Page 11 - Mobility Management, November 2018

greater than their body temperature.”
And that’s when a client’s risk for skin breakdown and
tissue injuries starts climbing. Here are six factors to consider about seating, microclimate and how complex rehab tech- nology (CRT) clients can be affected.
1. ASSESSMENT FOR MICROCLIMATE RISK IS CRITICAL
While evaluating clients for pressure injury risk is a typical part of a seating and mobility assessment, microclimate risk should also be checked — especially since clients at greater risk for pressure injuries could also be at higher risk for prolonged and trapped heat and moisture.
“For the active user who regularly performs weight shifts, you’re going to worry about microclimate less because they’re able to perform the actions they need to protect themselves,” Bowden said. “When [the client] is somebody in a tilt-and- recline wheelchair, or in a power chair with a complex seating system, maybe with custom-molded seating, they’re sitting in more insulation, and that has to be a factor in the [risk assess- ment] process.”
Clients who are more involved and who use more complex seating systems might also be less able to feel, discern or communicate growing discomfort, and they often use additional positioning components, many of which can create their own microclimates that need to be monitored.
2. MICROCLIMATES OCCUR BEYOND THE SEAT & BACKREST
The cushion and backrest interfaces tend to get the most atten- tion, but microclimates also form in other locations, wherever the client makes contact with a surface. That includes at armrests or under chest harnesses.
“Anytime [the client] touches a surface, you want to circulate air between client and surface at regular intervals,” Bowden said. “If you have someone in a chest strap and it’s a warm day, that’s further thermal insulation. A chest harness or arm trough will hold and trap heat.”
For positioning components such as shoulder supports or chest straps, Bowden added, “Fabric choice can be beneficial
to reduce a client’s risk. Fabrics such as ‘spacer’ fabrics enable good air flow. Of late, the CRT industry has introduced products with these fabric options [to] increase the comfort of clients and reduce the risk of skin breakdown.”
Of course, microclimate can be a concern elsewhere, such as at arm troughs, which generally feature foam surfaces. Arm troughs can also feature materials such as leatherette and less breathable options. So any kind of positioning piece can affect microclimate, depending on the types of materials used.
3. TIME MATTERS
Heat and moisture aren’t the only microclimate dangers. How long a client stays in that less-than-optimal environment also matters.
“If you sit in a hot car, and it’s 90°F, we can tolerate it
for five minutes,” Bowden said. “It’s uncomfortable, but the average person can tolerate it. After a while, it gets to the point where nothing is comfortable, and you just want to get out of the car. It’s the same way for someone in a seating system. For a certain amount of time — and that varies for everyone — the client is fine. After that, their body is cueing their brain
to say, ‘I’m not comfortable in my wheelchair anymore, and I need pressure relief.’”
That discomfort can cause decreased sitting tolerance and require the client to move from a wheelchair to a less mobile and functional location, such as bed. Other clients might lack the sensation to know that their microclimates have put them at risk. Wheelchairs with tilt and recline functions allow clients to more easily relieve pressure to refresh their microclimates.
“If you look at our pelvises, they’re pretty bony,” Bowden said. “Throughout evolution, humans have generally been standing, so we could have a bonier pelvis. But when we sit [wheelchair users] down, their ischial tuberosities are putting
a great deal of pressure on internal tissues of their cells. That causes deformation, it restricts bloodflow, and that’s a recipe for cells to start dying.”
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