The View from Where I Sit

Tag: research

  • THREE SOFT TISSUE THERAPIES FOR SCAR TISSUE

    Active Release Technique Therapy

    A.R.T is somewhat similar to massage therapy in that a therapist will use their hands to manipulate soft tissues. During A.R.T, however, the patient or the therapist will actively flex and extend different muscle groups during manual therapy. This active motion improves circulation and helps to break down scar tissue. A.R.T can help people with:

    • Plantar fasciitis
    • Tennis elbow
    • Shin splints
    • Carpal tunnel
    • Neck pain
    • Back pain

    One study found that A.R.T was helpful for people with neck pain as it improved range of motion and the pressure pain threshold score.

    Graston and Astym Therapy

    In Traditional Chinese Medicine, there is a therapy called Gua sha, which is where a therapist uses a tool, such as a smooth stone, to scrape the skin. Gua sha improves circulation and helps to break down scar tissue. Many therapists have taken the gua sha concept and applied it to different physical therapy techniques, such as the Graston technique and the Astym technique.

    Therapists that follow Graston and Astym protocols use plastic and/or metal tools to rub down soft tissues instead of their hands. If you have deeper areas of scar tissue that can’t be resolved by manual therapy, then these types of tools can be beneficial since the therapist can apply deeper pressure. These tools also come in a variety of shapes, which can help therapists pinpoint difficult-to-reach muscle groups, like the iliopsoas. Lastly, these tools help stimulate new cell growth in soft tissues and help the body resorb scar tissue.

    Dry Needling

    Dry needling is a therapy where practitioners use thin needles to break up scar tissue and reduce inflammation in trigger points. Trigger points are tight muscle fibers that can form from soft tissue trauma, muscle imbalances, and repetitive motions.

    Some people may confuse dry needling with acupuncture treatments. While dry needling looks like acupuncture, Healthline points out some distinct differences.

    For example, acupuncture is rooted in T.C.M and is meant to improve energy flow in the body; dry needling’s main focus is on correcting overly tight muscles with scar tissue. If your soft tissue injury has caused muscle spasms, then dry needling may be a good option. Some people’s soft tissue injuries may cause extreme sensitivity to touch, so dry needling may be a better option for these patients instead of A.R.T or Graston/Astym therapy. 

    I’m glad to know this because I only have a Tissue Viability Nurse and none of these techniques were suggested to me. I intend on trying out these new techniques soon.

    http://theresumexpert.com/2022/07/27/3-soft-tissue-therapies-for-scar-tissue/

  • Let’s Work Together to Stop The Pressure!!!

    https://www.shasbah.co.uk/spina-bifida/spina-bifida-pressure-ulcers/?fbclid=IwAR1g0wzmeyBLMxAs78HfH9CZrUD0A4lf6C52TP3w-O3EMutQuLDXv1qBfMk


    MY PRESSURE ULCER JOURNEY

    I never knew what pressure ulcers were until I got one for almost all pressure points. I am currently facing possible amputation. If this happens what am I gonna do?

    24 hour support will be needed. I don’t like the idea of amputation. The problem is, I’ve been having pressure ulcers, foot x-rays and MRIs/CTIs. I’ve had a series of meetings about my right foot. I’ve got antibiotics to take. Blood sugars, protein levels, blood circulation, feet pulses and kidneys all contribute to the feet. I also got to see photos from MRI scans. I got permission to take photos of them. The heel bone is infected. I know what it’s like to be cured of pressure ulcers, but they keep returning, especially on my feet. What’s going on?

    As a result, I have chosen to join the fight against pressure ulcers.

    During my first year of college, the pressure ulcers started. When this happened, I got a social worker, carers, District Nurses from the Chelsea and Westminster Hospital in London while studying. I also have a Tissue Viability Nurse and a Podiatrist. Before the pandemic, I visited the doctor’s office for appointments. Now I get home visits.

    One day, the wound on my right foot seemed smelly to the nurse as if it’s infected so I was on antibiotics for 7 days. Sensation and movement is limited from the ankles down as a result of lower spine damage due to Spina Bifida. Pressure ulcers can also be caused by bed mattresses or wheelchairs. Bermuda has a lack of resources and a lack of information. There are no Spina Bifida clinics/specialists in Bermuda. Lived with parents. Swimming in the salt ocean in Bermuda beaches has contributed to the healing process. Before England and College, I had no pressure ulcers.

