# Presentation: 084130

## Achieving Proper Wheelchair Positioning & Comfort 

**for the SCI Individual with Chronic Pain**
- Krysta Kingsbury OTR/L
- VA Boston Healthcare System

**56 year old C6 ASIA A spinal cord injured**
** ****male s/p MVA in 1970**
**Pertinent medical issues include AD, severe pain,   **
** ****obesity, and severe scoliosis**
**Initially came to w/c clinic in November 2004 for  **
** ****poor w/c positioning,  inability to perform  **
** ****pressure relief, and chronic pain**

**SCI persons can feel pain in areas where there is normal sensation and where there is little or no feeling after injury.**
**Paraplegics tend to have more pain than quadriplegics.**
**SCI individuals injured by gunshot have more pain than SCI persons injured by other factors.**

**For persons with severe chronic pain, proper positioning is imperative as their wheelchair is their access to the outside world.**
**Pain from improper positioning should not be a barrier.  **
** ****It is everyone's job to know how to provide proper positioning and know who to contact for further assistance.  **
**The patient is always the focus.**

**PATIENT PROFILE**

**CONSULTATION PROCESS**

**Consult was placed by MD for patient to be seen by VABHS SCI wheelchair clinic team.  Patient was evaluated and met criteria for new power chair with tilt and custom molded seating system by the SCI wheelchair clinic team.**
**Barriers to proper seating: obesity, inability to reposition/perform pressure relief, severe pain, severe scoliosis, and AD. **
**Solution: heavy duty frame, tilt function, custom molded cushion/backrest.**
**Other issues that may arise in these type of patients: architectural barriers, vision due to decreased cervical ROM, and need for non-hand controlled electronics.**
**Prior to new chair pt c/o 10/10 pain after sitting in the chair for 4 hours.  This made it difficult to go to MD appointments and do IADL’s.  After he was issued the new chair, the patient was able to increase his sitting time to 7 hours before reaching 10/10 pain level.  **
**He also noted that he was able to decrease his pain 1-2 levels if he tilted where as in his old chair he was unable to do that.**

**Ask the patient before you get them into the chair how they sit**
**Set up the chair before you get them into it (removing arm rest, head rest, inflating cushion etc.), **
**Look at the patient before you get them into bed to get an idea how they are positioned.**
** ****LISTEN to the patient. **
**Spend time with the therapists learning**
**Ask for the seating specialists to assist you,  **
** ****not you assisting the therapists.**

**OBJECTIVES**

**1:   Describe the consultation process when a SCI person needs to be evaluated by the proper wheelchair and seating specialists at the VA Boston Healthcare System.**
**2:   Identify two benefits of proper seating and positioning related to chronic SCI pain.**
**3:   List two helpful strategies related to proper seating and positioning which nurses can incorporate into their daily practice when providing nursing care to spinal cord injured persons with chronic pain.**

**FACTS ABOUT PAIN AFTER SPINAL CORD INJURY **

**STRATEGIES**

**CONCLUSIONS**

**IMPROPER WHEELCHAIR POSITIONING**

**BENEFITS OF PROPER POSITIONING**

**PROPER WHEELCHAIR POSITIONING**

-  **Increased sitting tolerance**
** ****Decreased pain**
** ****Increased community involvement**
** ****Increased independence in ADL’s**
** ****Decreased depression/anger**
** ****Decreased incidence of pressure ulcers**
** ****Decreased incidence of  medical issues**
** ****Increased quality of life**