Early progressive changes in tissue viability in the seated spinal cord injured subject

Abstract

The patient with spinal cord injury is at high risk of tissue breakdown at all times due to a number of adverse factors, such as reduced mobility and anaesthesia. It is therefore essential that each patient is prescribed appropriate support media during initial rehabilitation. In this study, the effectiveness of prescribed wheelchair cushions has been assessed in terms of tissue response at the ischial tuberosities. A total of 42 subjects who had sustained traumatic spinal cord injury within 1 year were monitored on at least two occasions during initial rehabilitation. Changes in transcutaneous gas response (TcPO2 and TcPCO2) were monitored concurrently with regional interface pressures. A series of six transcutaneous gas variables were established, as markers of tissue viability. Non-parametric statistical analyses revealed some significant correlations between these variables. The results of this study also indicate that (1) spinal cord injury subjects with lesions below T6 show a progressive decrease in ability to maintain blood flow in sitting on prescribed support cushions and (2) SCI subjects with lesions above T6 show a progressive improvement in tissue viability status at the seating support interface. Therefore results imply that paraplegics are at a potentially higher risk of tissue breakdown than tetraplegics and thus require effective support cushions with strict adherence to a pressure relief regime.