mobilityRERC state of the science conference: Individualizing pressure ulcer risk and prevention strategies

Pressure ulcers (PUs) remain a costly and, often avoidable, complication of full time wheelchair use. Clinicians routinely evaluate PU risk to assist in selecting devices and interventions that may prevent PUs from occurring. Clinical assessment of risk can be evaluated in many different manners, both formally and informally and, typically, is based on combinations of demographic, disability and client-reported behavioral factors. Many of these factors add to PU risk because they impact the physiology and/or biomechanics of the skin and tissue. This article results from a presentation during the Wheeled Mobility Rehabilitation Engineering Research Center's (RERC's) State of the Science Conference in 2012. The presentation's purpose was to present issues and concepts related to pressure ulcer prevention and set the stage for group discussion which followed the presentation. This article progresses through the current state of the science related to PU risk, starting with the tissue and cellular changes resulting from pressure, through the impact that external loading has on blood flow and tissue deformation, and ending with clinical assessment of risk based upon demographic and behavioral factors.

Factors leading to the development of PUs are numerous and varied, but the defining factor is excessive external loading or pressure on the skin. The amount of pressure needed to cause tissue damage varies widely within and across individuals--based on anatomy and the presence or absence of bony structures under the area of interest, tissue stiffness and other individual characteristics, and most importantly--the amount of tissue deformation that occurs. Clinicians routinely evaluate wheelchair users with respect to pressure ulcer risk, however, objective risk measurements that inform prescription are not readily available. A need exists to provide clinicians with objective measurements of pressure ulcer risk that can inform individualized interventions.