MINIMUM PHYSIOLOGICAL MOBILITY REQUIREMENT FOR MAN SUPPORTED ON A SOFT SURFACE

Conventional paraplegic nursing is based on ‘skin care’ only, i.e. 2 or 3 hourly turning on a soft bed. This gives the absolute minimum protection. Body weight acts through the skeleton, and is transferred to a natural hard surface, via wieght bearing bony prominences, which protect vital tissues from ischaemia. This is not so on a soft surface where pressure causes ischaemia of muscle. There is evidence that 20 minutes ischaemia injures muscle. Injured muscle can repair itself. The majority of decubitus lesions therefore go undetected. There is proof that ischaemic muscle necrosis occurs well before skin necrosis. Therefore the prevention of decubiti on the European bed should be based on 'muscle care'. Normal sleeping subjects make on average, one gross postural change every 11.6 minutes. It is postulated that this is the minimum physiological mobility requirement for man supported on a soft surface. The physiological gross postural change was determined by observing man sleeping on the ground. Excluding the prone position, the fully lateral, with lower limbs flexed, or the supine, are the only stable sleeping postures. Considering these and many other factors, the optimum nursing condition was determined, i.e. kinetic nursing, which is by definition: The automatic and continuous turning of a patient equally from side to side, in a given posture, through a maximum excursion of 124° at a minimum rate of 124° in 45 minutes. The Roto Rest beds are a practical means of providing this. © 1979, International Spinal Cord Society. All rights reserved.