Page 14 - Mobility Management, March/April 2021

ATP Series
IT’S NOT
ALWAYS
THE
CUSHION
By Laurie Watanabe
When Pressure Injuries Occur, Seat Cushions Are Often Blamed. But Truly, It’s Complicated
erhaps because they’re so conspic-
right now; I’m a non-clinical OT, but involved more in education and research. We do know that having an appropriately fitted wheelchair and cushion tends to reduce the incidence of pressure injuries. There was a great article by [David] Brienza that actually talked about that in long-term care. It’s one of the few random control trial studies about seating and pressure injuries in an elderly population.
“I think people jump to that conclu- sion that it’s the chair. But the reality is that pressure, friction, shear can happen anywhere. So it could be a slip during
a transfer that caused it, it could be a change in the client’s commode, it could be a change in their bed surface, it could be a number of different things. You really need to do a holistic assessment to look at the situation.”
Subtle Contributors
to Pressure Injury Risk
Those different causes can be far less obvious than the often-accused seat cushion.
“One of the studies that got me inter- ested in doing my Ph.D. was by [Jeanne] Jackson [and colleagues],” Norton said. “They did a really interesting longitudinal study out of the University of Southern California, and they looked [at]: What were the things that contributed to skin breakdown in the population that they saw?”
The first factor was perpetual danger: “There’s always a threat of a pressure
ulcer occurring, so people live with that threat, and it doesn’t seem like so much
of a threat anymore,” Norton explained. “It’s no different than if you’re living in a dangerous neighborhood and you avoid a certain alleyway, but the longer you live in that neighborhood, the more accustomed you get, and you start to go down that alleyway because it’s faster.”
The second factor is change or disrup- tion of routine. “People may be coping really well with managing their pressure, friction and shear,” Norton said. “Then there’s a change in caregiver. Or somebody has a routine when they’re traveling, and all of a sudden, their flight gets delayed.
P
uous, seat cushions are often blamed when wheelchair users develop pressure injuries.
But the real answers to why and how pressure injuries develop are much more complicated.
Linda Norton, M.Sc.CH, Ph.D., OT Reg. (ONT), is the Manager, Learning & Development for Motion [formerly known as Motion Specialties].
“I think it’s a lot of things,” Norton said when asked about the cause of pressure injuries. “I’m not seeing patients clinically
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