Life on Wheels (22 page)

The risk of pressure sores is higher when a person is new to managing his condition, before good skin care becomes habitual. You can prevent pressure sores with vigilant skin care every day:

Avoid unnecessary areas of pressure, noting contact at the knees, hips, buttocks, and sacral bone, ensuring proper fit and contact with braces, catheters, and clothing.

Regularly inspect areas that receive pressure.

Use the appropriate wheelchair cushion, and maintain it well.

Do pushups often in your wheelchair for pressure relief.

Shift your position and weight in your wheelchair if you are unable to use your arms to fully lift your body.

Use a tilt or recline system with your wheelchair if you are completely unable to accomplish posture shifts.

Do not wear rough or irritating undergarments.

Do not wear loose undergarments—wrinkles can cause increased pressure in small areas.

Keep your buttocks clean, particularly after your bowel program.

If your skin is dry, use moisturizers in area of regular contact.

If your skin is wet, bacteria and fungi can grow. “Moist” is different from “wet.”

Eat a balanced diet rich in nutrients needed for skin health—protein; vitamins C, A, and B complex; and zinc. Drink plenty of water to keep tissues moist and flexible.

You or a personal assistant should observe your skin daily for any indications of pressure sore development. Take Stage One indications just as seriously as an open sore. Use a mirror to check areas where contact normally occurs—the ischium, the sacrum at the bottom of the spine, hips, elbows, heels, insides of the knees, and so on. Inspection mirrors are available that include a strap for use by people with limited grip.

Skin breakdown can also occur from infection. The ischial area where you sit is at high risk because of its regular exposure to bacteria from your stool during bowel movements or from urine from incontinence or catheter accidents. It is possible for a microscopic invasion of the skin to occur and for infection to develop beneath the surface, resulting in significant skin breakdown. Prevention is simple. Keep the area very clean with good habits in your bowel program. Also pay attention to fevers, increases in spasticity, or episodes of hyperreflexia, which can be indicators of infection.