General discussion to papers of F. X. Keane, J. C. Chawla et al., A. G. Key et al., H. W. F. Jones and A. Evans

Abstract

Chairman: DR V. PAESLACK (Germany) PROF. M. WEISS (Poland). We believe that training for wheelchair posture is a goal of rehabilitation and should be made in stages. A patient should know that when the time comes to start to sit, it is a new position for him and he must understand that at this moment he is not prepared for that. From this point of view any feed-back system which was presented here is a very useful device but quite expensive, and we can replace it with good physiotherapy which would show the paraplegic how to lift himself from time to time and to understand that his weight-bearing surfaces are not valuable enough to support his weight. In our population we observe that use of physical activity and early sport application can help us in preventing bedsores. We are not observing many recurring sores following sport activities. I do believe that it is due to the fact that all general compensatory circulatory supply is better when the patient is applying physical activity. This is one of the reasons why we support the sport activities so strongly. The problem is what to do with tetraplegics, and here I was happy to hear those papers from South Africa as well as the polyester cushion application. We shall remember that a polyester mattress is the best trasportation tool we have now at our disposal. When we are dealing with acute cases and transport our patients in the position as he was found at the place of injury, the polyester mattress with vacuum is the best tool to keep the position until we can see the patient. The polyester system is excellent for measurement and application and relief of bedsores. When you take a polyester cushion and you insert foam pads underneath, then you can apply the vacuum in stages, using your electrical power system and pump. We applied a local ventilator under the feet to bring down heat. In a tetraplegic using his wheelchair for a longer period such a ventilator, applied from time to time, can be easily included. MR P. HARRIS (G.B.). Could Dr Keane remind us of the cost of the Rota Rest bed? The second question is to Dr Key about the maximum acceptable pressure, how much does this depend on the patient'S weight? And the comment thirdly, is that a year ago at this meeting Sir Ludwig, in the current August number of the journal, those of us in Edinburgh gave a paper on the Simpson-Edinburgh Low Pressure Air Bed. Now one's idea turns towards a low pressure seat and this is a thought we will hopefully discuss this in the future. Two questions; one point. DR V. PAESLACK. Mr Keane will you answer and Dr Key too. DR F. X. KE ANE (Ireland). The first question is what is the cost of a Rota Rest bed. The simple home version is a £1000, and I think the other large spinal bed is being sold for 4000 dollars now in the States. DR PAESLACK. Thank you, Dr Keane. DR A. KEY (South Africa). I should like to ask Mr Manley, the originator of this cushion, to answer that question. MR M. MANLEY (South Africa). There is "I think" a slight misunderstanding between the differences between pressure and weight. Pressure is independent of weight; pressure is load divided by the area to which it acts, and so the pressures quoted on the slide are in fact relevant for any type of body size, weight or shape. Actually while I am standing up can I make one of two points about Dr Keane's two papers. I think he has got a basic misconception about the way that body weight is transferred to the ground be it while the patient is lying or be it while the patient is sitting. He seems to think that a natural surface is by definition hard as the earth is hard. If you study the way in which a patient or a person lies in the natural environment, if you look at the way tribesmen live in the Amazon or any other part of the world where people do not have the advantages that we have in civilisation, even the stupidest person will put grass underneath him when

DOI: 10.1038/sc.1978.77

Cite this paper

@article{Chawla1979GeneralDT, title={General discussion to papers of F. X. Keane, J. C. Chawla et al., A. G. Key et al., H. W. F. Jones and A. Evans}, author={Jagdish C Chawla and Volkmar Paeslack}, journal={Paraplegia}, year={1979}, volume={16}, pages={423-427} }