Prevention of Pressure Sores and Specialist Seating Solutions

Pressure sores are common amongst those with limited mobility. This article aims to discuss the risks associated with pressure sores, preventative measures and solutions including specialist seating.

Risk of pressure injuries

Both skin and muscle need oxygen to function healthily. Being seated for longer than a few hours is known to increase the risk of pressure injuries because it reduces blood flow and consequently, oxygen to tissues.

Signs of pressure sores

A person's lack of sensation or reduced ability to change position can also heighten the risk of skin breakdown. When blood flow is restricted via compression (through sitting, bony prominences or asymmetrical loading), increased moisture (as a result of reduced thermoregulation and/or sweating) and shear (through sliding, spasms or vibration through a chair), redness may occur on the skin. This is the body trying to reoxygenate the affected area. Redness that doesn’t go away within half an hour is the first sign of a pressure sore.

Severity of pressure injuries range from uncomfortable redness that doesn’t go away all the way through open wounds that can prove to be fatal. In the later stages of pressure sores, total offloading (through bedrest) is usually the main course of action. This can be frustrating and extremely limiting to those afflicted.

Prevention of pressure sores and solutions

Daily activities to promote skin integrity and prevent development of pressure sores include:

• Keeping hydrated

• Good nutrition

• Incorporating pressure reliving materials into seating

• Having a routine for offloading pressure by lifting up out of or re-adjusting position in a chair to allow blood flow back to those vulnerable body prominences

Distributing pressure through offloading

Depending on skin integrity and individual movement, preventative offloading should occur at minimum every 1-3 hours.

A tilt in space wheelchair can be used to redistribute pressure from the bottom to the back without the need to transfer and is particularly useful tool for people who have difficulty adjusting their own position to offload and wish to do so independently or whilst out and about.

Seating solutions and cushions for pressure sores

Seating is another tool we can use to prevent pressure injuries. Pressure = Force/Area. If we assume that the force (in the case of seating, this would be the weight of the occupant) is fixed, the best route to affecting pressure is to look at the contact surface area.

On this basis, the golden rule of pressure relief  in seating is to maximise the body surface area in contact with the seat which in turn means that the peak pressure exerted through any given point is reduced. The two main ways to do this within a cushion are through shape and materials. 

Cushions with a higher contour are associated with increased pressure relief and more stable positioning. Stability in sitting can help to minimise shear whilst contouring can allow weight redistribution across the entire buttocks and thigh, rather than isolated to the ITs. Read more about out custom moulding here. 

Pressure relieving seating makes use of foams, gel and air. It’s not uncommon to use a combination of these materials, with the most immersive being located under high risk areas around like the ITs or the spine. These materials work on the same principle - the immersion of a body into these soft materials, maximises all available contact points between a wheelchair user and their seat. In high risk cases, it is possible to use closed air cell technology or custom moulding to completely offload a pressure site. Different fabrics for covers can also be employed to help with thermoregulation and keep moisture levels to a minimum. 

Pressure mapping

Pressure mapping measures the interface pressure between two surfaces. This technology uses a sensor and is extremely useful in determining specialist seating solutions for those at risk of pressure sores. At Wheelfreedom, we offer pressure mapping to our customers. The resulting data and our analysis tools offer insights to enhance product design, manufacturing, quality and research.

A properly set up chair can help to protect posture, reduce shear and optimise pressure distribution.

Did you know that almost 20% of your body weight is taken through the feet when sitting down?

When footplates aren’t positioned correctly, this weight is usually displaced through the area behind the knees (which don’t have much natural padding) or over a prolonged period of time, the body will compensate in an effort to find stability and leave the occupant sitting on the sacral area at the top of the pelvis. 

Below are two images from our pressure mapping service that we provide. The first picture on the left shows the pressure distributed when feet are unsupported and the second picture on the right demonstrates the pressure distributed with supported feet.

These images clearly highlight the benefits of using footrests as added support. They also show how pressure in the body is distributed to offer a more accurately tailored seating solution.

Book your seating assessment

If you or a loved one are living with reduced mobility and wish to find out more about the seating assessments we offer, get in touch with us to speak to a specialist.

Staying in the same position for a long period of time can lead to pressure ulcers and it is important you get the right equipment. At Wheelfreedom, we are trusted, knowledgeable, impartial, dependable and progressive. With thousands of 5 star reviews, feel reassured that you will receive a service that is tailored to your individual needs