UAB Health System Spain Rehabilitation Center
Date: October 8, 2006
This letter is to let you know how Barry has done using the Aquila Cushion. Barry is a 56 year old male who was injured in a car wreck in 1982, resulting in complete C5 tetraplegia. His medical history includes significant heterotopic ossification (HO) in both hips, L5/S1 discitis and osteomyelitis. He has a P1CC for convenience of managing medications when he gets sick.
Barry is an active person using his manual wheelchair for mobility. He lives in a wheelchair accessible apartment and lives alone. He has hired an attendant to help him with ADLs in the morning and evening, and is otherwise alone during the day. He has been sitting on a high profile ROHO cushion for years, and has become dependent with pressure reliefs in the manual wheelchair due to his weak upper extremities and HO in his hips. Posturally, he is locked in a sacral sitting position and no lordosis.
He has declined pursuing a power wheelchair with power tilt because he has no way to transport the wheelchair when friends or caregivers take him for appointments or other activities. He is an accomplished artist, builder of remote control airplanes, and attends church. He spend time with friends and enjoys life. He was in a wheelchair 7-9 hours/day. Around March 2005, he developed a decubitus ulcer at the base of his scrotum, which quickly enlarged and deepened. He was on bed rest for the next several months, only getting up once a week.
He was admitted to inpatient rehab January 5th, 2006, with problems with autonomic dysreflexia, possibly associated with toe infection, decubitus in his right ischial area and sacral area, recurrent UTIs, neurogenic bowel/bladder, or HO in back and both hips. His weight went from 148 pounds to just 116. The goal of rehab was to address medical issues and seating to increase his sitting tolerance. He was pressure mapped on his current High Profile ROHO cushion while in rehab with good readings. However, due to the fact that he is unable to perform an independent pressure relief, it was not recommended for him to sit on this cushion longer than 30 minutes without a pressure relief. The Aquila cushion was recommended because the cycles could be set to change the air pressure to help with pressure relief and allow Barry to be up in his wheelchair vs. bed bound.
Barry was seen in our outpatient clinic for fitting and training on the use of the Aquila cushion on February 9th, 2006. He was given a chart to note number of hours in the wheelchair sitting on the Aquila cushion, pain scores and noting daily skin checks.
We were in contact with Barry approximately every 6 weeks for the next 8 months on his use of the cushion, regarding his skin integrity, pain, and quality of life. He reported no pain using the cushion. His home health nurse helped us monitor his skin. Over these months, his skin condition varied and changes were made to the cushion along the way with the firmness to 3 and adaptations to the pads. His skin is not completely healed, but he has had 2 hospitalizations from infections of his 1CC line and was in bed for several days each time, which caused his sores to worsen, He was also having difficulty with his low air loss mattress pump malfunctioning. A loaner pump was provided, which too was not working well. After finally getting a functioning pump for his bed, his sores began improving again.
Barry did acquire a new sore right under his right distal hamstring tendon with the use of the first cushion provided. After some bed rest and wound care, it healed. The Aquila company provided a new cushion in which softness of the padding in all the cells was adjusted to address this. His home health RN has reported improvement in his skin, which is expected to continue as long as he stays healthy and now that his bed is fixed.
The major benefit the cushion gave Barry, in my opinion, is his quality of life. He went from being completely bed bound to being able to be up in his wheelchair, participating in his daily activities 6-8 hours/day on average. It was difficult to assess the true effect the cushion had on his sores because of other complicating factors noted above. Barry has been so much happier using the cushion and feels like, in his words, “I have my life back.
I do think the cushion has a place in the market for people just like Barry who need to stay in a manual wheelchair, but are unable to do a pressure relief independently and are high risk for skin breakdown. I support the theory and applications of alternating pressure cushions, and feel the Aquila Cushion is made well and the company is supportive and east to work with when customizing a cushion. I will use this cushion in the future for appropriate clients.
Cathy Henderson, PT, MS, ATP
To view the original report, click here: Case Study: UAB Health System