Long-term monitoring of persons with spinal cord injury (SCI): implication for pressure ulcer development.

It is well established that persons with Spinal Cord Injury (SCI) are at considerable risk of developing a Pressure ulcer (PU) at all times in their life following injury. This risk is associated with limited mobility coupled with impaired sensation leading to prolonged periods of support in bed or in a wheelchair. Monitoring has traditionally involved short term mapping of pressures on different support surfaces. More recently, pressure mapping systems have been adapted to acquire data over prolonged periods in lying and sitting postures. By identifying sharp transitions in the temporal profiles of selected pressure-related parameters and verifying these with customised software, a comprehensive analysis of posture and mobility can be achieved during each monitoring period. This approach was adopted with a heterogeneous cohort of SCI persons (n=12), who were in-patients at the Duke of Cornwall Spinal Centre and had been judged to be capable of “sitting out” in their wheelchair for at least four hours per day. This represented phase 3 of their rehabilitation, which had been identified in a retrospective analysis to represent a period in which individuals were particularly vulnerable of developing a pressure ulcer. The first in-patient analysis revealed considerable variation in movement behaviour in both bed and sitting across the cohort. Movements to offload vulnerable areas (MOVA) were explored. Closer examination revealed that two parameters, namely, average number of MOVAs per hour and maximum time between MOVAs. Notable trends were discovered when analysing the aforementioned parameters against the individual SCI level and ASIA score. There were, however, a few outliers to these general trends, which could be associated with specific co-morbidities. The initial analysis motivated an Individualized Pressure Ulcer Prevention Plan (IPUPP) which was examined with a small proportion (33%) of the cohort who remained as in-patients. This revealed considerable diversity in the second analysis of movement behaviour. In particular, a general improvement was only evident with those individuals who had experienced a previous history of bed rest of skin damage, as confirmed in their associated interviews. The analysis following discharge to the community, revealed some marked changes to the individual movement behaviour, which could be attributed to a number of factors, including differences in support surfaces to match community settings, carer capacities and individual functional potential following their injury. This bioengineering approach needs to be extended to accommodate a larger SCI population. This will enable a generalisation of the findings to ensure informed education and training of pressure ulcer prevention for the individual and their carer