    Pressure wounds usually take 3 months to heal. My wheelchair has a ROHO Cushion with air pockets. Now my footrests have air pockets. It’s ultimately an airbag under my feet. https://www.permobil.com/en-us/products?category=SeatAndPositioning

    Podiatry and District Nurses tend to clash from time to time. District Nurses visit three times a week while Podiatry only visited once. District Nurses know how to dress my foot correctly. Which one is more important?

    Pressure Sores (also called bedsores or decubitus ulcers)
    Pressure sores, also called bedsores or decubitus ulcers, are areas of broken skin and underlying tissues that have been damaged by pressure. Pressure (such as sitting in the same position for too long) restricts blood being supplied to the area, so the tissues become deprived of oxygen and toxins build up, which causes the skin and tissue cells to die. People with Spina Bifida may not feel this damage beginning because of reduced feeling in parts of their body.

    PURSUN GROUP IN LEEDS
    Prevention is better than cure! You must have tough skin. Pay attention to pressure points. Additionally, make sure you have good quality, well-fitting shoes that do not cause red marks on your feet. You may want to ask your GP to refer you to an orthotics centre to have shoes made especially for you. The styles are much better than they used to be!

    Make sure you have a well-fitting wheelchair with a pressure-relieving/ reducing cushion. Pressure mapping in the wheelchair cushion. Always use your footplates to support your feet and stop your legs from ‘hanging down’, which is bad for the circulation. Ergonomic Assessment required.

    Feet must be elevated above the head, especially in bed, for good circulation. Check your wheelchair does not leave red marks on your legs or body. When you see a reddened area of skin, tell your GP straightaway. Don’t wait to see if it improves on its own. If left untreated they can take a lot longer to heal. If you do have a skin breakdown, make sure your health professionals look at the reasons why it happened, and don’t just apply dressings. Change your sitting position frequently throughout the day and have a chair at home to sit in other than your wheelchair. Try to spend part of each day off your bottom. Check your skin regularly for pressure sores using a mirror to see areas of your body you cannot see otherwise. Pay particular attention to areas of skin where you have little or no feeling.

    Massage is now advised against as recent evidence suggests that it is not beneficial for pressure areas and may be harmful.

    https://www.nursingtimes.net/clinical-archive/tissue-viability/does-massage-help-to-prevent-pressure-ulcers-15-08-2011/https://www.nursingtimes.net/clinical-archive/tissue-viability/does-massage-help-to-prevent-pressure-ulcers-15-08-2011/


    Hygiene: Access to Showering facilities instead of bathing facilities in England. District nurses clean and dress wound 3x a week maximum, in addition to personal daily showering. Skin care included Aqueous cream. No scented creams are allowed on broken skin. I shower daily but due to pressure ulcers and a PICO, I also use a LIMBO to cover my damaged foot to keep it clean and dry.

    Why does immobility cause pressure ulcers?
    Poor mobility/immobility: Patients who are unable to independently change position are at increased risk of developing a pressure ulcer, due to pressure exerted over bony body parts which results in reduced blood flow to the tissues and subsequent hypoxia.

    CURE

    I also use a Profile bed, I prefer loose clothing vs tight clothing like dresses or sweat suits. Compression socks/stockings/orthopaedic shoes/socks because sensation and movement is limited from my ankles down.

    Incontinence can also contribute to pressure ulcers. Pressure ulcers must be kept clean and dry.
    Previously during the first four months of my first year in college, I skipped meals for the sake of my studies. I was also given a Dietician who put me on a high protein diet. My meal plan looks something like this:


    Breakfast
    Mid-morning snack
    Lunch
    Mid-afternoon snack
    Dinner
    Dessert

    Why does malnutrition cause pressure ulcers?

    Unplanned weight loss is a major risk factor for malnutrition and pressure ulcer development. Suboptimal nutrition interferes with the function of the immune system, collagen synthesis, and tensile strength.

