Mobility Products

Manual Wheelchairs

• Manual Overview
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Power Wheelchairs

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Wheelchair Components

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Wheelchair Accessories

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Wheelchair Seating

• Seating Overview
• Wheelchair Cushions
• Wheelchair Cushion Types
• Wheelchair Backrests
• Wheelchair Back Types
• Pressure Sores

Mobility Scooters

• Scooters Overview
• Travel/Portable Scooters
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Walkers

• Walker Overview
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Walking Aids

• Cane Overview
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Other Equipment

Lifts

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Ramps

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Resources

Fact Sheets

• Pressure Sores
• Wheelchair Sizing

Funding

• Medicaid (USA)
• Medicare (USA)

Dealers

• Wayfair
• The Wright Stuff

Pressure Sores

Pressure sores are also known as bed sores, pressure ulcers and/or decubitus ulcers can occur almost anywhere on the body and can be very difficult to cure. Even when they can be "cured" the area where they occurred will always be more susceptible to a recurrence than there would normally be

Basically, pressure sores are areas of the skin that has died due to lack of blood flow to the area. Once started, pressure sores grow and deepen over time and can become life threatening if not dealt with properly. Proper seating will help prevent pressure sores and in some cases actually aid in the healing of them if caught early enough.

Causes of pressure sores:

There are four main factors and a couple of lesser factors that will contribute to creation of pressure sores. Not all of these factors need to be present for a pressure sore to form but the more factors present, the more likely and more severe the pressure sore is likely to be.

1. Pressure - Pressure is the number one contributor to pressure sores. When the weight of the person's body squeezes the flesh between a boney prominence and a hard surface the blood flow is restricted and the flesh will be damaged.
2. Shearing - Shearing is the effect on the skin and flesh when the body tries to slide but sticks to a hard surface. Shearing will damage the skin and flesh if not controlled.
3. Inability to weight shift - Every able bodied person weight shifts frequently when sitting or laying down. Weight shifting relieves the effects of pressure, which is always present, and shearing, which is often present when sitting or laying down by restoring blood flow to the affected areas. People who can't weight shift will not be able to reduce pressure or shearing and restore blood flow to prevent a pressure sore.
4. Heat - Too much heat in an area under pressure will increase the effects of the pressure and moisture in the form of perspiration, further reduce the blood flow and increase the resulting damage to the flesh.
5. Moisture - Too much moisture in an area under pressure will increase the effects of the shearing and heat, further reduce the blood flow and increase the resulting damage to the flesh.
6. Poor nutrition - Poor nutrition will negatively affect the elasticity of the skin and reduce the amount of flesh between the person's boney prominences and any hard surface resulting in an increased the chance of damage being done.
7. Poor circulation - Because the damage of a pressure sore is caused by a lack of circulation, any condition that reduces circulation will add to the chances of developing a pressure sore.
8. Lack of pain sensation - Wheelchair users who are able to weight shift but have no sensation in their buttocks will often suffer from pressure sores because their brains do not receive the signals from the pressure areas to shift their weight.

Environmental contributors to pressure sores:

1. No wheelchair cushion - People who sit in a wheelchair for hours at a time need a cushion. The number of the above factors that come into play, the shorter the time period before a pressure sore will develop.
2. Low quality wheelchair cushions - Low quality cushions are only suitable for short trips in a wheelchair and not intended for long term sitting. The more of the factors listed above, the better quality pressure relieving cushion will be necessary.
3. Diapers - Diapers can reduce the pressure relieving qualities of a wheelchair cushion increasing the chances of pressure sore development.
4. Soiled diapers - Soiled diapers increase heat and moisture in the pressure area.
5. Sheets and blankets - It is unbelievable how many nursing homes and hospitals will fold up blankets and bed sheets and lay them on top of wheelchair cushions to prevent accidental soiling of the cushion. This action effectively will reduce the pressure reducing qualities of a $400.00 or $500.00 wheelchair cushion to that of a $25.00 chunk of foam in addition to causing a pressure sore that will cost many thousands of dollars to treat. Any decent wheelchair cushion will have a waterproof removable, washable cover that can be taken off if soiled. additional covers for wheelchair cushions can be purchased at any time to be used as replacements in case of soiling.

People most at risk for developing pressure sores are those either have no sensation of pain in that area or those who cannot shift their weight off the sore area. Although pressure alone can be enough to create a pressure sore, there are usually contributing factors in addition to pressure. These include, but may not be limited to, heat, moisture, poor diet and and shearing. Heat can be simply the heat generated by the patient's own body when sitting  or lying on a surface which doesn't allow the skin to breathe. Moisture can be from sweat or urination. Poor diet will affect the skin's health and skin which has lost elasticity or is generally unhealthy will speed the development of pressure sores. Shearing is when two surfaces try to slide against each other but can't. An exaggerated description of shearing might be sitting on a park slide that is sticky with a bare bottom, gravity wants you to slide down but your skin is holding it back.

Special cushions are available to deal with pressure, moisture and heat as much as possible for wheelchair use and special overlays and mattresses are available for beds. Each manufacturer of these products has their own ideas as to which systems are best but it really is dependent on the patient's individual circumstances. The basic options for pressure relief products are foam, gel and air products or a combination of one or more of the three.

Pressure mapping is a technique for determining how much pressure is being applied to areas of the body by placing a sensor pad between the patient's body and the surface it is touching. By trying a pressure mapping system with several cushions or mattresses the dealer and therapist can get a visual chart showing the differences between the different cushions.

Below are two images, of the right buttock, of a young lady named Jennifer. In normal cases you would image the entire buttock area but in Jen's case the right buttock was where the problem was. At the time Jen was about 13 years old and weighed about 75 lbs. She was uncomfortable on her scooter and we were trying to find a cushion which would solve her comfort issue. The first image is not actually on her scooter seat but on a padded surface similar to her scooter seat and the second is the cushion which worked best for her.

Click on images for larger pictures.

The scales on these images show the red areas as being the highest pressure areas and the dark blue being the lowest pressure areas. As you can see, the difference between the two is a dramatic example of how having a good cushion will disperse the user's weight over a larger area thus removing the small areas of high pressure. Although this was the right choice for Jen, someone heavier or with a different body size or shape might have to use a different product.

In theory, the best results from a pressure relief cushion or mattress will be obtained if the skin is bare and directly on the product. People with pressure sores should be kept off them as much as possible and people who are at risk for pressure sores should be wearing clothing with the lightest possible and stretchy materials. Unfortunately, walking through nursing homes and some hospitals you see these at risk people with diapers, clothing of heavy material or pads of some sort on the cushions to keep the pressure relief products clean. These practices increase heat and moisture which contribute to pressure sores and negating the pressure relief qualities of the cushion or mattress. Anyone who feels that cleaning a soiled cushion or patient's body is too much work won't believe how much more work it takes to treat someone with a pressure sore.