8th August 2024

Reduced mobility and pressure ulcers

In chronic neurological conditions, mobility may be reduced due to flaccid or spastic paralysis. Functional limitation can result in disuse atrophy, increased dependence, falls and fractures, increased risk of venous thromboembolism, predisposition to infection such as pneumonia, mood disturbance and pressure ulcers. Manage with comprehensive MDT and family input.

Pressure ulcers

People with chronic neurological disability may be at increased risk of pressure sores through various factors: reduced mobility and inability to reposition themselves, reduced sensation, incontinence, nutritional deficiency and cognitive impairment.

• Prevention:
  • On admission, assess risk of pressure sores using a validated assessment tool (e.g. Waterlow);
  • Frequent skin assessment, repositioning, nutritional supplementation if inadequate intake, barrier creams and pressure redistributing devices.
• Management:
  • Document pre-existing sores and raise safeguarding concerns if required;
  • Assess severity (see classification system below);
  • Choose dressings based on the degree of maceration, exudate and signs of infection: hydrocolloid dressings promote healing and alginate dressings are considered if significant exudate;
  • Consider Tissue Viability Nurse involvement;
  • Debridement if significant necrosis;
  • Consider systemic antibiotics if evidence of sepsis, spreading cellulitis or underlying osteomyelitis.

Image Source: Wikimedia Commons (2012). Wound stage, Licensed under a creative commons licence. Available for free at: https://commons.wikimedia.org/wiki/File:Wound_stage.jpg (Accessed: 17 January 2024)