    Pressure Ulcer Prevention at Home

    • Treat your skin gently to help prevent pressure ulcers.
    • When washing, use a soft sponge or cloth.
    • Use moisturizing cream and skin protectants on your skin every day.
    • Clean and dry areas underneath your breasts and in your groin.
    • DO NOT use talc powder or strong soaps.
    • Try not to take a bath or shower every day

    https://tvs.org.uk/stop-pressure/

    https://www.shinecharity.org.uk/self-care/skin-and-tissue#Sores

    https://nhs.stopthepressure.co.uk/patients.html

    https://medicinehealth.leeds.ac.uk/leeds-institute-clinical-trials-research

    Click to access SHASBAH-news-summer-2021.pdf

    Every day has to be a STOP THE PRESSURE day when you are a person living with skin vulnerability or reduced mobility.

    LET’S WORK TOGETHER TO STOP THE PRESSURE!!!

    STOP THE PRESSURE, START THE RELIEF!!!!

    STAY TUNED FOR THE REST OF THIS SERIES ON PRESSURE ULCERS!

  • The frequency of lymphoedema in an adult Spina Bifida population

    The Fight Against Pressure Ulcers

    Lymphoedema


    Lymphoedema is a swelling often of your legs which is due to fluid collecting in the tissues under the skin. This can leave you prone to cellulitis and skin breakdown, and can interfere with independence as your legs get heavy and difficult to move. Ask your GP to arrange treatment with pressure stockings or appliances, which are very effective.

    The National Lymphedema Network (lymphnet.org) defines lymphedema as “an accumulation of lymphatic fluid in the interstitial tissue that causes swelling, most often in the arms and/or legs, and occasionally in other parts of the body. Lymphedema can develop when lymphatic vessels are missing or impaired or when lymph vessels are damaged or lymph nodes removed.

    Feet
    It is suggested that you see a podiatrist/chiropodist regularly to have your toenails cut and hard skin removed if you have loss of feeling or poor circulation in your feet. Use a foot-softening cream on your feet and moisturiser on your legs to prevent cracking as bacteria can enter this way. If your skin is very dry, use aqueous cream instead of soap when bathing. Dry carefully between your toes and treat athlete’s foot straight away. Creams and sprays are available from pharmacies and larger supermarkets.

    There have been very few studies to date documenting the occurrence of lymphedema in the Spina Bifida population, despite a case series in 2001 that suggested that the occurrence may be higher than in the general population. A total of 240 electronic medical records from the Adult Spina Bifida Clinic from January 2005 to August 2008 were retrospectively reviewed.

    This is why incontinence/ moisture management, movement, and sensation are important for Spina Bifida patients.

    10 Methods to tackle swollen feet

    1. Drink 8 to 10 glasses of water per day
      Though it might seem counterintuitive, getting enough fluids actually helps reduce swelling. When your body isn’t hydrated enough, it holds onto the fluid it does have. This contributes to swelling.
    2. Buy compression socks
      Compression socks can be found at a drug or grocery store or even bought online. Start with compression socks that are between 12 to 15 mm or 15 to 20 mm of mercury.

    They come in a variety of weights and compressions, so it might be best to start off with lighter-weight socks and then find the kind that provides the most relief.

    1. Soak in a cool Epsom salt bath for about 15 to 20 minutes
      Epsom salt (magnesium sulfate) may not only help with muscle pain. It may also reduce swelling and inflammation. The theory is that Epsom salt draws out toxins and increases relaxation.

    Just make sure to get Epsom salts marked with the USP designation. This means that it meets standards set forth by the U.S. Food and Drug Administration and is safe to use.

    1. Elevate your feet, preferably above your heart
      Prop your feet on cushions, pillows, or even things like phone books, when you sleep. If you’re looking to reduce foot swelling while pregnant, try elevating your feet several times a day as well. Aim for about 20 minutes at a time, even on an ottoman or a chair.

    Try to avoid standing for long periods of time and stay off your feet when you can.

