scholarly journals A Primary Care Provider’s Guide to Prevention and Management of Pressure Injury and Skin Breakdown in People With Spinal Cord Injury

2020 ◽  
Vol 26 (3) ◽  
pp. 177-185
Author(s):  
Nicole R. Rosin ◽  
Robyn S. Tabibi ◽  
John D. Trimbath ◽  
Mary Kristina Henzel
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Wounds ◽  
Wound Care ◽  
Treatment Plan ◽  
Staging System ◽  
Advisory Panel ◽  
Skin Breakdown ◽  
Cord Injury ◽  
Pressure Injury

Skin breakdown, including burns and pressure injuries (PrIs), is a devastating complication of spinal cord injury (SCI). Chronic wounds place the person with SCI at high risk of infections, sepsis, and death. Skin health and breakdown is individual and multifactorial, thus prevention requires individualized education focused on patient preferences and goals. Assessment requires an accurate description of wound type/PrI stage, location, size, wound bed, wound margin, epithelialization, exudate, and peri-wound condition. PrIs should be staged using the National Pressure Injury Advisory Panel (NPIAP) staging system. Successful treatment requires optimal wound bed preparation, pressure off-loading, and access to surgical specialists if needed. Mattress and seating systems, pressure relief, skin microclimate, nutrition, and home supports should be optimized. To promote wound healing and aid prevention, identifiable causes need to be removed, risk factors improved, and wound care provided. Infection should be treated with input from infectious disease specialists. Consideration for specialized surgical management including flaps and primary closures should be coordinated with the interdisciplinary team to optimize outcomes. If comorbid conditions promote wound chronicity, a palliative rather than curative treatment plan may be needed.

scholarly journals Prevention and treatment of pressure sore following spinal cord injury

2020 ◽  
Vol 63 (10) ◽  
pp. 623-632
Author(s):  
Myeong Ok Kim
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcer ◽  
Wound Care ◽  
Pressure Sore ◽  
Therapeutic Interventions ◽  
Advisory Panel ◽  
Pressure Sores ◽  
Cord Injury ◽  
Pressure Injury

Pressure sores or pressure injury is a serious complication of a spinal cord injury (SCI), representing a challenging problem for patients, their caregivers, and their physicians. Persons with SCI are vulnerable to pressure sores throughout their life. Pressure sores can potentially interfere with the physical, psychosocial, and overall quality of life. Outcomes directly depend on education and prevention along with conservative and surgical management. Therefore, it is very important to understand everything about pressure sores following SCI. This review covers epidemiology, cost, pathophysiology, risk factors, staging, evaluation tools, prevention, education, conservative wound care methods, surgical treatment, and future trends in wound healing related to post-SCI pressure sores. A change in nomenclature was adopted by the National Pressure Ulcer Advisory Panel in 2016, replacing “pressure ulcer”with “pressure injury.” New concepts of pressure injury staging, such as suspected deep tissue injuries and unstageable pressure injuries, were also introduced. A systematic evidence-based review of the prevention of and therapeutic interventions for pressure sores was also discussed.

scholarly journals Musculoskeletal Deterioration and Hemicorporectomy After Spinal Cord Injury

2003 ◽  
Vol 83 (3) ◽  
pp. 263-275 ◽  
Author(s):  
Richard K Shields ◽  
Shauna Dudley-Javoroski
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Wounds ◽  
Physical Therapists ◽  
Skin Breakdown ◽  
Life Saving ◽  
Cord Injury ◽  
History Of ◽  
Saving Measure

Abstract Background and Purpose. The long-term management following an hemicorporectomy (HCP) is not well documented in the scientific literature. The purpose of this case report is to describe the 25-year history of a man with a spinal cord injury who experienced severe musculoskeletal deterioration and hemicorporectomy. Case Description. The client sustained T10 complete paraplegia at age 18 years, developed severe decubitus ulcers, and required an HCP as a life-saving measure 13 years later. The authors describe the chronology of several rehabilitation and prosthetic strategies and speculate on factors that may have contributed to their successes and failures. Outcomes. The client survived 12 years after the HCP and returned to independent mobility, self-care, and schooling despite complications with continued skin breakdown. Over the 12 years following discharge from the hospital after the spinal cord injury, he spent 749 days in the hospital. During the 12 years he lived after discharge from the hospital following the HCP, he was hospitalized 190 days. Discussion. The authors discuss factors contributing to the client's musculoskeletal deterioration including chronic wounds, postural deviations, and incomplete adherence to pressure-relief recommendations and raise considerations for physical therapists who treat patients after HCP.

