By Jennifer Rowland, Ph.D.

Pressure sores are a common and functionally limiting secondary condition for people with spinal cord injury (SCI). The risk for developing pressure sores is multi-factorial. This article will review factors associated with increased risk for pressure sore development among a group of people with SCI who were seeking treatment through a rehabilitation center pressure ulcer management program (Clark et al., 2006).

Participants included nineteen adults with SCI and one adult with transverse myelitis who were at least one-year post-injury, had completed acute rehabilitation for paraplegia or tetraplegia, and had been diagnosed with at least one pressure sore. They were asked questions about circumstances that either contributed to pressure sore development or contributed to the likelihood that they would not develop pressure sores later.

Among the factors contributing to pressure sore development were:

• Physical Factors: physical frailty, aging skin, pain, urinary tract infections, overweight/obesity;
• Health-Related Factors: lack of specialized equipment (i.e. pressure relief cushions), poor nutrition, alcohol/drug abuse;
• Psychological Factors: hopelessness, depression, stress;
• Social/Environmental Factors: isolation, lack of social support, inadequate finances;
• Other Factors: ability to engage in specific activities.

Among the factors buffering or decreasing the risk for pressure sore development were:

• Physical Factors: good physical strength, light or healthy weight;
• Health-Related Factors: use of appropriate specialized equipment, good nutrition;
• Psychological Factors: positive and resilient attitude; strong motivation to avoid pressure sores;
• Social/Environmental Factors: stable and supportive living environment, financial stability;
• Other Factors: strong drive or self-motivation, high level of physical activity.

The information gathered through these interviews highlights important points to consider when personalizing a pressure sore prevention strategy. First, behavioral prevention, such as performing pressure relief 'push ups,' is an important first step but should be combined with awareness of other important contributors such as proper nutrition and adequate equipment, and that visual skin checks need to be incorporated into a daily prevention plan. The person's individual living situation should also be considered when determining high-risk environments. For example, social support from friends or family members could help provide necessary transportation to medical appointments. It is therefore important to base a prevention strategy on the many factors associated with pressure sore development, all of which can play important roles in an effective health promotion plan.