Paralysis - Recommendations

If you are paralysed, it is important you take measures to prevent getting pressure ulcers.

Regular pressure relief in the wheelchair or in bed is essential to prevent pressure sores.

Skin care and pressure ulcers

Taking care of your skin is important if you have paralysis as you have an increased risk of developing a pressure ulcer.

Pressure ulcers develop when sustained pressure interrupts the blood supply to parts of the body. Blood contains oxygen and other nutrients required to keep tissue healthy. Without a constant supply of blood, tissue damage occurs and the tissue will eventually die.

Pressure ulcers do not develop in people with normal mobility because the body's regular movements stop pressure building up in any one part of the body.

For example, when you are asleep you may think you are lying still, but you will probably shift position up to 20 times a night.

If a person is unable to move regularly because of paralysis, pressure ulcers can quickly develop, sometimes over the course of a few hours.

Changing your position regularly is an effective way of preventing pressure ulcers. As a general rule, wheelchair users should change their position at least once every 15 to 30 minutes.

If you need to stay in bed, you should change your position at least once every two hours. If you are unable to change position yourself, a carer or relative can assist you.

Special cushions, mattresses and other pressure-relieving devices are also available to help reduce pressure on your affected limbs.

It's also important to keep the skin in the affected area clean and dry. Wet skin is more vulnerable to damage from sustained pressure.

Regularly check your skin for any signs of pressure ulcers. They usually begin as an area of red, unbroken skin that either feels warm and spongy or hard to the touch.

You can usually prevent affected skin getting worse by keeping it clean and not putting undue pressure on it until it has healed.

If the skin has broken or looks like an open wound or blister, you should contact your care team for advice.

Exercise

If possible, it is important to exercise regularly and achieve a good level of fitness if you are paralysed. The reasons for this are:

the fitter you are, the better your general level of health will be and the lower your risk of developing complications
regular exercise will help improve your bladder and bowel function
improved muscle strength will make it easier for you to use a wheelchair or orthosis and prevent problems associated with using mobility devices, such as shoulder or arm pain
maintaining a certain amount of muscle strength will prevent your muscles in the affected limbs becoming severely weakened

In the first few days or weeks after the accident or injury that caused your paralysis, or as part of your long-term treatment plan, you will be introduced to a physiotherapist (a specialist in physical rehabilitation and exercise).

Your physiotherapist will discuss different exercises and activities you can do. Depending on the extent of your paralysis, recommended exercises and activities may include:

weightlifting – an excellent way to improve upper body strength
hand cycling – arm cycles are specially designed bicycles powered by turning handles with your hands, rather than pedals with your feet
horse riding
wheelchair basketball
wheelchair racing
wheelchair tennis

If your paralysis is so severe that you are unable to carry out any voluntary exercise, functional electrical stimulation (FES) may be recommended. FES uses electrodes (small metallic discs placed on your skin) to deliver electrical currents to the muscles in your legs or arms to stimulate movement.