Impact of chronic osteomyelitis on wound healing and the quality of life of the patient with a chronic wound

WCET Journal ◽  
2019 ◽  
Vol 39 (2) ◽  
pp. 34-40
Author(s):  
Swapna Johnson-Kunjukutty ◽  
Carmel Delille
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Chronic Wounds ◽  
Medical Center ◽  
Financial Burden ◽  
Sudden Change ◽  
Care Hospital ◽  
Post Injury ◽  
Cord Injury ◽  
Pressure Injury

Spinal cord injury (SCI) patients have a higher risk of developing pressure injury secondary to limited mobility and lack of sensation. The James J Peters Medical Center is one of several regional spinal cord injury centres in the Veterans Affairs System. Veterans with SCI receive comprehensive care. Hospital- and community-acquired pressure injuries (HAPIs and CAPIs) can progressively advance to chronic stage IV pressure injury complicated with osteomyelitis. Chronic wounds that become infected can lead to sepsis if the wounds are not managed properly. The management of chronic wounds represents a significant financial burden for any health care system and a challenge for providers whose goals are to avoid prolongation of hospital stay, avoid complications, and minimise disruption in the patient’s life. A focus of the primary physician is to establish a rehabilitation plan that facilitates the patient to resume activities of daily living post injury and have a productive life in their community. However, despite the collaborative effort of the SCI team, the sudden change in the patient’s mobility can also have a detrimental impact on the patient’s mental status as well.

Skin Self-Screening Camera for Veterans With Spinal Cord Injury

2017 ◽  
Author(s):  
Christine Olney ◽  
Jennifer Leestma ◽  
Andrew Hansen ◽  
John Ferguson ◽  
Mary Murphy Kruse ◽  
...  
Keyword(s):  
Spinal Cord ◽  
At Risk ◽  
Spinal Cord Injury ◽  
Adaptive Design ◽  
Mirror Image ◽  
Cord Injury ◽  
Skin Integrity ◽  
Pressure Injury ◽  
Risk Areas ◽  
Screening Device

Veterans with spinal cord injury (SCI) are at high risk for developing debilitating pressure injuries, particularly to their seated areas (e.g. coccyx, sacral and gluteal) [1]. To prevent development of a pressure injury the Veteran with SCI is encouraged to invoke multiple prevention strategies [2]. One recommended prevention strategy is to conduct twice daily skin self-screenings. Skin self-screening is usually conducted in the bed, prior to arising in the morning and prior to sleep in the evening. The current method to conduct skin self-screening utilizes a mirror at the end of a long handle. The Veteran with SCI examines at-risk areas for changes in their skin integrity such as discoloration, swelling, or changes in skin texture. This method can take up to 20 minutes to complete. In the event there is a change to skin integrity, the pressure injury prevention protocol advises the Veteran with SCI to off-load that particular area for at least 24 hours [3]. Further, he/she is advised to consult with their skin specialist if the area does not resolve to normal color or texture within that next 24 hour period. The consequences of ignoring an early stage pressure injury can be serious e.g. weeks to months of hospitalization attempting to heal the injury, tens to hundreds of thousands of dollars in healthcare costs, possible surgery to close the wound and possibly death [4]. Informal interviews with Veterans with SCI clarified and validated that conducting skin screening with the mirror could be very challenging due to barriers such as: not having a baseline image to compare to; the mirror image not being viewable to the user due to lack of user flexibility or body habitus; the mirror does not easily allow a complete view of all the at-risk areas; the user not being able to discern what he/she is actually viewing possibly due to mirror image distortion and limited visual acuity. The need for a better skin self-screening device was evidenced by the advanced pressure injuries Veterans presented to their healthcare providers. Finding a pressure injury in the early stages of development and intervening immediately, such as repositioning, can improve the trajectory of the injury [5]. Therefore the project goal was to offer a better tool for and improve the efficacy of skin self-screening for the Veterans with SCI. To overcome the identified barriers, our team of VA clinicians and engineers of the Minneapolis Adaptive Design & Engineering (MADE) program invented such a device at the Minneapolis VA. This paper presents the patient centered iterative process that was used to develop a skin self-screening device and the future directions for this technology.

scholarly journals Treatment and cost of pressure injury stage III or IV in four patients with spinal cord injury: the Basel Decubitus Concept

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Christine Meier ◽  
Stefan Boes ◽  
Armin Gemperli ◽  
Hans Peter Gmünder ◽  
Kamran Koligi ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Stage Iii ◽  
Cord Injury ◽  
Pressure Injury

Poster 248: A Tunneling Pressure Injury with Direct Communication to the Hip Joint Diagnosed Via Fistulogram in a Patient with Spinal Cord Injury: A Case Report

