SCI Rehab. Stages of Pressure Sores. Prevention of Pressure Sores Develop due to pressure on skin, lack of blood supply, tissue death.

Transcription

1 SCI Rehab Basics of Bowel and Bladder Management, Skin Protection, Bathroom DME, Positioning, and Transfers SCI Rehab 101 Rehab Education Basics Skin, Bladder, Bowel Skin Protection and Pressure Sore Prevention! SCI deficits of Impaired/Absent Sensation Stages of Pressure Sores Catch it at Stage 1! Avoid a Stage 2, 3, and 4! Longer Healing! Prevention of Pressure Sores Develop due to pressure on skin, lack of blood supply, tissue death. April 25,

2 Bony Prominences High Risk Areas Skin Inspection for Protection. Ankle Malleoulus Sacrum/Coccyx Ischial Tuberosities Heels Inner Knee Greater Trochanter Hip Spine of Scapula/Shoulder Spine Spinous Process Inspect Daily! Patient or Caregiver! Inspect bony prominences and entire body. Looking for Redness, Sores, Unblanchable skin. Bed Positioning for Prevention Quarter Turn Bed Positioning. 45 deg Roll from Supine! Protects Sacrum, UE s, and LE s Turning and Repositioning Night Routine Every 2 hours or less. Positioning for Prevention Good Bad Bed Positioning with ADL s/rest Avoid laying on Sacrum! Avoid Sacral Shearing! Make sure hips bending with bed with self care and bed activities. Keep Head of Bed under 30 deg if need up for prolonged periods. April 25,

3 Positioning for Prevention Good/Bad WC positioning Avoid sitting on Sacrum! Get hips centered and back! Leg s positioned properly! Proper WC Cushion inflation! WheelChair Pressure Relief for Prevention Protect and relieve pressure from Sacrum/Coccyx and Ischial Tuberosities Power WC Tilt Recline for 2 minutes Manual WC Lateral Leans and Forward Lean, 30 seconds. Do both every minutes. Pressure Mapping Gives accurate reading of pressure distribution on seating surfaces. Used with WC Cushion and DME prescription and acquisition. FSA Pressure Mapping System. Additional Education for Skin Health and Pressure Sore Prevention Diet and Hydration Protein for would healing, tissue maintenance, and repair. Hydration hydrated tissue is healthier tissue. Smoking Cessation Smokers more likely to get a pressure sore. Smokers with sore s can slow healing by 50%. April 25,

4 Bladder/UTI Neurogenic Bowel Neurogenic Bladder in SCI disruption to S2-S5 segments which communicate sensory/motor components of bladder control. Intermittent Cathing Cathing Schedule typically Q4-Q6 Efficient Cathing fully empty bladder Cathing Techniques clean vs. sterile Good Cathing Techniques prevent: Autonomic Dysreflexia! Prevent UTI s! Prevent Bladder Spasms! Prevent Kidney Dysfuntion! Neurogenic Bowel in SCI Disruption to S2-S5 segments which communicate motor/sensory components of bowel control. SCI Bowel Program Scheduling - 1x/day Same Time!!! Positioning/DME Seated Up! Gravity Assisted! Appropriate DME needed! Bed Left Side Lying is best! Due to anatomy of large colon exiting rectum. Method Skills to learn! Suppository Insertion Inserting rectal stimulant into rectum to increase colon activity. Digital Stimulation - Inserting finger into anus and performing circular motions to relax anal sphincter to open and initiate peristalsis during to allow stool to pass. Promoting Bowel Health Diet Fiber to form stool. Hydration adequate water to form stool. Lifestyle more active = healthier bowel s. (healthier bowel motility) SCI Bathroom DME and Considerations Prevention: Avoiding Incontinence/Avoiding Constipation/ Bowel Impaction/ Autonomic Dysreflexia April 25,

5 Bowel Training on DME Toilet DME/ Para Does it allow for successful Bowel Program? Does it provide positional support needed? Does it allow for access to anus? Drop Arm Bedside Commode Allows for scoot transfer from Bed or WC. Can be used with bowel program. Good for Para with stronger trunk and good sitting balance. Covered by insurance. Padded Drop Arm Bedside Commode Padded seat for skin protection. Seat rotates for better access with bowel program. Covered by insurance in most cases. DABSC Transfers from Bed Set up right next to bed DABSC Transfer from WC Set up WC at degree angle to DABSC Use proper hand placement and body mechanics. Bathroom/ DME Para Hard Plastic Bench. $80 - $130 Padded Extended Bench. $120 - $200 Padded Extended Bench with Cut Out. $200 - $250 Not covered by insurance. Good for stronger/skilled para for use of Tub/Shower Combo. April 25,

