182 chapter 23
Summary: early prevention of pressure sores (For details, see Chapter 24.)
• Lie on a soft mattress or thick, firm, foam rubber pad.
• Place pillows and pads to keep pressure off bony areas.
• Change position (turn over from front to back and side to side) every 2 to 3
hours. To avoid pressure sores, lying on the belly is the best position.
• Keep skin and bedclothes clean and dry.
• Eat good food rich in vitamins, iron, and protein.
• Move and exercise a lot to promote
good flow of the blood.
• Check skin daily for earliest
signs of pressure sores—and
keep all pressure off beginning
sores until the skin is healthy
again.
Avoiding contractures
In the first weeks following a spinal cord injury, when the child is in a lying position,
joint contractures (muscles shortening) can easily develop, especially in the feet and
elbows. Pillows and pads should be placed to keep the feet supported, the elbows
straight, and the hands in a good position. Gentle range-of-motion exercises of the feet,
hands, and arms should begin as early as possible, taking care not to move the back
until the injury is healed. Further discussion on the prevention of contractures in the
spinal cord injured is on p. 184.
PHYSICAL THERAPY FOLLOWING SPINAL CORD INJURY
ASSISTED BREATHING AND COUGHING
Persons with spinal cord injury in the neck or upper back often have part of their
breathing muscles paralyzed. Slowly the remaining muscles become stronger and
breathing improves. But breathing often stays weak. The person may not be able to
cough well and can more easily get pneumonia.
To help the person cough, place hands as shown below. Ask him to cough, and as he
does, push firmly inward on the chest. Be careful not to move the backbone.
TWO-PERSON
ASSISTED COUGH
ONE-PERSON
ASSISTED COUGH
Do this several times
a day when the
person has a cold,
and more often if the
person develops more
trouble breathing or
seems to have a lot of
mucus in his lungs or
throat.
To help the child breathe
deep and to stimulate
the breathing muscles,
press lightly here while
the child tries to breathe
deeply in and out.
Do this for a few
minutes, several
times a day.
If the person has a lot of mucus in her
lungs, It also helps to lie her down, like this,
and pat her back briskly. This helps loosen the
mucus so that it can be coughed out. Be sure she
drinks lots of water to help loosen the mucus.
Disabled village Children