Page 20 - Mobility Management, July/August 2022

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Wound Care & Seating
recovery strategies. “That’s the ideal situation, where we remove all the pressure from pressure injuries. That’s how they heal. You have a reduction in the forces acting upon those cells. Cellular metabolism is restored, and they stay alive. But if you put them back into the same environment, you can expect the same result.
“So once the physicians learned the orthotic concept of the loading and offloading, they would not only send them to us for assessment and molding — but once that cushion was in place, they would prescribe sitting as part of the healing protocol.” Sitting upright has a number of benefits, not just for bodily functions, but also for overall well-being. “When a person is upright and engaged in life, they’re going to do better than if they’re in bed,” Giles said. But being able to sit upright requires careful consideration of how pressure will be distributed.
How to Distribute Weight Safely
While it’s common to hear about the need to offload weight from injured areas, Giles said, “The best thing about offloading is obvi- ously, there’s no contact. But I can’t offload until I appropriately load. Loading is the answer. So now we really focus on strategic loading, and the application of pressures, force isolation, strategic
loading, applied pressure points at tolerant areas. That’s really where our [Ride Designs] science is focused: Looking at that body, looking at where the scars are, where the history is, where the current wear patterns are.”
Just as she used to check wear on the bottoms of shoes while assessing gait, Giles now checks for evidence of how weight is distributed. “I look at the seat, the seat cushion, and the body
in that context,” she said “I’ll look at their skin and say, ‘What’s the likely place these people are sitting?’ I see the wear, I see the history. I can identify areas of high pressures, high friction, high shear strains and forces. So the real science and the real beauty of what we do is finding a place to put all the pressure where the skin can handle it.”
Finding enough safe areas to bear weight can be difficult for clients with a history of wounds.
Giles described Ride Designs cushions as a kind of orthotic: “So cutting the hole [in the cushion] is very easy once I have figured all that out. I could just carve away, once I have strategi- cally come up with where to apply all forces. It’s an orthotic and prosthetic concept; an orthotist created this concept.
“So it’s strategic loading, and not applying force where it can’t be tolerated. And oftentimes that includes the bony prominences,
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