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Thursday December 4, 2014 MYT 12:00:00 AM
Thursday December 4, 2014 MYT 4:47:22 PM
by anthony thanasayan
As the disabled community celebrated International Day of Persons with Disabilities yesterday, my thoughts turned to the subject of pressure sores.
I spoke to Professor Dr Amara Naicker Naysaduray, a consultant rehabilitation physician at Hospital Universiti Kebangsaan Malaysia, who offered pointers on how the disabled can stay on top of things.
“Pressure sores can affect wheelchair users in particular, and people with disabilities in general,” Dr Amara points out. “It can strike fear in persons with special needs as well as healthcare workers.”
Dr Amara explains that pressure sores, commonly known as bedsores, are primarily caused by prolonged pressure against the skin that limits blood flow to nearby tissues. With time, this unrelieved pressure will damage skin tissues and as more tissues die, the wound gets deeper.
Most at risk are those with medical conditions that limit their ability to change positions, require them to use a wheelchair or confine them to the bed for a long time. Other risk factors are weakness, paralysis, injury, illness and ageing.
Bedsores can develop quickly and are often difficult to treat. A wheelchair user, for example, may see sores developing – due to prolonged sitting – typically on the tailbone, shoulder blades and spine, and the back of arms and legs where they rest against the chair.
“Having a pressure sore not only affects the health of the individual, but also his or her confidence and social life,” says Dr Amara. “People with pressure sores tend to keep away from others for fear of the smell from the wound giving them away – not to mention the stains on seats.”
According to Dr Amara, bowel incontinence can cause life-threatening infections through bacteria from fecal matter, especially when there is a wound. “The best thing to do in the event of pressure sores is to seek the help of a medical practitioner who will evaluate the wound and conduct further tests, if necessary.”
There is a lot a patient can do to prevent pressure sores from occurring, even though there are no absolute guarantees.
Dr Amara stresses that position changes are important in preventing pressure sores.
“Frequent repositioning prevents stress on the skin and minimises pressure on vulnerable areas. Other strategies include taking good care of your skin, maintaining good nutrition, quitting smoking and exercising daily.”
Dr Amara recommends the following:
Reposition yourself in a wheelchair:
> If you use a wheelchair, try shifting your weight every 15 minutes. Lift yourself, if possible. If you have enough upper body strength, do wheelchair push-ups – raise your body off the seat by pushing on the arms of the chair.
> Look into a speciality wheelchair. Some wheelchairs allow you to tilt them, which can relieve pressure.
> Use cushions to relieve pressure and help ensure your body is well-positioned in the chair. Various cushions – air-celled, foam, gel, water-filled or air-filled – are available. Seek advice from rehabilitation team members, if necessary.
Reposition yourself in bed:
> Change your body position every two hours.
> Look into devices to help you reposition. If you have enough upper body strength, try repositioning yourself using a device such as a trapeze bar. Caregivers can use bedlinen to help lift and reposition. This can reduce friction and shearing.
> Try a special mattress. Use special cushions, a foam mattress pad, an air-filled mattress or a water-filled mattress to help with positioning, relieving pressure and protecting vulnerable areas. Your doctor or other care team members may be able to recommend an appropriate mattress or surface.
> Adjust the elevation of your bed. If your bed can be elevated at the head, raise it no more than 30 degrees. This helps prevent shearing.
> Use cushions to protect bony areas with proper positioning and cushioning. Rather than lying directly on a hip, lie at an angle with cushions supporting the back or front. You can also use cushions to relieve pressure against and between the knees and ankles. You can support your heels with cushions below the calves.
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