A. Problem Specifics
An important practicality of people in wheelchairs is that they must be in a balanced position throughout the ride - no slouching or drooping, no leaning forward or backward, no tipping, no sacral sitting and/or no slumping. We are after a neutral tilt, no sitting outside the "box", without a posterior pelvic tilt or with the pelvis not in the sacral sitting position but with anterior support. (Sacrum, Latin, "A triangular bone consisting of five fused vertebrae forming the posterior sect-ion of the pelvis"; Greek, "sacred bone once used in sacrifices".)
Adjustable Frame Bed
The reason for the insistence on this required posture is the fact that people in wheelchairs have a high risk of bedsores due to the lack of movement in the legs, poor circulation of the blood due to the lack of movement and inactivity due to possible recovery from a stroke and/or surgery.
B. Causes and Symptoms
A painful skin disorder occurs if a patient does not move about, regularly, and can develop a sore (bedsore) that may cause damage to deeper tissue layers affecting bone, tendons and muscle, according to JAMA(Journal of the American Medical Association). Bedsores occur when a patient is recovering from a stroke or surgery because of a lack of movement, little to no mobility and/or poor circulation. They are extremely painful and may appear as from "cracks" in the skin to open, deep bedsores, per se.
Some of the more obvious causes are Old Age, Skin Abrasions, Diabetes, Inadequate Diet, Un-awareness, Skin Sensitivity, Incontinence and Wheelchair Usage.
1. Old Age. Elderly patients may not be able to exercise as much as they once could. Mobility decreases with age that may cause bedsores to start.
2. Skin Abrasions. Causes include frequent pushing or pulling across the bed, too-tight clothing and rubbing against bed-sheets.
3. Diabetes. Causes nerve damage, hinders blood-flow and circulation, weakens overall health and hinders normal healing
4. Inadequate Diet. Not getting proper nutrients for good health usually leads to lethargy, lack of energy for exercising or just plain movement and diminishes blood circulation increasing the susceptibility for bedsores.
5. Unawareness. A limit of mental functioning as with Alzheimer's may leave patients highly susceptible to bedsores without the awareness to maintain proper hygiene providing a higher risk for bedsores.
6. Skin Sensitivity. Very sensitive or delicate skin can lead to bedsores very easily with skin irritation occurring more rapidly in patients with sensitive skin.
7. Incontinence. Bedsores occur more rapidly in patients with a lack of control of bodily functions. Level of skin-germs is increased along with skin moisture that develops skin infections, quickly progressing to bedsores more rapidly.
8. Wheelchair Usage. People dependent on a wheelchair for movement and mobility are prone to bedsores on the legs due to restricted circulation, etc. They occur as movement decreases becoming a serious problem.
C. What To Do About Them
For the wheelchair problems, specifically and foremost, the first order is to supply the user with a cushion designed for the relief of the poor posturing problems while maintaining all the cushion dynamics and increasing a stable pelvic position with the proper pelvic tilt. This means that the hips are all the way back in the chair against the backrest and one-to-two inches from the end of the cushion to the back of the knees guaranteeing a stable and correct pelvic position without sacral sitting.
D. Cautions With Solutions
The seat cushion is, seemingly, the simplest and easiest solution for the poor posturing problems as well as the related bedsore problems. However, caution must be taken to find the proper seat- cushion in the first place matching all the dimensional and posturing requirements of the user. Further, a watch over the situation is necessary to make sure that the seat dynamics remain the same and stable over a specified length of time.
Since the seat and cushion dynamics are always changing with time, with the user and with the wear, tear and usage of the wheelchair, it is mandatory to watch for changes and new discrepan-cies in the aforementioned measurements and characteristics.
Additional wheelchair options and accessories that could be useful in maintaining the desired and correct seating position include tension-adjustable back upholstery, back-supports, criss-crossing belts (as seat-belts in an automobile) and adjustable-frame wheelchairs designed for postural support. As one can observe, the possible adjustments and accessories are numerous on today's wheelchairs leading to the comfort, safety, mobility and convenience for the wheelchair user.
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Dec 11, 2011 18:36:14
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