6 Lateral Scoot Transfer to Extended Tub Bench -WC set up angle to bench. -Proper hand placement/body mechanics. Bathroom DME Basic Flat Bench Can be good option for lateral scoot transfer to tub. Resources for Tub Benches and Bedside Commodes Bathroom DME Basic Modifications Grab Bar/Hand Held Shower Installations Grab Bars inches is Ideal. Consider length needs. Bathroom Accessibility Is Accessibility good vs. bad? Does is allow for WC Accessibility for function skills? Hand Held Shower within functional reach. Simulate/Measure/Decide! April 25,

7 Roll In Shower Commode Chairs. Feature s: Self Propel, Flip Back Arm Rest s for lateral scoot xfers, Brakes, Adjustable Foot Rest, Handle s for Attendant Propulsion Cost s - $ $2500 Not Covered by Insurance Invacare Mariner Roll In Active Aide Rotating Seat (for anal access/hygiene) Angled Around Seat (for anal access) Upholstered Back Rest Firmer Back Rest. $800 - $1200 $ $1500 Roll In Shower Commode Chairs. RAZ SP Customized Seat Options Pressure Reduction Seating - contoured to decrease ischial/sacral pressure. More Customizable back rest, leg rest, body support. $ $2500 Tilt Recline Shower Commode Chairs Features: degrees of Tilt Recline, Flip Back Arm Rest s, Head Support, More Customizable body support. Not Covered by insurance. Active Aid Model 285 RAZ AT (Attendant Tilt) $3000 $ $3500 Bathroom DME/ Quad-Para Roll In Shower Commode Chairs Invacare Mariner Roll In SC: Active Aide Roll In SC: RAZ SP SC Chair: Tilt Recline Shower Commode Chair RAZ AT Shower Commode Chair: Active Aide Model 285: Ocean VIP Tilt Recline SC Chair: Chair.html April 25,

8 Tilt Recline/Roll In SC Chair Considerations. Costs - $ $3000 / Not covered by insurance. Positional needs with shower and bowel program. Caregiver Comfort/Competent with use. Transfer skills with SC Chair. (Patient and Caregiver) Features to promote independence with Bowel Program. Use with Accessible Shower???will it accommodate chair 5 by 3 is good Roll In SC Chair 7 by 5 is better Tilt Recline SC Chair (in tilt) Measure and decide! Bathroom DME Pneumatic Hoyer Lift/Sling with Shower Commode Chair. Principles of SCI Transfers SCI Transfers and Positioning Head-hips relationship Momentum Set-up Wheelchair Transfer surface Slide board Body mechanics and positioning Patient and therapist April 25,

9 Assisted Slide Board Transfer Assisted Slide Board Transfer Slide Board Transfer Dependent Slide Board Transfer April 25,

10 Quad Pivot Transfer Quad Pivot Transfer Para Techniques Para Techniques and Adaptations April 25,

11 Adapted Para Technique: Sit to Supine Adapted Para Technique: Supine to Sit Assisted Sit <> Supine Assisted Supine to Sit April 25,

12 Dependent Sit to Supine Dependent Supine to Sit Spasticity Pain Potential Barriers and Solutions/Adaptations Post-injury weakness Orthopedic precautions Somatotype Supine Positioning and Bed Mobility- For spasticity management, contracture prevention, posture, pain Shoulder position Leg management Use of pillows, wedges April 25,

13 Power Wheelchair Positioning Manual Wheelchair Positioning file://localhost/volumes/usb20fd/upmc SCI Course/Repositioning Diagram blue.docx Hip position Trunk lean Arms up check Knee and foot placement Translating Knowledge Into Clinical Practice Consider the use of a transfer assist device Level transfer when possible Vary the direction and surface Avoid a flat hand on the surface Avoid impingement positions, hand placement close to body with hand turned out Decrease flight distance with close set up Use a hand grip Feet firmly on ground Develop optimal upper limb strength for transfers Clinical Practice Guideline Gagnon, D 2009 April 25,

14 TAI References Transfer assessment instrument Designed initially for use with independent transfers Utilizes principles of safe transfers, including upper limb preservation strategies April 25,