From: Allison.Cozzi@f3216.n161.z1.fidonet.org (Allison Cozzi)
Newsgroups: misc.handicap
Subject: Medical Ergonomics
Date: 13 Apr 92 21:01:52 GMT
Reply-To: Allison.Cozzi@f3216.n161.z1.fidonet.org
Organization: FidoNet node 1:161/3216 - Computer Communicat, Concord Ca

Index Number: 21066

[This is from the Spinal Injury Conference]

-> In a message to Joe Chamberlain <22 Mar 92 15:11> Alan Hess wrote:
->
->  AH> I tried a chairback for support.  Unfortunately, it pushed my
->  AH> butt out too far, and in one day reopened by necrobutt because o
->  AH> how I sat.  I also didn't feel any
->  AH> straighter.  The back went byebye.  *adh*
->
->      That's what happened to me when I changed my seating arrangement
-> butts just grow use to a certain position and don't wannt to be foole

You're close. An explanation by a *good* medical ergonomicist (that's
*me*!) would explain it as follows: The goal of designing an adequate
seating system for orthopedically or neurologically involved folks is to
maximize the contact area to the appropriate seat cushion. The pelvis,
when held in certain positions, creates angles that are
counterproductive to the maintenance of healthy tissue and results in
the pressure sores you mentioned. Decubiti are aggravated (and often
caused) by moisture, heat and pressure. Elimination of any of those
risk factors will lessen the chances of tissue necrosis. So if
incontinence is a problem, then that needs to be handled (Tegaderm will
protect a suspicious *unbroken* skin lesion by keeping moisture totally
away from skin and can often allow it to heal over by itself. If the
skin is broken, there are other products to allow for healing while
still providing a moisture barrier to the affected skin.) If heat is the
problem, then regular "airing" of the area, unclothed, will help and
doing without any vinyl or rubber garments as much as possible as well
as sitting on plain cotton sheeting rather than a vinyl seat cushion  or
cushion cover which will reflect the body heat right back at your body
and aggravate the problem will help also. But if pressure from being
positioned on a worn out or inappropriate cushion or mattress will bring
almost certain tissue destruction. If you have an active decubitus
ulcer, you might mention an alternating pressure pad (APP) to your
doctor. It will require a prescription, is covered by all major
insurances (including Medicaid, Medical, medicare) to the best of my
knowledge and does wonders to alleviate undue pressure. They know that
if they don't treat a pressure sore correctly and swiftly, it will cost
them lots more in the long run. But for the long haul, it is best if you
can find your way into the hands of a good surgical fitter, orthopedic
appliance fitter, medical ergonomicist and/or physical therapist to have
a cushion designed that will hold your pelvis in a position that will
maximize the contact area, minimize pin-point pressure from bones
beneath, and avoid shearing and stretching of the skin.
     Does that throw more information that was needed into the ring? As
a newcomer to the echo, I truly don't want to bend noses out of shape by
offerring up information that wasn't asked for. However, after working
in this field for several years (and subsequent to my own injury), I
have seen so many cases of pressure sores, etc. that should never have
happened had the free availability of information been present.

                                                        Allison

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