What causes pressure sores?
Pressure sores occur when the skin is pressed between the bones of the skeleton and a hard surface which restricts the normal flow of blood, oxygen, and nutrients to the area. Subsequently the skin cells die, forming a pressure sore.

This condition can be a problem to people with spina bifida as they may also have a reduced circulation in the area due to their lack of movement. If there is a problem with the supply of blood to an area, the brain usually sends a message to the body to change position so that the cells will once again receive a proper blood supply. A person with spina bifida has areas of skin which do not have any feeling and often have partial or complete paralysis, and so does not receive these messages. If the pressure continues the blood supply is cut off, causing pressure sores.

Regular visual checks are essential, as the lack of sensation can mean that wounds can occur without being physically noticed.
The usual places for sores to form are:

• On the behind.
• Behind the knees
• On the heels
• On the feet, ankles, and hips.

Prevention of pressure sores
Preventing pressure sores involves several steps:

• Checking the skin every day to identify any areas that appear red, white or brown in colour, as discolouration could be the first sign of a pressure sore forming.
• Identifying the source of pressure or irritation and removing it. This is not always easy as there are often many contributing factors. For example a person who is under-weight may have problems with the lack of a protective fat layer. There are devices, such as inflatable cushions, designed to assist in this area.
• Shifting position every 15 minutes can help by allowing circulation to flow into different areas.
• Suitable wheelchairs, footwear, and braces must be fitted and checked carefully by a qualified person to ensure there is no pinching or rubbing.
• Wearing loose clothing can help prevent rubbing, although care must be taken that loose clothes do not bunch and create their own problems. Tight clothing can reduce circulation.
• Avoid storing objects in pockets or on the seats of wheelchairs. A cigarette packet, for instance, if sat upon can pinch skin.
• Hygiene! Ensuring the skin is kept clean and dry will help protect from rashes and bacteria.
• Exercising regularly may improve circulation considerably lessening the risk of pressure sores.
• Don't smoke! Smoking reduces the circulation in the body.
• Avoid very hot surfaces, which can burn the skin.

Preventing pressure sores takes a little effort, but it is very worthwhile; pressure sores take a long time to heal.

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Some other problems from lack of feeling
Burns from the following:

• Sunburn on the legs and feet especially if shoes and socks are usually worn
• A wheelchair left in the hot sun. The child transferring back into a hot wheelchair may burn his or her buttocks, legs and feet
• Hot drinks or chips held on the lap
• Hot car or bus seats and seat belt buckles

Because of poor circulation and poor nerve supply, the skin is not strong and will burn more easily than normal.
How to prevent burns:

• Wear shoes and socks and long pants where practical
• Both the person and his or her carer should be aware of the dangers
• Always check for hot surfaces

Scrapes from the following:

• Children crawling on rough ground (especially pool surrounds) may scrape their knees, ankles and toes.
• During transfers from the floor to the wheelchair people may scrape their body and legs on the footplates.
• During transfers from wheelchair to chair, people may scrape their buttocks. This can be a big problem if it happens repeatedly.

Any scrape or scratch may take longer to heal than in another person.
How to prevent scrapes:

• Wear shoes and socks and long pants where practical
• Wear kneepads
• Use good transferring techniques
• Both the person and his or her carer should be aware of the dangers

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