Geoff, and the many others who have posted on this thread,
Firstly thanks very much everyone for your suggestions. She is sitting on an
air-system cushion - it contains lots of pyramid-shaped tea-bag sized
air-packets and provides better postural support than a Roho. When she sits
out, she looks pretty symmetrical. However, her poor tolerance of sitting
out is not just related to problems with her pressure area - she finds it
very tiring although her tolerance for this has improved gradually over the
last 6 months. She needs to sit out to maximise her chances of getting the
nutrition she so desperately requires. She has only managed to put on some
weight since we sorted out the seating - so, on balance I believe it is in
her better interests to risk more pressure to gain more nutrition. Remember,
we are still only talking 2 periods of 40 mins per day.
There isn't enough space in the house for a prone tray. Also, she is blind
and is well-orientated to her current positions. She has an environmental
control system which she is managing to use well.
I'm afraid I'm not equipped with enough time or equipment to embark on a
specific wound therapy application as many of you have suggested although I
think I will discuss this principle with our pressure management specialist
Nurse. If there's enough evidence then the practice ought to follow !! If it
is something that I supervise personally, it will need to be a system that
can either be left in situ or be delegated to carers.
Thanks again everyone !
Nikki Adams [log in to unmask]
----- Original Message -----
From: "Geoff" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, October 01, 2002 4:36 AM
Subject: Re: Pressure sore management in MS
> Nikki,
> I read your post with interest. What type of cushion is she sitting on?
> Is it fluid (Jay2 type) or air (Roho type)? The air cushions don't offer
> the most optimal positioning, but they are the best for overall pressure
> relief. Since the sore is over her ischial tuberosity, I would guess that
> seated pressures are more the problem rather than lying ones. If the tilt
> is adequate with the chair (somewhere around 60 degrees), the pressures
over
> the tuberosities should approach zero in full tilt. If this is the case,
> then more frequent and longer duration pressure relief may be necessary.
> Unfortunately, many sores are stubborn and unrelenting enough not to
> tolerate any pressure whatsoever. In these cases, the patient has only
two
> choices: stay off of it until it heals (months and months), or opt for
skin
> flap surgery. If you exhaust all options, I'd ask her physician to
counsel
> her to seriously consider the surgery.
> Depending on the person's upper extremity function, many have found at
> least some independence in mobility pushing a prone cart. It's not the
best
> means of mobility, but it's better than nothing.
> There are also many new advances in wound care available. Each option
has
> varying levels of success with individual patients. There is the
medication
> Regranex, which works well when there is 90% or more granulation tissue in
> the wound (although it is expensive). Other options include dressings
> attached to a vacuum machine (negative pressure therapy), dressings with
> heating pads (thermotherapy), electrical stimulation (galvanic and
> microstim), pulsed lavage (alternative to whirlpools), etc, etc.
> I hope you find what works for the benefit of your client. Pressure
sores
> are probably one the most tenacious and frustrating problems we deal with
in
> our profession.
>
> Warm Regards,
> Geoff Mosley, PT, NCS
> MRC
> Mount Vernon, MO
>
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