PM&R ◽  
2018 ◽  
Vol 10 ◽  
pp. S82-S83
Author(s):  
George Chen ◽  
Amanda Farag ◽  
Steven B. Epstein ◽  
Cordelia H. Enyaosa ◽  
Keith Claffey ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Case Report ◽  
Hip Joint ◽  
Direct Communication ◽  
Cord Injury ◽  
Pressure Injury

Expression of MMP-8 in Pressure Injuries in Spinal Cord Injury Patients Managed by Negative Pressure Wound Therapy or Conventional Wound Care

2017 ◽  
Vol 44 (4) ◽  
pp. 343-349 ◽  
Author(s):  
Mukesh Kumar Dwivedi ◽  
Amit Kumar Bhagat ◽  
Rajeshwar Nath Srivastava ◽  
Amita Jain ◽  
Kavita Baghel ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Care ◽  
Wound Therapy ◽  
Cord Injury

scholarly journals Spinal Cord Injury Induced Osteoporosis: Case Report and Current Literature

2021 ◽  
Vol 9 (2) ◽  
pp. 155-159
Author(s):  
Abdulai Bangura ◽  
Thomas Shuler ◽  
Lisa Wright ◽  
Anne Lake
Keyword(s):  
Bone Mineral Density ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Bone Loss ◽  
Bone Mineral ◽  
Treatment Plan ◽  
Treatment Options ◽  
Definitive Treatment ◽  
Mineral Density ◽  
Cord Injury

Background: Among the various etiologies of osteoporosis, spinal cord injury has a drastic progression of the disease, causing weekly bone loss. There is no definitive treatment for the prevention of osteoporosis in these individuals. This review illustrates the recent findings on the pathophysiology, treatment, and management of spinal cord injury-induced osteoporosis. Furthermore, we cover a case of a male patient who experienced severe bone loss after a spinal cord injury at the age of 21 years. The Case: We have a 57-year-old man with a history of AIS grade A spinal cord injury, level T11 with rod fixation from a motorcycle collision at age 21. His fracture history following the injury includes tibia, femur, and vertebral fractures. Bone mineral density imaging revealed notable T-scores ranging from -3.1 to -3.4 at the hip and femurs. Treatment plan consisted of teriparatide, dietary supplements, and physical therapy. Biomarkers from baseline to post one month of treatment revealed the following: procollagen type 1 N-terminal propeptide from 38 mcg/L to 70 mcg/L and C-terminal telopeptide from 209 pg/mL to 88 pg/mL, representing an increased bone formation and decreased bone resorption, respectively. After two years, bone mineral density T-scores improved to -2.7 on the left and the patient was capable of standing for the first time with the assistance of a standing frame. Conclusion: Our case exemplified the progression of the disease and treatment options. A basis for the derivation of future innovative therapies has been covered. Favorable treatments and management are described in the review.

Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury

2016 ◽  
Vol 31 (7) ◽  
pp. 871-880 ◽  
Author(s):  
Alison M Cogan ◽  
Jeanine Blanchard ◽  
Susan L Garber ◽  
Cheryl LP Vigen ◽  
Mike Carlson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Pressure Ulcer ◽  
Pressure Ulcers ◽  
Educational Interventions ◽  
Included Study ◽  
Community Dwelling ◽  
Inclusion Criteria ◽  
Skin Breakdown ◽  
Cord Injury

Objective: To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI). Data sources: Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention. Each database was searched from its inception with no restrictions on year of publication. Review methods: Inclusion criteria required that articles were (a) published in a peer-reviewed journal in English, (b) evaluated a behavioral or educational intervention for pressure ulcer prevention, (c) included community-dwelling adult participants aged 18 years and older with SCI, (d) measured pressure ulcer occurrence, recurrence, or skin breakdown as an outcome, and (e) had a minimum of 10 participants. All study designs were considered. Two reviewers independently screened titles and abstracts. Extracted information included study design, sample size, description of the intervention and control condition, pressure ulcer outcome measures, and corresponding results. Results: The search strategy yielded 444 unique articles of which five met inclusion criteria. Three were randomized trials and two were quasi-experimental designs. A total of 513 participants were represented. The method of pressure ulcer or skin breakdown measurement varied widely among studies. Results on pressure ulcer outcomes were null in all studies. Considerable methodological problems with recruitment, intervention fidelity, and participant adherence were reported. Conclusions: At present, there is no positive evidence to support the efficacy of behavioral or educational interventions in preventing pressure ulcer occurrence in adults with SCI.

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