Page 26 - Mobility Management, August 2018

ATP Series
Friction & Shear
impairment in wheelchair users, Prewitt said: “Functionally, it becomes the same thing. They don’t have a way to recognize that there’s an issue going on. Because they’re dependent for care, whether they cognitively don’t know to weight shift or are phys- ically incapable of weight shifting or offloading. Research has shown that with tilt-in-space chairs, whether someone is depen- dent for it or they do their own tilting schedule, they don’t do as much as recommended in terms of angle, nor do they spend as much time there as is recommended.”
Prewitt described a continuum of shear risk, starting with the fact that complex rehab wheelchair users spend a lot of time sitting. Poor nutrition, poor circulation, loss or atrophy of muscle, heat and moisture can all raise the chances of shear-re- lated injuries. Transfers done with poor mechanics — dragging instead of lifting — can also raise injury risk, though active wheelchair users who transfer a number of times per day might counteract some of that risk simply by being more active.
“They certainly are at risk, as is anybody in a chair,” Prewitt said. “But if you put it on a continuum, the more active user is probably less likely to have some of those issues purely because of their activity levels. The more dependent a person is, for their mobility, for their transfers, etc., probably the higher at risk they are. The more active they are, the less risk.”
Technology & Shear Risk
Referring to the role that complex rehab technology (CRT) can play in reducing shear risk and related injuries, Prewitt said, “Proper-fitting equipment, properly supportive equipment to facilitate a stable posture, is probably one of the biggest things that can be done. We talk about movement that occurs, and that everybody, even sitting still, is always moving. But if you’ve
got someone who’s at risk, the more you can do to have them
not move around any more than necessary, the better their chances are. So, proper offloading of the bony prominences or directing of the load for proper fit to facilitate a stable posture. And whether we’re talking about offloading by tilting a chair
for pressure purposes or simply for better mechanics in self propulsion, you can change seat angle to make someone more stable in their chair. It’s not just because of pressure. If you put them at a slightly different seat angle, they have suddenly become more stable against gravity, and there’s less movement of their ITs underneath them.”
That said, every CRT client is different. Combine that with the still-evolving nature of understanding shear, and Prewitt admitted, “It’s so complicated. Every individual is just that — an individual. It becomes very difficult to start making generaliza- tions because the sample size is still relatively small. There’s a lot of traditional pressure ulcer history out there, but understanding the deep tissue injury and some of the effects of shear strain is relatively new. And by relatively new, we mean in the past 10
or 15 years, starting to say, ‘Wait a minute: This wound isn’t the same as that wound in terms of how it progressed. Why?’
“There are a lot of whys being asked without a lot of answers to the whys yet.” m
Resources: National Pressure Ulcer Advisory Panel
The National Pressure Ulcer Advisory Panel (NPUAP) continues to be the “authoritative voice for improved patient outcomes in pressure injury prevention.” The NPUAP Web site (www.npuap. org) offers resources, from illustrations of the different stages of pressure injuries to educational opportunities and news about pressure injuries and wound care.
And there’s a lot of news to report. In 2016, NPUAP adopted pressure injury as the preferred term over pressure ulcer, and Suspected Deep Tissue Pressure Injury was shortened to Deep Tissue Pressure Injury (DTI).
“The original definition was written over 10 years ago and little was known about the problem of DTI at that time,” the NPUAP said. “Today, more is known, and we are able to diagnose with more accuracy.”
A Time of Change
The site also includes industry news, including the NPUAP’s June 20 announcement that it has released a new consumer survey.
“The Consumer Survey will provide critical information to inform the 2019 revision of Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline,” NPUAP said in its announcement.
“Systematic literature reviews and evidence appraisals are well underway as the NPUAP works with its international partners, the European Pressure Ulcer Advisory Panel (EPUAP) and Pan Pacific Pressure Injury Alliance (PPPIA), to incorporate new evidence into the third edition of our international guideline.”
The NPUAP is seeking input from patients (or their caregivers and families) who have had a pressure injury or have taken steps to prevent one.
The consumer survey can be found at http://international- guideline.com/consumers. It’s available in English, Arabic, French, German, Japanese, Korean, Mandarin, and Thai.
The NPUAP’s annual conference is traditionally scheduled for March, with the 2019 edition now slated to take place March 1-2 in St. Louis. m
24 AUGUST 2018 | MOBILITY MANAGEMENT
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It’s impossible to completely isolate what happens in one area of the body — Curt Prewitt