Spinal Cord Injury Information

I sincerely hope the information presented will be useful and help you and yours cope with this devastating injury.

If you do not find a subject shown here, please let me know and I will certainly try to research the information and present it on this website in continuing updates.

SCI INFORMATION, Hygiene

This important section is devoted to hygiene, and includes information and tips on daily and SCI specific hygiene, our skin and how to care for it, how to protect our skin from injury, suggestions for the alleviation and treatment of pressure sores, bladder and bowel programs.

Pressure Sores

  Pressure can come from outside of your body, such as from the seat of your wheelchair or from the mattress on your bed. The pressure of your weight pushes your bones onto blood vessels, especially in areas where bones normally stick out somewhat. The blood vessels become trapped between the outside surface and your bones and get closed off. Blood, which carries oxygen and nutrients, cannot get past that point. Unless the pressure is relieved, the cells that are fed by those blood vessels will die, and a sore will form. Be aware that this kind of problem can arise in as short a time as 30 minutes.

  Regular pressure releases will allow the blood vessels to open again and prevent this. Fortunately, pressure causes changes in your skin that provide early warning signs that the cells are not getting adequate circulation. These early warning signs of damage are redness and firmness.

  Shearing occurs when two layers of tissue right next to each other are pulled in opposite directions. This can also lead to skin breakdown. The blood vessels in the layers of the skin are closed off by the pulling.

  Shearing can happen if you slip down in your wheelchair. It also can happen when you sit in bed. If the head of your bed is elevated, you may slide down, which then can lead to shearing.

  Shearing plus direct pressure from the weight of your body increases your risk of getting pressure sores.

  Friction produced from constant rubbing or pulling of your skin across surfaces can cause blisters. It should be avoided. Friction occurs when you drag your butt across a bed, toilet, or other surface during a transfer. Friction can also be caused by spasms.

  The most important way to treat pressure sores is to remove the cause. Remove all pressure!

· Keep off the pressure sore.

· Keep the area clean and dry.

  There are different ways to manage pressure sores after they have developed. Some may even require surgical repair. All ways of treating pressure sores take a long time to work and require keeping pressure off the area. If you develop a pressure sore, have it taken care of immediately.

Skin Inspection Tips:

1. Do it twice a day. before you get out of bed, inspect those areas that have pressure when laying down, and after you get into bed. inspect those areas with pressure when sitting.

2. Check all your bony prominences (ankles, elbows, heels, hips, tailbone) below the level of your injury.

3. Use a mirror to see those bony areas behind you, like your sitting bones.

4. If you cannot use a mirror or check your skin yourself, get someone (family member or care giver) to check those areas for you.

5. Look for reddened areas, cuts, scrapes, and bruises, anything that seems different needs to be carefully looked at.

6. If you find a reddened area, immediately check the "Troubleshooting" table for what to do next.

Areas to Check

• Thick crotch seams, especially on blue jeans.

• Binding in the groin area with pressure on your scrotum.

• Tight shoes, especially with swollen feet.

• Socks with elastic tops that bind around your lower leg.

• Straps holding your drainage system that are too tight.

• Condoms that have been applied too tightly.

Problems to Avoid

• If you have clothing that you have never worn before, wash them before wearing and check your skin after one or two hours for redness or chaffing.

• Buy jeans that are designed with low-profile seams (not bulky) in the groin area.

• Re-adjust your scrotum as you get dressed and move about. Be certain that you are not sitting directly on it.

• Clip the top of tightly fitting socks.

• Check the fit of shoes carefully and watch your feet for signs of edema (swelling).

• Loosen or change the position of your drainage system.

• Feel over the boney areas for lumpy changes.

• Think back to the time when your underwear was too tight, when your socks strangled your legs, or the seams in your jeans rubbed you raw. These things can still happen; you just may not feel them. It is important to check the fit of your clothes and shoes and to be certain that they are not too tight.

POSITIONING / TURNING

  Changing your body posture takes pressure off of your bony prominences. Some helpful tips for positioning / turning are contained below.

In Bed

  Change your position according to your skin tolerance level. Use the routine of side to side to back for turns. Sleep on your stomach (prone).

  Use an alarm clock at first to wake you for your turns. After a while, turning in bed may become automatic for you.

  Get someone else to turn you (like your attendant) if you cannot do it for yourself.

In a Wheelchair

  Do pressure releases every 15 to 30 minutes to take the pressure off of your tailbone and sitting bones. Ask your physical therapist for a set of diagrams of pressure-release exercises.

  The following are options you will have, work with your therapist to find which is best for you.

1. Push up out of the seat of your wheelchair with your hands slightly forward.

• Lean side to side.

• Shift your position as much as possible.

• Bend your chest forward onto your knees.

• Tilt your wheelchair back or use your recliner if you have one.

• Get someone else to lift your buttocks off the seat of your wheelchair.

• Be a wiggle worm. It doesn’t come automatically, but constant moving allows the blood to continue flowing.

2. Check your posture. Make sure that your ankles, the sides of your knees, and your hip bones are not leaning up against parts of your wheelchair. Your body has a natural balance and symmetry to it. Spasticity and muscle strength imbalances can disrupt this balance and cause a change in your posture. Tight muscles in your trunk and legs can do the same.

Watch out for:

• A curving or twisting of your back (spine).

• Sitting on one hip or to one side more than the other.

• Tightness of your legs or of your trunk that prevents your body from keeping its normal balance.

3. Make sure your footpetals are adjusted for your height.

4. Sit up as straight as possible in your wheelchair.

5. Always use a well-maintained cushion, preferably designed for the SCI.