Page 18 - Mobility Management, July/August 2022

ATP Series
Wound Care
& Seating
Pressure injuries are dangerously common among people who use wheelchairs. But the professionals who treat those injuries and the ones who recommend and configure
wheelchairs and seating don’t routinely cross paths. A Venn diagram of wound care specialists and seating specialists would typically show little overlap.
Could clients benefit if there were more collaboration — more overlap — between the two fields?
Collaborating with Wound Care Professionals
Daniella Giles, PT, DPT, ATP/SMS, is the Clinical Educator at Ride Designs and has been a physical therapist (PT) for 20 years. Though nurses are often associated with wound care, Giles said PTs “do have scope of practice, including wound care, that is actually greater than nursing.
“An RN [Registered Nurse] does not do debridement — removal or cleaning out of tissues. And therapists do several different kinds of it. Sharps debridement we’re allowed to do. We do mechanical debridement, which is basically scrubbing it, whether it be with a machine and water or different lavage water systems.”
Giles noted her background in acute rehab: “That was my first job, and we did wound [care]. You had to debride anything that had orders for debridement. That was 20 years ago, so I haven’t been doing that for a long time. But it’s within our scope, and it’s something that we’re familiar with.”
Though Giles said she couldn’t specifically recall, as a seating clinician, collaborating with a wound care professional, she acknowledged that sharing information could be helpful in
18 JULY-AUGUST2022|MOBILITYMANAGEMENT
How Collaboration Can Reap Better Outcomes
By Laurie WatanaBe
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determining wheelchair seating strategies.
“I went from [acute rehab] into [seating] equipment, and of
course, wounds are always part of what we’re doing with equip- ment,” she said. “I have asked extensive [wound care] questions of the caregivers and the patient: ‘Exactly what are you doing? Show me the supplies. What is the routine? When is the last time the doctor made a change? Who is coming out? How often?’
“I would love it if we could communicate with [wound care professionals] when we’re doing a certain intervention or equip- ment wise. Then we could say, ‘Did you see anything good last week?’ or ‘Inadvertently, did you see something bad? Is there a new [affected] area? How are things doing?’”
Telehealth could facilitate these collaborations. “I think that would be fabulous if, now that we’re doing so much videoconfer- encing, we could just get a snippet of what they’re doing,” Giles said. “I know they’re busy, but could we get a five-minute report or contact with them? Could we say, ‘Hey, can you send us notes or advice? What would you like to see? How are you going to determine healing? When are there positive signs?’
“I’m sure that would only benefit the patient.”
Why Wound Histories Are Important
Knowing a wheelchair user’s history of pressure injuries is important, Giles said, because wounds permanently impact skin.
Even after the patient has recovered from an injury, Giles explained, “We never say, ‘There’s no wound there.’ We say, ‘There’s a healed [Stage] 4’ or ‘There’s a healed [Stage] 3.’
“You never backstage. The depth that [the injury] is to begin with is then a healed [injury] of that depth. You never say it’s a
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