Explanation
Lifestyle categories

Treating a category IV pressure ulcer and solving lateral trunk instability

The Vicair Multifunctional back as part of a pressure ulcer treatment plan

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Background

All wheelchair users are at risk of developing skin damage. When there are additional aggressive positioning needs, this risk only increases. This clinical case describes the treatment of a category IV pressure injury and the process of achieving lateral trunk stability. The person in this case study is a CVA patient with hemiplegia.

Mr. W. is an active 80-year-old male, who is still living life to the fullest. In 2010 Mr. W. suffered a CVA (aneurism in the cerebri media), resulting in a coma and hemiplegia. After one day Mr. W. awoke from his coma. Surgery was performed immediately, including a coiling procedure, at the Academic Medical Centre in Alkmaar (The Netherlands).

After a 6-month rehabilitation period at the Military Rehabilitation Centre Aardenburg, Mr. W. had recovered from the paralysis of his left leg caused by the CVA.

In 2011 a manual wheelchair was purchased, as the fatigued Mr. W. still wanted to fully participate in society. Because of his poor posture in this chair, a category II pressure injury on his spine developed. In an attempt to solve the poor posture and the pressure injury, the Rehabilitation Centre’s occupational therapist prescribed a power tilt-in-space wheelchair, with the intention that this chair would help to improve the body posture. The chair’s tilt-function should also redistribute the pressure.

However, in the period 2011-2014 the pressure injury problem was never fully resolved. In this period the kyphotic posture got worse because of osteoporosis. To treat fibromyalgia a low dose of prednisone was added to the list of daily medication. The patient also increasingly suffered from polyneuropathy, resulting in intense sharp pains. In 2015 I became Mr. Th. W.’s outpatient occupational therapist. I asked the local council health department to provide him with a Vicair back cushion.

The Problem

The tilt-in-space chair was provided with a Deep Contour foam back cushion. This back cushion provided insufficient pressure redistribution. Also it did not provide optimal body posture as it was not able to fully follow the kyphotic body contours. The small wound on his spine had progressed into a category IV pressure injury (see pictures).

Pressure ulcer development with wheelchair back cushion Vicair Multifunctional back

Implementing Vicair into the seating solution

filling grade adjustment Vicair Multifunctional back clinical case
Filling grade overview +
adjusted compartments

Through the use of the Vicair Multifunctional back we were able to offload the pressure on the pressure injury area. We removed SmartCells from the centre compartment to achieve this.

Because of the depth of the Vicair back support we were better able to follow the contour of his kyphosis, resulting in improved pressure distribution.

When Mr. W. became tired, he tended to lean to the right. By fixing a lateral support with a Vicair custom made insert on it to the wheelchair back, Mr. W. was sufficiently supported and able to maintain his upright position. The Vicair custom made insert should also help to optimally redistribute pressure to prevent pressure sores in that area.

Vicair Multifunctional back with Vicair Custom Made lateral support

The Conclusion

The pressure redistribution and high level of comfort provided by the Vicair Multifunctional back, enable him to rest in the tilt position of his chair without experiencing any pain.
After 3 months of using the Multifunctional back the category IV pressure injury on his spine has healed (see picture).

Clinical case vicair multifunctional back healed decubitus wound

Mr. W. experiences less pain when driving in his power wheelchair. This increases his independence. Mr. W. feels that he is
finally in control of his own seating position. As a result pain relief medication was reduced: from 8 to 2 daily morphine pills.

By using the Vicair Multifunctional back and lateral support Mr. W.’s comfort, pressure redistribution and stability have improved significantly. With the pressure injury healed Mr. W. has more independence, as the amount of wound care and pain medication could be reduced. Because of this Mr. W. has a clearer mind and is able to stay active for longer periods during the day.
Altogether these improvements enable Mr. W. to do what he wants to do most: to live life to the fullest.

Anneke Vogelenzang, OT & Owner “Ergotherapie West Friesland” Occupational Therapy Centre

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