Keep the big picture in mind

The wheelchair cushion is the usual suspect responsible for causing pressure injuries for wheelchair users. However there are many other possible causes (other equipment, non-wheelchair seating, etc.) as well as risk factors that contribute to pressure injury development. Rarely will a single cause be identified as the sole factor. A comprehensive pressure risk assessment should be implementing for each client. A comprehensive pressure risk assessment should be implemented for each client.

Commonly used pressure risk assessment tools (such as the Norton , Braden and Waterlow scales) lack sufficient sensitivity to be useful in the context of spinal cord injury pressure management because any individual with SCI is rated at ‘very high risk of pressure injury’. The ‘Spinal Cord Injury Pressure Ulcer Scale’ (SCIPUS) is an alternative scale that has been specifically designed for individuals with SCI in the acute or rehabilitation phases of treatment.¹

It is therefore important to utilise a team approach to pressure risk management along with additional investigations to select suitable interventions and implement prevention strategies. The Pressure Management Assessment Tool (PMAT) is particularly useful in collating a range of information and identifies functional aspects of pressure injury development from a 24 hour perspective.²