Skin integrity should always be an important consideration, for anyone in a wheelchair. Skin is the human body’s largest organ. When properly maintained, the skin of people inconvenienced by wheelchairs need not be compromised or broken-down. However, this takes continued vigilance, and knowledge.
The first thing I hope everyone will consider is abstinence from anti-spasm medication. Tissues and skin are more likely to break-down when the muscles and the skin atrophy. That’s right, skin can atrophy. Atrophy means to decrease in size or waste away. Skin can atrophy, much in the same way as muscle can. Here's an article suggesting that Hyaluronate – a large carbohydrate component of the extracellular matrix, the material that surrounds cells – may be a potential treatment for atrophic skin. The medical community, and, more importantly, people inconvenienced by wheelchairs, need to consider that conventional wisdom – the traditional medical approach to spasms (anti-spasm medication) – can have far worse effects on the body than moderate or even extreme muscle spasticity. It is pretty much universally accepted that when the body tissues (muscle and skin) are medicated into dormancy – through anti-spasm drugs – those tissues lose size ... they atrophy. Likewise, it makes sense that when muscles go dormant they also lose resiliency. Decreasing the size of that protective layer between bone and skin – muscle – is like asking for pressure sores. Again, I am not a medical professional, but this hypothesis is based on empirical data and logic. Read and consider the section Stop The Meds! Even if you cannot control your muscles, they can still stay active, and hopefully not atrophy. Taking anti-spasm drugs accelerates the atrophy process. Talk it over with your doctor. Weigh the benefits and the detriments of anti-spasm medications. I'll bet you'll be glad you did. I shunned anti-spasm drugs, and I sit for 18 to 20 hours a day without any weight shifts. I don't have any pressure sores or skin problems. I know I'm glad I opted to refuse any anti-spasm drugs (the spasms eventually subsided on their own anyway). Think about it. Say no to drugs. Another good weapon wheelchair users have against skin break-down is a good cushion. The first cushion I had was a gel cushion (I won't dredge up the brand name). It was kind of cool to see how the space-age-type gel moved around in the plastic that attached to the foam cushion. But sitting on it, my skin started to break down. So I changed to a "Dry Flotation®" Enhancer® cushion made by Roho®. I've use that type of cushion ever since. It is a rubber cushion consisting of individual compartments filled with air that look like fat pickles [see picture]. The "pickles" are different heights and sizes so that the cushion is contoured to better distribute body weight and reduce pressure (the non-contoured, high-profile cushions don’t provide as much stability). The cushion is contained nicely in a zippered cushion cover that can be taken off and washed. My covers are black, but I think they are available in other colors too (around $25). These cushions are not inexpensive, but can be found for a fairly reasonable price online (about $330). Keep an eye on eBay®. Too much moisture can be an enemy of the skin, for people who sit for long periods of time in wheelchairs. There are various theories and methods for keeping one's backside and crotch dry so that the skin does not deteriorate. The trick is to keep the skin supple but not moist. Powders can chafe. I've found a good skin barrier in a product called Lantiseptic® Skin Protectant. A thin layer will help protect the skin without providing a wet catalyst for necrosis. I don't use it all the time, but if my skin starts to look bad, we put some on for a few days and keep an eye on it. You also want to be sure that your clothes are not binding on your skin. Wrinkles, pockets, snaps, and buttons can add pressure to the skin and possibly start break-down. So it's a good idea to pay attention to the clothes and undergarments you wear. See Clothing & Shoes.
In the event that you do experience breakdown or full-blown pressure-sores, there are a vast array of products that claim to heal decubiti. I would suggest contacting a wound care specialist for state-of-the-art treatments and cures. The most important element to healing and repairing skin that has been compromised is to keep pressure off while it heals. This may require bed rest, and/or a combination of cushions.
Your backside is not the only part of your body that is subject to pressure sores. The heels and the balls of your feet, your legs, your scapula (shoulder blades), and even vertebrae ... any bony prominence ... can be the source of pressure sores. External sources such as wheelchair leg rests, tight side pieces, and improperly-fitted arm-rests can also cause pressure sores. We should always be on the lookout for pressure on areas of our bodies we cannot feel.
One of the things to pay close attention to is the angle of your thighs while seated in your wheelchair. If they are not parallel to the floor, your weight might not be distributed evenly over the long bones, which may lead to pressure sores. If your foot rest (whatever kind) is set too high or too low, this will put extra stress on your skin in various areas (including the skin on your heels).
As with any of the perspectives shared on this website, you should not take them as medical advice. The insights shared are for consideration between you and your healthcare professionals, so that you can consider courses that doctors and nurses can approve, but about which they have not thought. Ideas that have already been put to the test and worked, at least for this one person. Yes, some of the thoughts expressed in this web site run counter to conventional medical protocol. But they come after many years of experience and thoughtful consideration, and in some cases, trial and error. The only way healthcare progresses is through review of newly attempted treatments and protocols, based on sound logic. Think outside the vbox, to adapt and overcome!
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