Tips to Prevent & Treat Bed Sores And Pain in a Home Recliner & Lift Chair
Tips to Prevent & Treat Bed Sores And Pain in a Home Recliner & Lift Chair
For people with limited mobility, sleeping or spending their day in a hospital bed is not always possible. Comfort and care are often found at home in a home recliner or lift chair. This is quite common when suffering from conditions such as ALS, Parkinson's, Congestive Heart Failure (CHF), TSCI, debilitating injury, and other conditions that limit mobility. For others, sleeping in a recliner is a more practical choice due to advanced age or obesity. Whatever the condition, limited mobility or the inability to reposition oneself increases the incidence of pressure injury AKA bedsores, and the risk of potentially fatal infections such as MRSA. Below are several tips on how to help prevent and heal bedsores and help alleviate pain in a home recliner or lift chair.
THREE MAIN CONSIDERATIONS
- Attain Proper Positioning
- Prevent Skin Shear & Friction
- Redistribute Pressure often
PROPER POSITIONING HELPS PREVENT PRESSURE SORES
It is difficult for those who are less mobile to achieve and maintain a proper seating position in a home recliner or lift chair. Even with assistance, the patient may not be positioned properly. Due to the seat depth of many home recliners and lift chairs, patients may not be able to get far enough back in the chair to attain proper positioning.
For patients who are 5' 9" or less, seat depth can be more crucial. Typically a patient is positioned in front of the chair as close as possible to the recliner with the back of their calves touching the recliner seat prior to sitting. Once seated, there is often a gap between the patient's hips and the back of the chair. This is because the seat depth is too deep for the patient's height. To find comfort the patient leans back without alleviating the gap. This forces them to sit directly on the tailbone or sacrum “sacral sitting”. Rather than sitting upright, this improper seating position can cause additional pressure on the tailbone. This can cause pain and prolonged pressure can lead to skin breakdown.
Sitting upright with the weight balanced is very important. Improper balance can cause IT pain, that is pain in the Ischial Tuberosity or Sit Down Bones. Without the ability to reposition, prolonged pressure can lead to pain and skin breakdown. Since the skin is thin over the boney prominences of the coccyx, sacrum, IT, it does not take long for pain or pressure sores to develop.
- One way to prevent sacral sitting is to place the patient's hips against the back of the recliner or wheelchair back.
NOTE: This may be more difficult in a recliner due to the patient's height and the seat depth requiring repositioning. However, this repositioning can be the source of skin shear. Ideally, with the patient's back against the back of the chair, there should be a gap between the inside of the knee and the recliner seat. A proper back cushion may help reduce the seat depth and improve patient positioning.
- When seated, weight is placed on the IT Ischial Tuberosity aka Sit Down Bones. If seated improperly, pressure is not evenly distributed and therefore can be the source of pain. It is essential that the patient is in a neutral seating position and not leaning. Leaning can add additional pressure.
- If possible, recline slightly. This helps offload weight from the tailbone/coccyx to the back.
- Purchase a Pressure redistribution cushion that fits in your Recliner or Lift Chair. The cushion that you purchase depends on the severity of the pressure ulcer, the patient's ability to reposition, and long-term prognosis. (see below)
PREVENT SKIN SHEAR
When repositioning, shifting/sliding back in a recliner can create skin shear. The inability to lift one's weight off the recliner seat surface during repositioning can create injury to the skin. Skin shear occurs when the skin and underlying bones move in opposite directions. This happens when the force needed to break the friction (grab) between the patient and the recliner seat surface, moving in opposite directions, is greater than what the skin can withstand. These opposing forces can tear the skin.
Well-intentioned caregivers without the strength to offload the patient's weight before repositioning can create skin shear.
TIPS TO PREVENT SKIN SHEAR INJURY
- A non-shear, low-friction cover material such as Vyvex can help prevent skin shear and friction injuries. This highly specialized material feels like human skin, is anti-bacterial, anti-microbial, stain-resistant, and fluid-proof.
- Prevent repositioning when bearing weight in a seated position
- Use a slide sheet
- Use a recliner cushion with a non-shear, non-friction cover. This type of cover is present on the recliner cushions listed below.
PRESSURE REDISTRIBUTION TO PREVENT PRESSURE INJURIES
Prolonged pressure between the body and the recliner seat, especially where the bone is closest to the skin, can impede vital blood flow to the skin. In fact, the pressure between the body and the support surface exceeding capillary closing pressure will prevent blood from flowing within the skin. Blood supply to the skin is what keeps it healthy. Reducing or blocking the blood supply to the skin rapidly leads to skin cells dying and skin breakdown, aka tissue injury aka bed sores. For some, a pressure injury can occur in just 2 hours. Elderly patients with thin or brittle skin or conditions that restrict blood flow such as diabetes can accelerate the formation of pressure injuries.
TIPS TO IMPROVE PRESSURE REDISTRIBUTION
- Reposition often
- Purchase a pressure redistribution cushion for your recliner or lift chair
There are many factors that determine what type of cushioning is appropriate to help redistribute pressure including, if sores are currently present, location of sore, the stage, mobility, patient weight, and more.
Below are several types of cushions that can be used in a recliner or lift chair and when to use them:
RECOMMENDED CUSHIONS FOR PRESSURE REDISTRIBUTION IN A RECLINER
• Fluidized Gel Recliner Overlay - For patients whose skin is clear, mild to moderate risk of skin breakdown and the patient is able to reposition themselves. This type of cushions is not ideal for someone who can not reposition themself.
• Gel-Flex Bariatric Recliner Overlay - For patients over 250 lbs up to 1000 lbs. whose skin is clear, mild to moderate risk of skin breakdown and the patient is able to reposition themselves
• Recliner Air - Air/Gel/Foam - Prevention and healing with alternating pressure in the seat only. For patients whose skin is affected with an early stage to late stage bedsore on their bottom with moderate to severe risk of skin breakdown and the patient is unable to reposition themselves. The back is a fluidized gel for pressure redistribution and the heel wedge is foam to help prevent heel ulcers
• Alternating Pressure Coccyx Cushion - Specifically targets the coccyx area for the prevention and treatment of pressure injuries. For early to late-stage ulcers with moderate to severe risk of skin breakdown, and the patient is unable to reposition themselves or completely offload their weight before repositioning.
• Alternating Pressure Recliner Overlay. - Full body head to heel prevention and healing. For patients whose skin is affected with an early stage to late stage bedsore with moderate to severe risk of skin breakdown and the patient is unable to reposition themselves or completely offload their weight before repositioning.
All the above cushions can be customized
There are many factors that can lead to the development of a pressure ulcer. The tips above are some of the more common yet addressable issues that can help maintain healthy skin.
None of the information above is meant as medical advice or to be used to diagnose or treat a pressure wound. Always seek the assistance of a medical professional or seating specialist.
About the Author:
Jeff Adise has been in the wound care industry for over 25 years. He is a product specialist and the developer of innovative therapeutic support surfaces for the treatment and healing of Stages I-IV pressure injuries in home recliners, lift chairs, wheelchairs, and beds. His innovative products are recommended for use by wound care specialists, physicians, caregivers, disease-related organizations for conditions such as ALS, across the US. In addition, Jeff is working with a team of Doctors and Ph.D. researchers to develop an Investigational New Drug shown to greatly improve the quality and speed of wound healing while reducing infection.
tel: 888 450-0045