis.
2. Move body from side to side and lean forwards to relieve pressure.
Lean from side to side to lift part of the buttocks away from the wheelchair, then lean forward to reduce the pressure from the back of the buttocks. This exercise should be done every 15-30 minutes. This exercise is good for people who are unable to lift the body by themselves such as those who may have spinal cord injuries (neck), are partially paralyzed, have muscular dystrophy, and elderly people. Note that the axles of the wheelchair caster should face front for wheelchair stability.
3. Change seating posture to alter the pressured area
Users who are unable to lift the body should use wheelchairs with tilt or recline functions to help release pressure. Tilt and reclining wheelchairs shift most of the weight from the buttocks to the back, so the skin of the buttocks can gain better blood circulation.
In human anatomy, the hamstring refers to one of the three posterior thigh muscles, or to the tendons that make up the borders of the space behind the knee. Tight hamstrings often lead to poor wheelchair positioning. Many wheelchair users sit with their knees extended and their feet in front of the body, which automatically moves them into posterior pelvic tilt. This tilt leads to precarious sacral sitting, dangerous sliding, and possible skin breakdown.
Tight hamstrings often lead to poor wheelchair positioning. Many wheelchair users sit with their knees extended and their feet in front of the body, which automatically moves them into a posterior pelvic tilt position. This tilt leads to precarious sacral sitting, increasing the chance of bedsores and possible skin breakdown.
Aside from muscle relaxing massages, a solution for wheelchair users with tight hamstrings may be to change to adjustable swing-away footrests that can be adjusted to the correct length and angle.