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Can the Right Seating Help Prevent Pressure Sores?

Lady reclined in care chair

As we have covered in previous articles, pressure sores (commonly known as bed sores) develop from continued pressure to the surface of the skin, causing the underlying tissue to break down. They are a serious problem in hospitals and cost the NHS a staggering £3.8m per day.

However, the good news is that choosing the right type of seating can go a long way in preventing pressure sores.

How seating can prevent pressure sores  

Posture

The first factor to consider when choosing a chair is seat size, because not only does it ensure the patient’s comfort but it determines their sitting posture, which is the main driver in how pressure is distributed across the body. Some common postural conditions that can develop which cause pressure sores are:

  • Posterior tilt – the pelvis is tilted backwards which means the patient is sitting on their sacral area. Typical presentation is a hunched posture with face looking downwards. They will tend to slide forwards in the chair causing pressure damage to the sacral area. Ensure the seat height and depth are correct and the footplate and back angle are adjusted to the right level.
  • Kyphosis – curvature of the spine. This can cause pressure damage to the protruding area of the spine in contact with the backrest.
  • Windswept hip – caused by pelvic rotation, the lower limbs are pushed to one side of the chair. This can cause a build-up of pressure on one side of the pelvis.

All our riser recliner chairs are made-to-measure, and the key dimensions to get right to ensure good posture are:

  • Seat height – this is important to ensure that the knees are not pushed upwards and the top of legs are level.
  • Seat depth – this ensures that the person sits all the way back in the chair without putting pressure on the back of the legs.
  • Seat width – there should be an inch or two’s gap on each side of the body to allow the arms to rest comfortably on the armrests but prevent the patient leaning to one side.
  • Arm height –the armrests should provide sufficient support for the arms without putting pressure on the elbows or causing the shoulders to hunch.
  • Back height – the patient should be able to rest their head comfortably back in the chair and have the right support around the head and neck area.

The fantastic thing about our Lento care chair range is that the seat height, depth and width are all fully adjustable so can be changed to suit whoever is using the chair. You just need to choose one of three main models, paediatric (Little Lento), mediatric or bariatric, then you can adjust the dimensions of the chair yourself to fit the patient perfectly.

Lento Modular Care Chair

Pressure relief

Pressure-relieving foam or gel can be built into the contact surfaces of the chair. It is important that this is incorporated into the existing dimensions of the chair and not added as extra cushioning, otherwise the seat dimensions will change and affect posture. All our rise recliner chairs can have pressure relief built into the seat as an optional extra.

One point to bear in mind here is that the material covering the chair needs to be a specific type of fabric, such as VP (vapour permeable). If you use a standard fabric or vinyl this will remove all the pressure-relieving benefits of the gel or foam underneath. The type of seat cushioning used can be helpful in relieving pressure caused by windswept hip (see above).

Another point to consider with pressure relief is the type of backrest on the chair (see our seating e-book p. 59-61). You can opt for a soft or hard backrest or a ‘waterfall’ type back with several cushions which can be shaped around the patient. This is important for those with spinal deformities like kyphosis or scoliosis (see above).

Tilt-in-space

When seated in an upright position most of the pressure from the person’s body weight is on the legs and buttocks. However if we change the angle of the chair we can use the power of gravity to redistribute some of pressure and move it away from the legs or buttocks, and reduce the chance of pressure sores developing.

This is where the tilt-in-space mechanism comes into play. All our riser recliners have either manual or electric tilt-in-space action, so the patient can be tilted back in the chair without changing their sitting profile. This spreads the pressure over a larger area, thus reducing the degree of pressure in any one particular place.

This function can be helpful in preventing the build up of pressure caused by posterior tilt (see above).

Regulated motion

When a patient does not have the ability to change their position themselves, regulated motion can be built into some of our care chairs so that the seat angle changes automatically at set time intervals, say every 20-30 minutes. This is an option on some of our care chairs where the patient’s needs are typically more advanced.

 

Other helpful tips for preventing pressure sores

The acronym ‘SSKIN’ is used by many clinicians in healthcare environments and is a useful aide in pressure management.

Surface – what contact surface is the patient sitting on, and what kind of pressure-relieving material is built into the chair?

Skin inspection – regularly checking the condition of the skin around pressure points to spot signs of pressure sores.

Keep moving – regular movement to help distribute pressure. If the patient is severely immobile use tilt-in-space to change weight distribution.

Incontinence – moisture from body fluids exacerbates sores so ensure incontinent patients are kept clean and dry.

Nutrition/hydration – ensure patients have a balanced diet and drink plenty of fluids to maintain good skin health.

In summary, seating combined with the right skin protection strategies can make a significant difference in avoiding pressure sores. As we have covered in this article there are many different aspects to specialist seating that should be considered when choosing a chair. Making the right choice is an important step on the way to good pressure management.

For further details on our Lento seating range and advice on avoiding pressure sores contact our team:

    Graeme Wilson
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