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Key Points

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  • The early detection of suspected pressure ulcers in individuals with SCI may be improved through the use of a handheld dermal phase meter and ultrasonography.
  • Magnetic resonance imaging may be helpful to anticipate the development of osteomyelitis secondary to non-healing SCI-related pressure ulcers.
  • Circulatory biomarkers in people with SCI have not yet proven to be useful or feasible to enhance early detection of suspected pressure ulcers.
  • Electrical stimulation likely decreases ischial pressures.
  • Electrical stimulation may increase blood flow to tissues.
  • Electrical stimulation likely increases tissue oxygenation.
  • Electrical stimulation likely helps to prevent pressure ulcer formation or progression by reducing ischial pressures and increasing tissue oxygenation.
  • Pressure mapping studies using able-bodied subjects should not be generalized to the SCI population because pressure differences exist between the two groups.
  • Typical areas of high pressure for the SCI population include sacrum, coccyx and/or ischial tuberosities.
  • Data generated from pressure mapping studies on seniors should not be generalized to the SCI population.
  • Early attendance at specialized seating assessment clinics should be part of a comprehensive rehabilitation program.
  • More research is needed to determine if early attendance at a specialized seating assessment clinic results in pressure ulcer prevention over time.
  • Structured pressure ulcer prevention education, helps individuals post SCI gain and retain knowledge of pressure ulcer prevention practices.
  • Research is needed to determine the specific educational needs of individuals with SCI required to reduce the risk of pressure ulcer formation.
  • More research is needed to determine the best approaches of pressure ulcer prevention education to reduce pressure ulcers post SCI.
  • Research is needed to determine the role of behavioural contingencies and other behavioural strategies in pressure ulcer prevention post SCI.
  • Research is needed to determine why some individuals adhere to pressure ulcer prevention strategies and others do not.
  • The role of telerehabilitation in delivering prevention education and treatment to those individuals with SCI living in the community is not yet proven; more research is needed.
  • Electrical stimulation added to standard wound management promotes healing of Stage III and IV pressure ulcers post SCI.
  • More research is needed to determine optimum electric current and application protocols to improve healing of pressure ulcers post SCI.
  • Laser treatment does not improve pressure ulcer healing post SCI.
  • Ultrasound/ultraviolet C should be considered as an adjunct treatment when pressure ulcers are not healing with standard wound care post SCI.
  • Pulsed electromagnetic energy improves wound healing in Stage II and Stage III pressure ulcers post SCI.
  • Pressure ulcer healing after a SCI is improved when topical negative pressure therapy is administered as compared to traditional sodium hypochlorite dressing changes.
  • Normothermic dressings may improve healing of pressure ulcers post SCI.
  • Recombinant human erythropoietin shows promise in assisting with the healing of stage IV chronic non-healing pressure ulcers post SCI.
  • Additional study is required to validate platelet-rich plasma therapy as a possible treatment for severe, non-healing pressure ulcers in people with SCI.
  • The anabolic steroid agent Oxandrolone does not promote healing of serious pressure ulcers post SCI.
  • Occlusive hydrocolloid dressings are useful for healing of stage I and II pressure ulcers post SCI.
  • Platelet gel dressings used within the first two weeks of treatment will trigger pressure ulcer healing post SCI.
  • Pulsatile lavage therapy is an effective, and likely safe, non-surgical management and debridement method for the treatment of grade III and IV pressure ulcers secondary to SCI.
  • Maggot therapy is also likely useful in this patient group. Silicone moulding may also be considered as a radical en bloc debridement method for grade IV pressure ulcers in people with SCI.
  • Use of topical oxygen therapy may have a positive association with healing of pressure ulcers post SCI but more research is needed.
  • People with spinal cord injury with persistent grade III and IV pressure ulcers in the thigh and buttock region may benefit from surgical reconstruction.
  • Medihoney may be useful to treat persistent stage III and IV pressure ulcers in individuals with SCI.
  • Cured rot and flat sore ointment may be superior to arnebia root oil to promote accelerated healing of pressure ulcers in people with SCI.
  • Arginine supplementation in individuals with SCI may be helpful in accelerating pressure ulcer healing.
  • Pressure point localized cooling is not an effective pressure ulcer prevention strategy for people with SCI.