C LI NI CA L P E RSP EC T IVE - C EU A RTI CL E
PRESSURE INJURY PREVENTION AND HEALING AS A PART OF WHEELCHAIR SEATING Written by JILLIAN CACOPARDO, MPT, ATP/SMS
Pressure. Presión. Pression. DrÚck.
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The definition of pressure is “the continuous physical force exerted on or against an object by something in contact with it.”1 Whatever the language, the definition is the same. What differs are someone’s medical diagnoses and co-morbidities, lifestyle and habits, ability to retain learned information, and psychosocial affect. With a more complex individual, a higher incidence of pressure is likely. Literature about pressure focuses on prolonged periods of time spent in a sustained position while related research focuses on wheelchair seating and time spent in bed. Although wheelchair seating and time in bed may lead to the majority of pressure injuries, more obscure causes have also been found. These need to be brought to light to allow team members to identify causes and make optimal recommendations. Shear is also a force that can play a role in wound development. Shear is defined as “a strain in the structure of a substance produced by pressure, when its layers are laterally shifted in relation to each other.”1 Whether individually or in combination, pressure and shear are forces that can contribute to wound development as well as non healing wounds and can be found in not-soobvious places. While areas of pressure injury can include the malleoli, medial aspect of the knees, calcanei, occiput and scapulae, for this article, pressure injury will focus on the seated body surfaces including the sacrum, coccyx, ischial tuberosities and greater trochanters.
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DIRECTIONS 2022.1