    1. Get moving!
      If you sit or stand in one area for a long period of time (like at work), this can lead to swollen feet. Try to move a little bit each hour, even if it’s a walk to the break room, a walk around the block at lunch, flexing your knees and ankles, or a lap around the office.
    2. Magnesium supplements can be helpful for some people
      If you retain water, you might have a magnesium deficiency. Eating foods high in magnesium can help. Magnesium-rich foods. Trusted Source to add to your diet include:
    • almonds
    • tofu
    • cashews
    • spinach
    • dark chocolate
    • broccoli
    • avocados
    • Taking 200 to 400 milligrams of magnesium daily might help with the swelling. But before you take any kind of supplement, ask your doctor. Magnesium supplements aren’t right for everyone, especially if you have a kidney or heart condition.
    1. Make some dietary changes
      Reducing your sodium intake can help decrease swelling in your body, including in your feet. Opt for low-sodium versions of your favourite foods, and try to refrain from adding salt to meals.
    2. Lose weight if you’re overweight
      Being overweight can cause reduced blood circulation, leading to swelling of the lower extremities. It can also lead to extra strain on the feet, causing pain when walking. This can result in being more sedentary — which can also cause fluid buildup in the feet.

    Losing weight can help ease the strain on your feet and possibly reduce foot swelling as well. Talk with your doctor about whether you need to lose weight and healthy ways to go about doing so.

    1. Massage your feet
      Massage can be great for swollen feet and can also promote relaxation. Massage (or have someone massage them for you!) your feet toward your heart with firm strokes and some pressure. This can help move the fluid out of the area and reduce swelling.
    2. Increase your intake of potassium-rich foods
      A potassium deficiency can contribute to high blood pressure and water retention. If you have no dietary restrictions, consider eating foods containing potassium. Some potassium-rich foods. Trusted Source include:
    • sweet potatoes
    • white beans
    • bananas
    • salmon
    • pistachios
    • chicken
    • Try drinking orange juice or low-fat milk instead of soda, too. If you have any medical conditions, especially kidney issues, talk with your doctor before adding lots of potassium to your diet.

    How long should I elevate my feet to reduce swelling?


    The more the swelling and the longer there has been swelling, the longer and more frequently your need to elevate your legs. Start with 20 minutes twice a day. This might do the trick. If not, go to 30 minutes or even an hour.

    LET’S WORK TOGETHER TO STOP THE PRESSURE!!!

    https://www.shinecharity.org.uk/self-care/skin-and-tissue

    https://mobilitymgmt.com/Articles/2011/06/01/Lymphedema.aspx

  • Dietary Impact of Food on Pressure Ulcers

    Pressure ulcers (also known as pressure sores) occur when the skin and surrounding tissue is damaged by medical devices or the weight of the body pressing down. This restricts blood flow and the delivery of oxygen and nutrients to the area. They often develop where bones are close to the skin such as on the lower back/spine, hips, heels and elbows. Having a poor nutrient and fluid intake can increase the risk of pressure ulcers.

    The risk increases in those who are underweight or overweight. Maintaining a healthy weight and eating a balanced diet can reduce the risk of developing pressure ulcers. You should try to adopt a meal plan like this:

    Breakfast
    Mid-morning snack
    Lunch
    Mid-afternoon snack
    Dinner
    dessert

    This is because being overweight can reduce mobility and increase the weight bearing load through pressure areas such as the bottom.
    Being underweight can mean there is less natural padding on bony areas such as the bottom and hips.
    The skin needs a good supply of fluid and nutrients to maintain its circulation and keep it supple.


    Nutrition and pressure damage
    Once a pressure ulcer has developed, nutrition plays a vital role in the healing process. This is because the body needs protein, energy (calories), vitamins and minerals (such as vitamin C, iron and zinc), and plenty of fluids to support the wound healing process.

    Protein
    Your body may need more protein if you have a pressure ulcer. Foods that are high in protein include meat, fish, eggs, dairy products, nuts, beans and pulses. Try to have at least one of these foods at each meal. Aim to have one pint of milk per day or a variety of milk and dairy foods such as milk puddings, cheese or yoghurts.

    If you are overweight choose low fat versions. They contain the same amount of protein as full fat versions but are lower in calories. There are also some yoghurts, ice cream and milks available that contain higher amounts of protein.

    If you use milk substitutes, soya milk contains a similar amount of protein as cow’s milk. Oat, rice, hemp and nut based milks contain significantly less protein.

