RESUMO
Introducción. La lesión medular afecta la calidad de vida y el estado de salud de la persona que la padece. Por su parte, el uso de una silla de ruedas adecuada a las necesidades y características particulares de cada individuo puede aumentar los cuidados en la salud, prevenir complicaciones como las úlceras por presión e incrementar la calidad de vida. Objetivo: Valorar la percepción de la calidad de vida y dar seguimiento a la formación de úlceras por presión como indicadores del impacto que tiene un programa basado en las "Pautas de suministro de sillas de ruedas manuales en entornos de menores recursos" de la OMS. Material y Métodos. A un grupo piloto de lesionados medulares se les otorgó una silla de ruedas adecuada; se les aplicaron los cuestionarios CHART-SF y WHOQOL-BREF para medir su calidad de vida y se les hizo seguimiento del desarrollo de úlceras por presión durante 12 meses. Resultados. Los principales hallazgos fueron una mejor percepción de la movilidad en el CHART-SF, mientras que en el WHOQOL -BREF el grupo no percibió ningún cambio, ni positivo ni negativo, en su calidad de vida. Los pacientes no desarrollaron úlceras por presión durante el estudio. Conclusiones. Los cuestionarios aplicados no son suficientemente sensibles para medir la calidad de vida en pacientes con lesión medular.
Introduction. Spinal cord injury affects the quality of life and health status of the person who suffers it. On the other hand, the use of a wheelchair adapted to the particular needs and characteristics of each individual can increase health care, prevent complications such as pressure ulcers and increase quality of life. Objective: To assess the perception of quality of life and to monitor the development of pressure ulcers as indicators of the impact of a program based on the WHO "Guidelines for the provision of manual wheelchairs in low-income settings". Material and Methods. A pilot group of spinal cord injured persons were provided with a suitable wheelchair; they were administered the CHART-SF and WHOQOL-BREF questionnaires to measure their quality of life and were followed up for the development of pressure ulcers for 12 months. Results. The main findings were a better perception of mobility in the CHART-SF, while in the WHOQOL-BREF the group did not perceive any change, either positive or negative, in their quality of life. Patients did not develop pressure ulcers during the study. Conclusions. The questionnaires applied are not sufficiently sensitive to measure quality of life in patients with spinal cord injury.
Assuntos
Humanos , Masculino , FemininoRESUMO
Pressure ulcers are tissue damage resulting from the constant pressure on the underlying soft tissue to bony prominences for long periods. Some of the most common ulcers are developed at the ischial tuberosities area (ITs). It has been found that stresses produced in the underlying tissue to the ITs may exceed 5 to 11 times the surface stresses, making it necessary to estimate the forces generated between the soft tissue and the ITs. However, it is not possible to determine these stresses in vivo in a patient, due to ethical reasons. This paper presents a mechanical model of the pelvis-soft tissue in order to study the behavior of contact forces. The model simulates the load on the ITs of a male subject of 70 kg weight and 1.70 m height, which were recorded for 8 min. The registered forces in the model were compared with the surface forces estimated from pressure records measured by the Force Sensing Array system in a patient with spinal cord injury. After 2 min, both forces measured in the model, and the ones estimated in the patient followed the trend described by Crawford during clinical measurements of pressures during sitting. It was also found in the model that measured forces below the ITs are higher than those measured below soft tissue, which suggests that the model may be valid for the study of the forces generated inside the tissue.
Las úlceras por presión son daños en el tejido, derivados de la presión constante por periodos prolongados sobre el tejido blando subyacente a una prominencia ósea, algunas de las úlceras más comunes se desarrollan en la zona de las tuberosidades isquiáticas (TI´s). Se ha detectado que esfuerzos generados en el tejido subyacente a las TI´s pueden exceder entre 5 a 11 veces a los esfuerzos superficiales, lo que hace necesario conocer las fuerzas que se generan entre el tejido blando y las TI´s, sin embargo medir estos esfuerzos in vivo en un sujeto, no es posible por razones éticas. Este trabajo presenta un modelo mecánico del sistema pelvis-tejido blando con la finalidad de estudiar el comportamiento de las fuerzas, el modelo simula la carga en las TI´s de un sujeto masculino de 70 kg y 1,70 m, en el cual se registraron por 8 min. Las fuerzas registradas en modelo fueron comparadas con las fuerzas superficiales estimadas a partir de los registros de presión medidas por el sistema Force Sensing Array, en un paciente con lesión medular. A partir de 2 min, tanto fuerzas medidas en el modelo, como estimadas en el paciente, siguen la tendencia descrita por Crawford para mediciones de presiones clínicas durante la sedestación, también se encontró en el modelo que las fuerzas medidas por debajo de las TI's son mayores a las medidas debajo del tejido blando; lo que sugiere que el modelo puede ser válido, para el estudio de las fuerzas que se generan al interior del tejido.
Assuntos
Humanos , Estresse Mecânico , Úlcera por Pressão , Modelos BiológicosRESUMO
INTRODUCTION: Pressure ulcers are a dominant health problem for people who, for various reasons, must spend most of their time in a seated position. The spinal cord injury patients are the most affected for this situation. One strategy to prevent pressure ulcers is throughthe use of special seats. In the Instituto Nacional de Rehabilitación, contoured special seats have been developed according to anatomical measure of spinal cord injured patients. OBJECTIVE: To find one or more combinations of test materials that reduced pressure below 60 mmHg, in the ischial area, in order to help to prevent pressure ulcers. MATERIAL AND METHODS: The special seats were fabricated using thermoplastic materials and polyurethane foams, following prosthetic fitting technique; and were tests in healthy volunteers. RESULTS: The results were compared with a vinyl seat, because most of wheelchairs have it. All different test combinations were superior to vinyl seat, specially the two polyurethane foam- polypropylene combinations. A group of nine patients with spinal cord injury were recruited to test the designed seats, for a three month period. DISCUSSION: The results showed that pressure values are lower in the special seats than in the vinyl seats. No complications or pressure ulcers were found during follow up.
