Pressure management.

The prevention or minimisation of the occurrence of pressure sores is an important consideration in the rehabilitation of physically disabled people, especially for the wheelchair user with a spinal cord injury. Although there is little definitive information on the cause of pressure sores, several intrinsic and extrinsic factors have been highlighted. Probably the most significant causative factor is the application of force to the skin surface. The relationship between the magnitude of pressure and its duration; the temperature and humidity at the interface; and the physiological effects that this has on the microcirculation and lymphatic drainage are discussed in this article. It is suggested that a rationale for the prevention of pressure sores includes the limitation of the duration of pressure applied to the skin surface and the reduction of the peak pressures particularly at vulnerable sites. In this context the design criteria for a clinical interface pressure measurement system, and the uses and limitations of the commercially available options, are considered. The development of a structured programme of wheelchair and support surface provision, assessment and follow-up is required.