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      Pressure Relieving Effect of Adding a Pelvic Well Pad to a Wheelchair Cushion in Individuals With Spinal Cord Injury

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          Abstract

          Objective

          To identify the pressure relieving effect of adding a pelvic well pad, a firm pad that is cut in the ischial area, to a wheelchair cushion on the ischium.

          Methods

          Medical records of 77 individuals with SCI, who underwent interface pressure mapping of the buttock-thigh area, were retrospectively reviewed. The pelvic well pad is a 2.5-cm thick firm pad and has a cut in the ischial area. Expecting additional pressure relief, it can be inserted under a wheelchair cushion. Subjects underwent interface pressure mapping in the subject's wheelchair utilizing the subject's pre-existing pressure relieving cushion and subsequently on a combination of a pelvic well pad and the cushion. The average pressure, peak pressure, and contact area of the buttock-thigh were evaluated.

          Results

          Adding a pelvic well pad, under the pressure relieving cushion, resulted in a decrease in the average and peak pressures and increase in the contact area of the buttock-thigh area when compared with applying only pressure relieving cushions (p<0.05). The mean of the average pressure decreased from 46.10±10.26 to 44.09±9.92 mmHg and peak pressure decreased from 155.03±48.02 to 131.42±45.86 mmHg when adding a pelvic well pad. The mean of the contact area increased from 1,136.44±262.46 to 1,216.99±255.29 cm 2.

          Conclusion

          When a pelvic well pad was applied, in addition to a pre-existing pressure relieving cushion, the average and peak pressures of the buttock-thigh area decreased and the contact area increased. These results suggest that adding a pelvic well pad to wheelchair cushion may be effective in preventing a pressure ulcer of the buttock area.

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          Most cited references20

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          Prevention of Pressure Ulcers Among People With Spinal Cord Injury: A Systematic Review.

          To evaluate the literature on the effectiveness of bed and wheelchair positioning and repositioning in the prevention of pressure ulcers (PUs) in both the spinal cord injury (SCI) and non-SCI populations.
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            Effects of wheelchair cushions and pressure relief maneuvers on ischial interface pressure and blood flow in people with spinal cord injury.

            To investigate the effectiveness and interactions of 2 methods of pressure ulcer prevention, wheelchair cushions and pressure relief maneuvers, on interface pressure (IP) and blood flow of the buttocks.
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              • Article: not found

              Patient repositioning and pressure ulcer risk--monitoring interface pressures of at-risk patients.

              Repositioning patients regularly to prevent pressure ulcers and reduce interface pressures is the standard of care, yet prior work has found that standard repositioning does not relieve all areas of at-risk tissue in nondisabled subjects. To determine whether this holds true for high-risk patients, we assessed the effectiveness of routine repositioning in relieving at-risk tissue of the perisacral area using interface pressure mapping. Bedridden patients at risk for pressure ulcer formation (n = 23, Braden score 95% of the observation period. Thirteen participants were observed in three distinct positions (supine, turned left, turned right), and all had specific skin areas (166 +/- 184 cm(2)) that exceeded pressure thresholds for >95% of the observation period. At-risk patients have skin areas that are likely always at risk throughout their hospital stay despite repositioning. Healthcare providers are unaware of the actual tissue-relieving effectiveness (or lack thereof) of their repositioning interventions, which may partially explain why pressure ulcer mitigation strategies are not always successful. Relieving at-risk tissue is a necessary part of pressure ulcer prevention, but the repositioning practice itself needs improvement.
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                Author and article information

                Journal
                Ann Rehabil Med
                Ann Rehabil Med
                ARM
                Annals of Rehabilitation Medicine
                Korean Academy of Rehabilitation Medicine
                2234-0645
                2234-0653
                April 2018
                30 April 2018
                : 42
                : 2
                : 270-276
                Affiliations
                Department of Rehabilitation Medicine, National Rehabilitation Center & Hospital, Seoul, Korea.
                Author notes
                Corresponding author: Zee-A Han. Department of Rehabilitation Medicine, National Rehabilitation Center & Hospital, 58 Samgaksan-ro, Gangbuk-gu, Seoul 01022, Korea. Tel: +82-2-901-1634, Fax: +82-2-990-8473, zeeahan@ 123456catholic.ac.kr
                Author information
                https://orcid.org/0000-0002-9699-9132
                https://orcid.org/0000-0002-3920-7258
                https://orcid.org/0000-0002-3075-4191
                https://orcid.org/0000-0003-4431-4549
                https://orcid.org/0000-0001-9400-6283
                https://orcid.org/0000-0002-0506-0403
                https://orcid.org/0000-0002-8070-2218
                Article
                10.5535/arm.2018.42.2.270
                5940603
                9a2fb57d-e675-4f06-89b3-06574c1f0ab0
                Copyright © 2018 by Korean Academy of Rehabilitation Medicine

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 29 March 2017
                : 21 July 2017
                Categories
                Original Article

                Medicine
                spinal cord injuries,pressure ulcer,wheelchairs
                Medicine
                spinal cord injuries, pressure ulcer, wheelchairs

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