Article

Pressure ulcers (PUs) remain a costly and, often avoidable, complication of full
time wheelchair use. Clinicians routinely evaluate PU risk to assist in selecting
devices and interventions that may prevent PUs from occurring. Clinical
assessment of risk can be evaluated in many different manners, both formally and
informally and, typically, is based on combinations of demographic, disability
and client-reported behavioral factors. Many of these factors add to PU risk
because they impact the physiology and/or biomechanics of the skin and tissue.
This article results from a presentation during the Wheeled Mobility
Rehabilitation Engineering Research Center's (RERC's) State of the Science
Conference in 2012. The presentation's purpose was to present issues and concepts
related to pressure ulcer prevention and set the stage for group discussion which
followed the presentation. This article progresses through the current state of
the science related to PU risk, starting with the tissue and cellular changes
resulting from pressure, through the impact that external loading has on blood
flow and tissue deformation, and ending with clinical assessment of risk based
upon demographic and behavioral factors. Implications for rehabilitation: Factors
leading to the development of PUs are numerous and varied, but the defining
factor is excessive external loading or pressure on the skin. The amount of
pressure needed to cause tissue damage varies widely within and across
individuals--based on anatomy and the presence or absence of bony structures
under the area of interest, tissue stiffness and other individual
characteristics, and most importantly--the amount of tissue deformation that
occurs. Clinicians routinely evaluate wheelchair users with respect to pressure
ulcer risk, however, objective risk measurements that inform prescription are not
readily available. A need exists to provide clinicians with objective
measurements of pressure ulcer risk that can inform individualized interventions.

Langue : ANGLAIS