Terms to Know: Spinal Cord Injuries and Skin

By Lee Ann Hoffman, O.T., MSc. Rehabilitation

September 16, 2017

Topics: Spinal Cord InjurySCI Health

Pressure Injury

You may have also heard of pressure injuries referred to as bed sores, decubitus ulcers, pressure sores, and pressure ulcers.


A pressure injury is the result of damage to the skin and the tissue beneath it. It can present as an open wound or still be intact.


Tissue that lies in areas where boney prominences (such as heels) are located are usually the most susceptible. External factors, such as a medical device or something in the environment, may also be a cause of increased pressure at the skin’s surface. Prolonged, localized peak pressures – in combination with friction and shear – may result in a pressure injury.


Friction and shear, microclimate, nutritional status, general skin health, perfusion (passing of fluid through a system), and existing comorbidities can also affect the skin health and soft tissue.


It’s important to remember that once a pressure injury has occurred, that area will always remain vulnerable to damage.


Skin Integrity


Skin integrity refers to the health status of the skin.


As the body’s largest organ, the skin’s role is to protect, regulate body temperature, and provide sensory information. Healthy skin has elastic properties.


Skin that has been compromised due to health conditions such as diabetes, previous history of a pressure injury, or aging may be more at risk of future injury because of the skin status being vulnerable and fragile.


You can promote skin health and integrity by practicing good skin care, performing skin checks, paying attention to fabric composition, maintaining a nutritional diet, practicing safe patient handling, and proper positioning amongst other preventative measures.


Friction and Shear


Friction refers to the resistance between two surfaces while shear describes the deformation or distortion of the tissue. Both friction and shear play a part in the development of pressure injuries. Friction on the skin’s surface may result in skin impairment and cause the shear strain in the tissue. These two factors can increase the risk of tissue breakdown and lead to pressure injuries.




Microclimate refers to the environment created when an individual comes in contact with something such as a seat cushion, back support, or mattress. The surface temperature of the skin and moisture play a vital role in the microclimate of the skin.


It is essential that a healthy microclimate is achieved. To help achieve this, moisture control and heat dissipation need to be addressed. Ignoring these factors can negatively affect the health of the skin and tissue in the contact zones, especially if you have mobility challenges, are unable to sufficiently shift your weight, experience excessive sweating, or incontinence.


The accumulation of moisture can cause changes in the skin’s surface, allowing it to be more susceptible to injury through maceration, friction, and shear.


Heat Dissipation


Heat dissipation refers to the ability to disperse the accumulation of heat.


The transfer of heat occurs from tissue to blood and is dependent on the rate of heat produced by the tissue and the rate at which the blood is flowing through it. Heat is dissipated directly from the blood, across the tissue, and to the skin.


Some fabrics have the ability to assist with heat dissipation and can help prevent the excessive accumulation of heat, resulting in the creation of a healthier skin-surface environment.




Edema is a collection of fluid that can often be seen in areas of the body such as the lower limbs. It is associated with several medical conditions.

Spinal Cord Injuries and Skin

Edema occurs when the small blood vessels release fluid into the surrounding tissue. The extra fluid builds up and causes the tissue to swell. It can be uncomfortable and painful as it makes the skin in the affected area tight and heavy.


If edema is suspected, a quick check may be of value. Place a fingertip on the edematic area for a few seconds. The fingertip may result in a dent or divot forming on the surface of the skin. Remove the finger and observe how long it takes for the tissue to return to its previous state. The longer the dent or divot remains, the more edematic the body part is.


If you are experiencing these symptoms, be sure to discuss them with your physician and seek further support to ensure that your edema is being monitored and managed properly.

How to Help Prevent Pressure Injuries


Lee Ann Hoffman, O.T., MSc. Rehabilitation

Lee Ann Hoffman, O.T., MSc. Rehabilitation

Lee Ann qualified as an Occupational Therapist in 1999 in South Africa. She completed a post graduate certificate in Posture Management for complex disabilities in 2010, and obtained a Master of Science degree in Rehabilitation: Posture Management, 2015 in the United Kingdom. Lee Ann has experience in working with children and adults with complex disabilities and adopts the 24-hour approach to postural management. She is currently a clinical educator for Invacare USA.

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