Problem Solvers

Serving Unique Support Needs

Understanding mobility patients’ special bed and support needs is integral to their overall wellbeing.

• By Joseph Duffy
• Apr 01, 2010

Unlike patients who can easily get in and out of bed without assistance and those who can easily reposition themselves during sleep, mobility patients need a treatment plan that spans 24 hours per day, including when they sleep. Integral to their comfort and health is paying particular attention to the time spent per day in the supine position, which for some patients is more than 50 percent of the day.

“Mobility patients are high-risk but it depends on just how sedentary they are,” says Jim Acker, vice president of sales and marketing, Blue Chip Medical Products, a manufacturer of myriad therapeutic support surfaces. “Not all of them have breakdown because they are young and very active, where older patients have a greater chance of breakdown. But they are still in wheelchairs, and just about all mobility patients should use some sort of preventative product.”

Unique needs of mobility patients

Although mobility patients come in all ages and sizes, they share common support needs that should be considered in any preventative and therapeutic planning. Perhaps the most important support need for mobility patients is proper pressure redistribution.

“With their limited mobility, or in some cases complete lack of mobility, a sleep surface that provides pressure reduction will be vital to minimize the chances of pressure ulcer development,” says Mike Sedlak, group product manager of homecare beds/therapeutic support surfaces, Invacare, a manufacturer of wheelchairs and other home medical equipment. “There are a variety of sleep surfaces available to the patient, ranging from pressure-reducing foam mattresses to more advanced alternating pressure and lateral rotation mattresses. Which one is right for patients will be at the discretion of their medical professional.”

Another important need is ease of transference from wheelchair to bed to wheelchair, which is a significant safety issue. Acker points out that you can use a high-quality air mattress, but if it sags when attempting to get out of bed, you can fall to the floor.

“Softer support surfaces make transfers more difficult in and out of bed,” says Lois Brown, rehab clinical education specialist, Invacare. “It is more difficult to achieve sitting balance on a firm surface but with a patient who is at risk of pressure sores, it is likely that a foam or air mattress will be necessary and this may increase the challenge of the transfers. Pressure is always the No. 1 priority, but it is important to evaluate all the options in order to meet all the needs of the patient.”

Brown says that bed height affects transfers as well. A bed that is higher than the wheelchair can impede the patient’s lateral transfer or even stand-transfer to get into bed. A seat-to-floor height where patients can easily reach their feet to the floor improves transfer safety.

“There are several strategies and assistive devices to help with transfers out of bed,” says Brown. “If the head of the bed can be elevated, this can help the individual to sit and position him or her to sit on the edge of the bed before transfers. The use of an adaptive device, such as an overhead transfer bar, can help patients, such as spinal cord patients, to lower or raise themselves in the bed. This type of transfer device or a side rail on the bed can also help patients with any trunk or upper extremity weakness to help facilitate rolling onto their side in preparation for sitting up. There are many different types of transfer handles that can be attached to the side of the bed to assist, much like the side rails of a hospital bed.”

Acker suggests support surfaces that have perimeter borders, which makes the edges of the bed firmer, resulting in easier transfer.

Another unique concern for mobility patients is moisture control, especially significant when treating a mobility patient with an ulcer.

“The ideal climate for breakdown is having pressure and heat and moisture build up,” says Acker. “That causes breakdown much more quickly.”

Acker suggests that this problem can be addressed by using the right type of material or barrier between the patient’s skin and the support surface. Be aware that there are many low-quality fabrics on the market that can cause the patient to sweat.

Acker warns that if you lie on coverless foam it actually heats up very quickly. So for mobility patients, it’s important to use the right type of cover and foam.

“You’ve seen the tempurpedic foam on TV,” says Acker. “It’s great for people who are not compromised and it is very comfortable. But it has a tendency to retain heat, which encourages breakdown. The problem is elderly people see these commercials and want the mattress. They have limited mobility because they sink into the foam and they have heat and moisture build up because they don’t have the ability to reposition themselves during the night.”

Acker also warns against shear force (friction). He says when you transfer on and off a bed, you want low shear force, which allows patients to transfer without damaging the skin. Acker says a cover and an air system with low air loss within the mattress help control this issue.

Bed and support awareness

Although Acker says that preventative measures and high-quality products have done a lot for mobility patients, there is still a large group who are not getting the help they need, due to lack of knowledge, costs and insufficient insurance coverage. One encouraging trend he sees, however, is that physical and occupational therapists are no longer just concerned with what patients sit on, but what they sleep on, as well.

“Everybody is so concerned about what cushion they are sitting on during the day and then they lie down on their bed and all the good that cushion did, they breakdown while they are in bed,” says Acker. “It gets reversed by being on an inadequate support surface. But now there’s an awareness, and physical and occupational therapists are educating their clients on that versus giving them a really good cushion and then letting them sleep on their regular mattresses at home.”

Finally, in an industry that offers no real testing of support products, Acker suggests that the best way to find out if a product works is to ask for references.

“When we have a nursing home facility or hospital that wants to buy 200 mattresses, they ask, ‘What other hospitals around the country are the products in?’ ” says Acker. “We have a list that we provide with contact information and we invite people to call them. That can be done on the homecare level as well. Patients just need to do their homework.”

This article originally appeared in the April 2010 issue of HME Business.