How do physical therapists help people with spinal cord injuries prevent pressure sores?

Physical therapists will assist the patient in learning their functional mobility skills—so bed mobility, transfers—in a way that prevents a lot of shearing, a lot of damage that can happen to tissues, say on the sitting surfaces and what is contacting the transfer board, or the bed, or the chair during the transfers. We also look at someone’s seating and positioning, to their posture in the wheelchair, to make sure that they are evenly distributing pressure across those weight-bearing surfaces too—like the ischials or the buttocks, the thighs, the hips and the sacrum, making sure we’re not taking additional pressure in those areas. And overall, just prevention of damage to the tissues that are not sensate after a spinal cord injury.

We’re involved in wound management from prevention of wounds, to recovery from wounds and to getting back to living life after a wound. Because if we’re not doing our job with wheelchair seating and with skills training, then we’re not teaching you how to prevent wounds. However, once there is a wound, the therapist has to be a key part of the investigation team of understanding why the wound occurred. And sometimes it’s very obvious that “I bumped my bottom when I was being transferred on to an airplane.” And likely that scenario won’t happen again, but we also need to understand with that newly-healed skin that is very fragile, how can we protect it? Are any of your prior skills or prior seating maybe not be ok now with that fragile skin, and maybe we need to rework those things. In some facilities, physical therapists are also involved with the actual wound healing and using electrical stimulation, which is a modality we use for wound healing, so we can be involved in that aspect. Anybody who has a flap surgery post-wound should have physical therapy going in and helping get the tissue stretched out after the flap surgery. Physical therapy and occupational therapy need to then be relooking at all of your skills, all of your equipment, not just your wheelchair, but your bathroom equipment, everywhere you sit and/or spend any length of time.