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
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
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.
An adjustable bed may incorporate one or allow of the following
- 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
- 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.
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 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.
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
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
- 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.
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.
A number of factors influence the likelihood of developing a
- 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
- 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 &
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.
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.
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.
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.
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.
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
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.
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
References and further information
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