Embracing a pressure care challenge

A 14 year-old boy was recently admitted with pressure sores. This happens because when there is abnormal sensation (this boy has paraplegia) a person does not adjust their position and blood supply to weight-bearing areas is compromised. If this happens for long enough, tissue dies. After we issued this boy with his first ever wheelchair his pressure sores spiralled out of control resulting in 3 pressure sores down to the bone on his "bum" and several others on his knees. Pressure sores are deadly and we have unfortuntely seen several patients die of what is actually a preventable condition.

One day, the seriousness of this patient's condition struck me and i decided to do everything i could possibly do to stop this boy from dying. The only way to really get rid of pressure sores is to not lie on them and wait for them to heal. This gets complicated when there are many sores and thus the positions available for lying/sitting are few. This patient had the added complication of contractures in his hips and knees which made positioning him in prone (on his stomache), which is the only position he can lie in without being on his sores, very difficult. See picture below (this is the best we could do using wedges).

I decided the answer would be to build a positioning device that would allow his to lie prone in as much alignment possible. Marlie (awesome physio) had came to the same conclusion and together we began to apply basic seating principles in a whole new way. Neither of us had ever seen anything like this done before, so it was an exciting innovating challenge. The planning:

The basic structure:The final piece - with abduction block added and lateral supports on the left to correct the windsweeping posture:

Before:After:

Before:

After:

After lying comfortably :) in prone for a few weeks, his hip and knee ranges increased to such an extent that the cushion angles needed to be adjusted and he could then lie almost flat :)

The pelvic pressure sores eventually healed and i'd like to believe i played some part in saving this boy's life.

My biggest lesson from this project: If you can dream it, you can do it!