    Iron
    Iron is important for the healing process by helping to maintain adequate blood haemoglobin levels. Foods that are good sources of iron include meat, fish and eggs. Iron is also found in other food such as beans, pulses, green vegetables and dried fruit, but these are less easily absorbed.

    Vitamin C
    Vitamin C helps with the absorption of iron from your food and also directly with the healing process. Vitamin C is found in a wide variety of fruit and vegetables. It is not stored in the body so a daily supply is needed. Vitamin C is destroyed during the cooking process, so it is important not to overcook your vegetables, or if possible, steam them. Drinking a small glass of fruit juice (150ml) with your meal is a good way to improve your intake. If your vitamin C intake remains low you may need to take a supplement.

    Zinc
    Zinc is important for the formation of new skin tissue and to help pressure ulcers to heal. Good sources are lean red meat, shell fish, milk, cheese, bread, lentils, beans and cereal products such as wheatgerm.

    Vitamin and mineral supplements
    If you cannot eat enough foods containing key vitamins and minerals then you may need to take a supplement. If you are unable to manage a varied diet, or have a poor appetite, an “A to Z” type vitamin and mineral supplement may be necessary and these are available from many high street chemists. If you are managing to eat a full and varied diet then there is no benefit in taking high levels of vitamins and mineral supplements – in fact, this can be harmful.

    Fluid
    Dehydrated skin can become dry and fragile. It is important that your skin is kept moist from the inside. You should aim for 1.5 to two litres per day (six to ten mugs). This could include any liquid (tea, coffee, milk, water, juice) but not alcohol. If you are overweight avoid drinks that contain sugar, choosing sugar free alternatives or using low-calorie sweeteners in hot drinks.

    Body weight
    If you are overweight, losing weight could help to reduce the risk of pressure ulcers and protect a newly healed pressure ulcer. However, if you restrict your intake too much whilst a pressure ulcer is healing it could delay the healing process.

    It is important that you maintain a balance to your diet so that your body continues to get all the nutrients it needs. Simple changes that you could make to your diet if you are overweight are:

    • Cutting out sugar from hot drinks or using a sweetener.
    • Using low fat cooking methods such as grilling, baking, microwaving or steaming rather than frying.
    • Opting for snacks that are lower in energy and fat such as low fat yoghurts and fruit.
    • Remember to have meals that are balanced. Try not to miss meals.
    • Aim to lose an average of no more than 0.5 to 1kg a week.


    If you are underweight, pressure ulcers need a lot of nutrients to help them heal. If you are underweight you may not have enough nutrient stores in your body so you will need extra nutrition from your diet. Without nutrients the healing process may take longer. Some changes that could help to increase your intake are:

    Ensure that you have regular meals. If you find it difficult to prepare and cook meals then there are a wide variety of tinned, chilled or frozen ‘ready meals’ available. Frozen or tinned vegetables can also be useful.
    Try to have three small meals and two to three nourishing snacks throughout the day (such as yoghurts, cheese, nuts and biscuits).
    If your appetite is poor, try to also include two nourishing drinks each day such as: milk, malted milk drinks, fruit juice or powdered supplement drinks which are available from your local chemist or supermarket.
    Oral Nutritional Supplements (sip feeds)
    If your food intake remains low, it may not be enough to help heal the pressure ulcer. If this is the case, it may be necessary for you to have some prescribed oral nutritional supplements. These types of drinks provide a rich source of energy, protein and other nutrients. A dietitian may be available to discuss with you the most appropriate one and how many you will need. You should not take additional vitamins and mineral supplements if you are taking three or more oral nutritional supplements per day.

    If you have diabetes, poorly controlled diabetes can delay healing. Diet and medication may need to be adjusted to achieve good diabetic control. Speak to your GP, nurse or dietitian if you require help with this.

    Eating a balanced diet and having a healthy body weight will help to reduce the risk of developing a pressure ulcer. If you have a pressure ulcer, eating and drinking well will help it to heal. If you are overweight then it would be beneficial to try to lose weight gradually. If you are underweight then weight gain will help improve the padding over the bones. This can be best achieved by eating small and frequent meals and snacks.

    For more information, you can follow: https://www.bda.uk.com/resource/pressure-ulcers-pressure-sores-diet.html.