Treating a category IV pressure ulcer and solving lateral trunk instability
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 report describes the treatment of a category IV pressure injury and the process of achieving lateral trunk stability. The person in this case report 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 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).
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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