Options for Pressure Relief in a Wheelchair

Female doctor crouches down to check on a senior woman in a wheelchair.
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Everyone who spends time in a wheelchair needs to regularly relieve the pressure that sitting puts on their skin and underlying tissue. Our bodies were not designed to sit in the same position for extended periods of time. If steps are not taken to relieve the pressure that sitting in a wheelchair can cause, skin breakdown can occur.

This article is for people whose aging loved ones are spending increasing time in a wheelchair, particularly in the nursing home setting. Many of the strategies listed below apply to people of all ages in a wheelchair, but the advice is tailored to the nursing home setting for specificity.

Pressure relief is something that must be considered whenever a wheelchair is introduced to someone’s life. Throughout the aging/disease process, the plan for pressure relief will likely change.  Sometimes this is prompted by the emergence of a pressure ulcer, but, ideally, an observant professional who recognizes that strategies that have been working are no longer sufficient, initiates the change.

Pressure Relief

Sitting or lying in a particular area limits the flow of blood to that region, especially to parts of your body that are bony, causing the pressure to be the greatest. In most cases, this will trigger a sense of discomfort or the “pins and needles” sensation, telling your body to change positions. This change could be a simple crossing your legs in a different direction or shifting around in your chair.

The aging and disease process can disrupt this normal cycle. Your sensory system may not tell you when relief of pressure is needed. You may not have the physical ability to relieve that pressure. In worst-case scenarios, the consistent lack of blood flow can lead to the development of a pressure ulcer.

Involving the Right Staff in a Pressure Relief Program

As simple as changing positions to relieve pressure may sound, it can quickly become a complex issue. Factors such as the following must be taken into account:

  • Can the patient safely perform pressure relief themselves or what degree of support do they need?
  • Can they remember to perform regularly pressure relief?
  • Is their sensory system compromised in any way, compromising their body’s ability to remind them to change positions?
  • Is the integrity of their skin compromised in any way making them more susceptible to skin damage?
  • What daily activities are important and meaningful for them to participate in and how can pressure relief be incorporated into these?
  • Do they have the right equipment they need?
  • What systems are in place to make sure that the pressure relieving measures are working?

The nursing department will typically coordinate a daily routine for your loved one that involves pressure relief. If your loved one is complaining of discomfort in their chair, an order for occupational therapy or physical therapy may be appropriate. Your therapist can then conduct a holistic evaluation of above factors and make recommendations. In some cases, a therapist who specializes in wheelchairs (an ATP/SMS, Assistive Technology Professional/Seating and Mobility Specialist) may be called in for a consult.

What Patients Can Do

If your loved one can perform and direct their own pressure relief, there are several options to consider.

If they can move or asked to be transferred from their wheelchair to a recliner or bed, this should take place a couple of times throughout the day, limiting blocks of time within the wheelchair to a couple of hours at a time. While in a wheelchair, they should be relieving pressure regularly, as frequently as every 15 min.

Modifications to the Wheelchair

Finding the right wheelchair and wheelchair accessories for a patient is a delicate balance of making sure their wheelchair allows the client as much movement as safely possible, but also ensuring that the chair is comfortable, and pressure relief is an option.  Several pressure-relieving options limit mobility. For example, if the patient can use their legs to propel their wheelchair forward, certain cushions or heel protectors on the leg rests could comprise this important independence.

Making sure the wheelchair fits the patient is the first step in preventing unnecessary pressure. Is the chair the right width, so it doesn’t rub on the hipbones too much? Are the leg rests the right length? If they aren’t, this puts undue pressure on the buttocks.

Common pressure-relieving accessories include: Wheelchair cushions (foam, gel, air), tilt-in-space wheelchairs, and heel cushions.

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