Case Series/Study

(CS-019) Activity-Based Restorative Therapy (ABRT) and the risk of developing Medical Device Related Pressure Injuries in pediatric patients with Spinal Cord Injury: A Case Report

Co-Author(s):

Marjorie Morgan, PTA

Introduction: Between January 2019 and October 2020, 58 pediatric patients with spinal cord dysfunction were seen with wounds at a specialized outpatient rehabilitation center. 31 of these patients either reported a history of Medical Device Related Pressure Injuries (MDRPI) or had a MDRPI at admission. There is a paucity of literary in the pediatric spinal cord population regarding MDPRI. In this case report, <span style="font-variant-ligatures: normal; font-variant-caps: normal; orphans: 2; text-align: start; widows: 2; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; word-spacing: 0px;">the authors will explore the causes associated with MDRPI within the pediatric SCI population. Methods: <span style="font-size: 10.0pt; line-height: 115%; font-family: 'Arial',sans-serif; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; color: black; background: white; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Of the 31 patients, 11 were diagnosed with tetraplegia and 20 were paraplegia of which 17 were non-traumatic injury of origin and 14 were traumatic. They average a score of 56.7 on the Spinal Cord Independence Measure III (SCIM-III), 17.3 on the Braden Scale, and 19.1 BMI. 14 patients were stratification as sensory and motor complete.<span style="font-size: 10.0pt; line-height: 115%; font-family: 'Arial',sans-serif; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; color: black; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;"> <span style="font-variant-ligatures: normal; font-variant-caps: normal; orphans: 2; text-align: start; widows: 2; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; word-spacing: 0px;">The following were mechanics in which the MDRPI were acquired: 26 with orthotics, 1 with trach ties, and 4 with wheelchairs. <span style="font-variant-ligatures: normal; font-variant-caps: normal; orphans: 2; text-align: start; widows: 2; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; float: none; word-spacing: 0px;">Once an MDRPI was identified, a wound specialist was consulted for management, treatment, and education with the goal of preventing future pressure injuries. Results: <span style="font-size: 10.0pt; line-height: 115%; font-family: 'Arial',sans-serif; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Chi-Square analysis showed a lack of sensation is associated with an increased likelihood of developing an MDRPI (p< .05). There is also an association with lower SCIM and Braden Scores. Policies were reviewed, and modifications were made to decrease the risk of re-occurrence. Staff in-services were held to educate staff members on the proper use of equipment, promote regular skin checks, and create wear schedules to build up tolerance to devices such as orthotics. Discussion: <span style="font-size: 11.0pt; line-height: 115%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Although MDRPI may not appear serious, initially, if not addressed immediately, it could develop into a larger wound and need a significant amount of time to heal. As demonstrated by these cases, pediatric patients with spinal cord injury who participated in ABRT are at high risk for MDRPI due to decreased sensation, more regular use of wheelchairs and/or orthotics to assist with mobility, and massed practice therapy interventions. Modifications and changes, along with education, were given to patients, caregivers, and therapists to improve skin protection and prevent future MDRPI. Trademarked Items: References: National Pressure Ulcer Advisory Panel. Best Practices for Prevention of Medical Device-Related Pressure Injuries. Updated May 2017.

Kayser SA, VanGilder CA, Ayello EA, Lachenbruch C. Prevalence and analysis of medical device-related pressure injuries: Results from the International Pressure Ulcer Prevalence Study. Adv Skin Wound Care. 2018;31(6):276-85.