The relationship between pressure offloading and ischial tissue health in individuals with spinal cord injury: An exploratory study

Abstract

Objectives: To compare thickness and texture measures of tissue overlying the ischial region in able-bodied (AB) individuals vs. individuals with spinal cord injury (SCI) and to determine if there is a relationship between pressure offloading of the ischial tuberosities (IT) and tissue health in individuals with SCI.

Design: Exploratory cross-sectional study.

Setting: University setting and rehabilitation hospital.

Outcome Measures: Thickness and texture measurements from ultrasound images of tissues overlying the IT were obtained from AB individuals (n = 10) and individuals with complete or incomplete traumatic and non-traumatic SCI American Spinal Injury Association Impairment Scale (AIS) classification A–D (n = 15). Pressure offloading was measured in individuals with SCI and correlated with tissue health measurements.

Results: The area overlying the IT occupied by the muscle was significantly greater in the SCI when compared with AB cohort. The area occupied by the muscle in individuals with SCI appeared to lose the striated appearance and was more echogenic than nearby skin and subcutaneous tissue (ST). There was no correlation between offloading times and thickness, echogenicity and contrast measurements of skin, ST and muscle in individuals with SCI.

Conclusion: Changes in soft tissues overlying the ischial tuberosity occur following SCI corresponding to the loss of striated appearance of muscle and increased thickness of the area occupied by the muscle. Further studies using a larger sample size are recommended to establish if thickness and tissue texture differ between individuals with SCI who sustain pressure injuries vs. those who do not.

Keywords:

• Pressure injuries
• Pressure offloading
• Spinal cord injuries
• Ischial tuberosity
• Sitting
• Wheelchair users

Disclaimer statements

Contributors None.

Conflicts of interest The authors report that there are no conflicts of interest.

ORCID

Sharon Gabison http://orcid.org/0000-0002-5202-3736

Sunita Mathur http://orcid.org/0000-0001-5564-9796

Milos R. Popovic http://orcid.org/0000-0002-2837-2346

Additional information

Funding

This work was supported through the Health Commercialization Fellowship, Health Innovation Hub, Faculty of Medicine, University of Toronto, the Dalton Whitebread Scholarship and the Ontario Student Opportunity Trust Fund (OSOTF) Toronto Rehabilitation Institute – University of Toronto Scholarship and the Ontario Neurotrauma Foundation-Résau provincial de recherche en adpatiation-réadaptation (ONF-REPAR) Research Grant.