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Lifestyle aids: beds, bed transfer & ulcer prevention

Information Services
 
 

Lifestyle aids

Lifestyle aids: beds, bed transfer & ulcer prevention

Lifestyle aids such as adjustable beds, transfer equipment, ulcer prevention strategies and pressure cushions can be important for people with catastrophic brain injuries.

 

A severe to catastrophic brain injury may mean that a person will be spending much of their time in bed. It is very important to select the right sort of bed and supports, and minimize the chances of bed sores.

 

Selecting an adjustable bed

When selecting an adjustable bed it is important to consider the needs of the individual. There is a range of beds on the market with a variety of options and accessories to meet an individual's support, comfort and functional needs.

 

Bed adjustments

An adjustable bed may incorporate one or allow of the following adjustments.

  • Height adjustment: also called hi-low function enables the bed height to be adjusted. This may be needed to assist transfers or for carer tasks such as changing bed linen or nursing someone in bed. Some beds have an extra low height adjustment.
  • Backrest adjustment: This may be used to support the user in a semi-sitting position or to assist the user from lying to sitting.
  • Knee break adjustment: This function elevates the knees without elevating the feet. This may be used to help prevent the user sliding down the bed.
  • Leg elevation: This elevates the users legs from the hip and may be used to help prevent or reduce leg swelling.
  • Trendelenberg or reverse Trendelenberg: This feature allows the entire bed to be tilted towards the head or towards the feet. This may be useful for individuals with a range of medical conditions such as circulatory problems, breathing difficulties or reflux.

 

Companion beds

These are two beds that can be placed directly beside each other. Depending on the needs of the users, both or only one of the beds may be adjustable.

 

Accessories

Accessories may include:

  • Bed rails
  • IV Pole
  • Built in massage
  • Removable head board
  • Self-help pole
  • Bed extensions
  • Alternative controls
  • Removable foot board
  • Battery backup
  • Voice activation.

 

Other considerations

Adjustable beds may be manually or electrically adjusted. Electrically adjustable beds have a hand-help controller and allow the user to adjust the bed while they are in it. Manually adjustable beds tend to use a footpump or hand-wind mechanism. Some adjustable beds can be folded for transport and storage.

 

More adjustable beds are on castors to allow the bed to be repositioned. Most also have locking castors which may be individual locks or a central locking mechanism. Directional castors on some beds may assist in steering the bed in one direction.

 

Beds are available with different load capacities. It is important to consider the combined weight of the user and mattress when checking this specification. Different beds have different clearance space under them. This is important to check if the user will be hoisted in and out of the bed.

 

Mattresses suitable for adjustable beds

Mattresses for adjustable beds are specialized as they need to be flexible and able to bend with the movement of the bed. They come in a variety of types.

  • Inner spring: the most common style of mattress. They consist of padding over springs (which support the user's posture while they sleep). Manufacturers recommend this type of mattress should be replaced approximately, every 10 to 13 years.
  • Latex: these can be firm, and it is not known whether they offer the same postural support as an innerspring mattress. Latex mattresses can be a better choice for users who are incontinent. They can also be a good option for older people, as they do not have to be turned as regularly.
  • Foam: these are generally lighter and easier to flip and turn. Many foam mattresses are now covered with a water-resistant two-way stretch covers that can protect the foam from incontinence as well as assisting with pressure care. Different densities and combinations of foam further improve the pressure care qualities.
  • Pressure care mattresses: some users at risk of developing pressure ulcers require a mattress that provides a high level of pressure care. These are available as either an overlay that lies on top of an existing mattress, or as a complete mattress replacement system.

 

Bed transfer equipment

Some people have difficulty getting in and out of bed, or repositioning themselves in bed. Other people may be unable to move themselves in bed at all, and require the assistance of carers. There is a variety of devices that can assist individuals to transfer or reposition independently, as well as aids to assist carers to reposition as individual in bed.

 

Self-help devices

Raising the bed on bed blocks may make it easier for the user to stand from the edge of the bed. A bed ladder attaches to the foot of the bed and allows the user to pull up from a lying position by pulling up on each rung on the ladder. Rungs can be grasped with the hand, or the whole forearm can be slid through the run for extra leverage.

 

A bed stick provides an anchor point for people to grasp to assist them to turn in bed. These devices are placed between the mattress and the bed platform. Care must be taken to ensure that the device is properly fitted and secured. Some bed sticks protrude upward from the bed base to be in line with the mattress top. Other designs extend above the mattress level.

 

A self-help pole, which is often known as a monkey pole, consists of a metal pole at the head of the bed with a chain and triangular handle which hangs above the user's head. These poles can be helpful when a person needs to lift themselves up from the surface of the bed. Some people find them difficult to use, as they require substantial upper body strength.

 

Slide and self-turn tubes can be used by people to assist to turn themselves over in bed independently. These are made of nylon materials, which provide a slippery surface therefore allowing the person to turn more easily.

 

Leg lifters are designed to help a person lift their legs in or out of bed. More complex electrical inflatable leg lifts are also available. An electric bed with an adjustable backrest can also be used to assist someone who has difficulty moving in bed to get from a lying to a sitting position.

 

Equipment to assist carers

Sliding is often one of the easiest ways for a carer to reposition an individual in bed. There is a range of sliding aids designed to assist in this task. These include:

  • Single thickness slide sheets are often nylon, and designed to be doubled back on themselves. The helper bunches the corners to get a grip.
  • Tube-type sliding aids, where the material is sewn end to end, provide a slide movement sideways or up a bed depending on the placement and size of the material tube.

 

More complex aids, that also minimize friction and prevent bunching of material under the user, include semi-rigid transfer aids with a flexible sheet of plastic inside a padded cover and air-filled mats. Both come with handles to assist with pulling.

