Returning to sit

What is healed?

There should be NO open areas including scabs, bleeding areas or hard scaly tissue.

Management of scar tissue

Scar tissue is weaker than normal skin and has poor circulation. It is more likely to split and is slower to heal with recurrent breakdowns.

Heal the area in a stretched position. This will help prevent the area from splitting when returning to sit. This may include sitting on the commode (if able) and stretching the hip to 90 degrees.

Getting ready to sit

• Address the causative factor.
• Repair and service the equipment.
• Conduct an on-bed postural assessment even if this isn’t a suspected causative factor. Someone’s range of movement may have changed due to prolonged bed rest. This can be performed at any point in time when on bed rest and when close to sitting.
• The first sit may require the presence of a therapist and nurse to perform a pre and post-skin check and gauge the outcomes of the sit. They can assess whether adjustments need to be made to the equipment and transfers or how quickly the sitting program can progress.

Why do a sitting program?

A sitting program will allow the skin to gradually get used to pressure, shear, and stretch and identifies any changes early. This provides better outcomes and can prevent setbacks if issues are identified early.

During the sitting program

Monitor the area: Perform a pre- and post-skin check with each sit. Wound dressings should not be used when sitting as it makes it difficult to check the skin and see how the sitting impacts the newly healed area.

Seating surface: The sitting program should only be done in the wheelchair, not on the bed or the shower commode. Consider an air cushion that will maximise surface area contact.

Transfers: Prolonged bed rest and deconditioning can impact the quality of transfers. Temporary adjustments to hoisting or assisted transfers may need to be considered.

Orthostatic hypotension: Prolonged bed rest and deconditioning can impact increase the risk for orthostatic hypotension. Caution should be taken with initial mobolisation.

Equipment trials: It is best to avoid introducing equipment trials until the person has completed a sitting program or is back to their usual routine.

Timing of sits: Rest at least an hour between sits and position off the newly healed skin area in bed. This will allow recovery of circulation to the tissue.

If redness or breakdown occurs: Redness that doesn’t disappear within 30 minutes or any damage to the skin such as a blister or split requires offloading until it heals.  Once the skin area has healed it is recommended to restart the sitting program from Day 1.

Returning to activities: It is recommended to keep activity to a minimum during the sitting program to allow the skin to recover and readjust to sitting. This can include travelling long distances in the car, shear from travelling across uneven ground and using different equipment such as a sports wheelchair or swimming.