AA

Specialized Seating Clinics

Developing the ability to maintain skin integrity and prevent pressure ulcer formation is an important component of any SCI rehabilitation program. Prevention education includes an emphasis on taking personal responsibility for maintaining healthy skin through personal care, inspection of skin, pressure relief and correct use of prescribed equipment. The incorporation of seating clinics into both the inpatient and outpatient rehabilitation program has been shown to reduce the incidence of pressure ulcers and readmission rates due to pressure ulcers (Dover et al. 1992). Seating clinics not only provide education but also make recommendations for appropriate seating systems based on interface pressures, thermography and assessment of tissue viability. Verbal and visual feedback is provided to the individual with SCI and active participation is encouraged (Dover et al. 1992; Coggrave & Rose 2003; Kennedy et al. 2003).

Table: The Effect of Specialized Clinics on Pressure Ulcer Prevention

Discussion

Kennedy et al. (2003) studied 50 individuals with SCI participating in a comprehensive rehabilitation program. The individuals were divided into 3 groups to determine if attendance at a specialized seating assessment clinic (SSA) would improve skin management ability as evidenced by lower “to be achieved” scores on the skin subscale of the Needs Assessment Checklist (NAC); optimal timing of attendance at the SSA was also studied. Results indicated significant differences between group 1 (attendance at SSA prior to NAC 1 (within one month of mobilization)) and group 3 (no attendance at SSA) at both NAC 1 (p<0.05) and NAC 2 (on admission to pre-discharge ward) (p<0.01). Skin management “to be achieved” scores were significantly lower for individuals who attended SSA before their first NAC at both time points. Significant differences were also observed between “to be achieved” scores at first and second NAC within all groups: Group 1(p<0.0001), Group 2 (p<0.01) and Group 3 (p<0.01). Results indicate that attendance at a SSA did improve individual’s skin management abilities and that early attendance was optimal. The results also indicate that attendance at SSA is an adjunct to the skin management abilities taught during a comprehensive rehabilitation program. More research is needed to determine if early attendance at a SSA translates into prevention of pressure ulcers over time.

For study reviews related wheelchairs and seating as well as the effects of position/postural changes in relation to pressure management, as measure by interface pressure mapping and blood flow measurements, please refer to the SCIRE Wheeled Mobility chapter.

Conclusion

There is level 2 evidence (from one cohort study; Kennedy et al. 2003) showing that early attendance at specialized seating assessment clinics increases the skin management abilities of individuals post SCI. 

  • 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 (SSA) results in pressure ulcer prevention over time.