 

Pressure ulcer prevention

Pressure ulcers are also known as decubitus ulcers, bed sores and pressure sores. Prevention of pressure ulcers is very important. Once a pressure area has developed that area is then more at risk of a second pressure ulcer developing.

 

Pressure ulcers can happen very quickly, within 10 to 20 minutes in some cases. They can be very painful and costly, both emotionally and financially. Pressure ulcers are easy to prevent but difficult to treat.

 

What is a pressure ulcer?

A pressure ulcer occurs when the skin and tissue underneath breaks down. This may be caused by constant pressure on the one area. The first sign of a pressure ulcer is a redness of the skin. This can then develop into a broken skin area that looks like an abrasion, pimple or blister. Eventually, if unchecked the pressure ulcer can destroy the underlying tissue, tendon, joint and muscle to leave an open wound down to the bone.

 

Risk factors

A number of factors influence the likelihood of developing a pressure ulcer:

  • Inability to regularly change position - immobility, being restricted to either sitting or lying down increases pressure especially over bony areas
  • Dietary intake - dehydration, oedema, weight loss or obesity and poor diet affects the health of the skin
  • Moisture - skin remaining damp due to perspiration, urine and faeces can contribute to the breakdown of the skin surface
  • Poor circulation - skin receives less oxygen and nutrients leading to skin breakdown
  • Alteration in sensation - may not feel discomfort and pain or the need to change position.

 

Preventing pressure areas

  • Check daily for reddened areas of skin, especially on these areas ear, elbow, iliac crest, hip (trochanter), knee, toe. Seek advice from a health professional.
  • Change position regularly. This helps oxygen and nutrients in blood flow back into the cells of the skin, avoiding skin and tissue death.
  • Avoid stretching or pulling on the skin, especially when moving from one place to another or when changing position. Avoid creases, folds and crumbs in the clothing and on the sitting or lying surface, as they can cause high pressure points.
  • Spread the person's weight evenly over the largest area possible. This will help to disperse the pressure. Use a suitable pressure reducing cushion, mattress or protector to help achieve this. Seek advice from a health professional.
  • Keep the skin clean, dry and in good condition. Use breathable fabrics near the skin. Seek professional advice on managing incontinence where appropriate.
  • Ensure adequate nutrition and fluid intake. This will give the skin the best chance to be healthy.

 

Pressure cushions, mattresses & protectors

Pressure cushions, mattresses and protectors can assist in preventing the development of pressure areas and aid comfort. Pressure cushions alone will not remove the risk of developing pressure areas. They should be used in conjunction with other pressure management strategies, including regular position changes and good skin care.

 

Careful consideration of many factors relating to the client and the environment is necessary when selecting the right equipment to manage pressure care. It is best to seek advice from a health professional such as an occupational therapist, physiotherapist or registered nurse to ensure that the correct equipment is obtained to meet the needs of an individual.

 

Different materials are used for pressure cushions, mattresses and protectors. Some materials offer a high level of pressure reduction, whilst others provide less pressure reduction and may improve comfort only. Below are some commonly used materials.

 

Sheepskins

There are both natural and synthetic sheepskins for use in beds and on chairs. They offer comfort, and can also be placed over rough surfaces to protect fragile skin. Sheepskin does not offer good pressure relief, so it is suitable for use with people at low risk of pressure areas only.

 

Foam

There is a variety of natural and synthetic foams available of different densities and styles (e.g. flat, egg crate, pinhole, gridded). Foam is easy to cut to shape to suit the user. It requires little maintenance but has a short lifespan. It is useful as an aid in comfort. Foam is best suited to people at low to medium risk of pressure areas.

 

Fiber (natural or synthetic fibers)

These can provide a cushioning effect in a mattress or a cushion. They require regular laundering and "fluffing up" to maintain their degree of comfort. They provide a stable base, but flatten quickly under the user. Fiber products are generally suitable for people at low to medium risk of pressure areas.

 

Water

These types of cushions and mattresses are mostly used for comfort. They conform to the body's shape as the water displaces. They require minimal maintenance, but even a small cushion can be heavy to move. They are unsuitable for use in sitting as they are very unstable due to the continual dispersion of water. Generally, water cushions are suitable for use by a person at low to medium risk of pressure areas.

 

Gel

There is a number of types of gel and different ways for it to be contained in the cushion. Each will conform in different ways to the user's shape. Gel can be useful to absorb vibration and is generally quite stable. According to the type selected, a gel cushion can suit people at low, medium and occasionally high risk of pressure areas.

 

Fluid

There is a range of new fluids, which are neither gel nor water and have many different pressure relieving properties. These fluids are usually used in combination with other materials within a cushion or mattress. Depending on the type of cushion chosen, they can be suitable for people at low, medium or high risk of pressure areas.

 

Air/alternating air

These may have one, a few, or many air chambers in a cushion or mattress, and are lightweight. They work on the principle that the user will be suspended or "floating" on the air cells. The lowest air pressure needed to lift the person clear of surface contact is usually the principle used for inflation. Daily checks for the correct inflation level is recommended. There is risk of a puncture, and many styles do not offer the stability some users require. The air in these mattresses can be static or alternating. An alternating air mattress is connected to a motorized pump which constantly changes the pressure in the different chambers of the mattress. Depending on the type chosen, they are suitable for people at low, medium or high risk or pressure areas.

 

Combination

Some cushions and mattresses combine two or more materials to obtain the properties of each in the product. Common combinations include foam and fluid, foam and air, gel and air and gel and foam.

References and further information

LifeTec has kindly allowed reproduction of this fact sheet. You can telephone, fax or e-mail any enquiries to LifeTech for further information from one of their therapists about products - visit the Lifetec website for details. 

 

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