Can-SCIP Coach App
  1. Can-SCIP
  2. Recommendations
  3. Guidelines
  4. Section 2 - MANAGEMENT OF SCI COMPLICATIONS

S - SKIN INTEGRITY




Use a support surface (seat cushions and backrest) with advanced pressure-redistributing properties, compared with standard seat cushions and backrests, to minimize peak pressure areas around bony prominences and protect soft tissue from bruising and injury. (Adapted from PU-ONF 2013, p.109; Level C)
Address pelvic asymmetry, postural instability, kyphosis, and spasticity, using postural management and support surfaces. Evaluate the effects of posture, deformity, and movement on interface pressure distribution and the influence of subdermal tissue loads on sitting support surfaces. (PU-ONF 2013, p.112; Level B)
Consider the effects of clothing, shoes, and additional layers on the surface’s microclimate and pressure-redistributing properties. (PU-ONF 2013, p.112; Level C)
Recommend support surfaces and equipment based on observations and client and caregiver feedback during the sitting simulation and trial. (PU-ONF 2013, p.113; Level C)
Implement a trial of at least 24 hours and ideally of several days to ensure the equipment addresses pressure and microclimate issues, as well as functional and lifestyle needs. (Adapted from PU-ONF 2013, p.113; Level C)
Provide an individually prescribed wheelchair and pressure-redistributing seating system in collaboration with the individual who will be using the equipment. Ensure wheelchair configuration, postural supports, and sitting surfaces facilitate optimal wheelchair positioning and function. (PU-ONF 2013, p.117; Level B)

Consider a variety of factors for comprehensive pressure management when selecting a wheelchair cushion:

  1. influence of cushion characteristics, including weight, on wheelchair performance
  2. pressure-redistributing or offloading characteristics at bony areas
  3. positioning capabilities for postural management in resting and dynamic positions
  4. maintenance of a supported and symmetrical resting posture to prevent postural deterioration over time
  5. adequate stability for function and prevention of long-term postural deterioration
  6. microclimate management
  7. shear and friction reduction at the user-cushion interface
  8. comfort
(PU-ONF 2013, p.120; Level B)
Avoid placing additional layers between a support surface and individual with unless deemed essential. If an additional layer is necessary, the layer should be thin, breathable and stretchable. (Adapted from PU-ONF 2013, p.120; Level C)
Consider power weight-shifting technology (tilt-in-space, reclining) when other methods, such as active pressure redistribution or pressure redistribution through functional movements, are not effective or not possible. (Adapted from PU-ONF 2013, p.122; Level C)
Encourage the use of power weight-shifting technology, such as tilt, recline, and stand, frequently throughout the day to reduce the effects of sitting pressure on bony prominences of the buttocks. Individualize these strategies for each individual using pressure mapping, palpation, and skin response. Start with a position change that can be maintained for 2 minutes, at least once every 15 minutes. (PU-ONF 2013, p.123; Level C)
Add full tilt gradually where possible to increase blood flow over the ischial tuberosities. A minimum of 30° tilt is required to adequately redistribute pressure and increase blood flow. (PU-ONF 2013, p.123; Level B)