By Dr. James Wilson, DO
Preventing pressure injuries (aka wounds) is one of the most important goals for people after spinal cord injury. Wounds happen fast and take a long time to heal. They can be costly to you and the healthcare system. Wound prevention can be minorly disruptive to majorly invasive in your everyday life, but treatment is usually much worse. In addition, the health risks associated with pressure injuries Are just as significant. For these reasons, like with most medical complications, prevention is key.
Good skin protection plans usually revolve around appropriate equipment, offloading, bowel and bladder continents, and general health such as nutrition, blood flow, etc. Unfortunately plans may be derailed during travel, even for the most conscientious people. Depending on your mode of transportation, you may have restrictions on your seating surface, time, space, and support/help. Let’s look at each of these one by one.
Equipment:
- Unless you are driving in a wheelchair accessible vehicle, most people don’t travel in their wheelchair. On an airplane this means transferring to a transport chair then an airplane seat then back to a transport chair Before returning to your wheelchair.
- While you can’t bring your wheelchair on the plane you can bring your seat cushion. If your seat cushion is small enough to fit on an airplane see, consider removing it from your wheelchair and bringing it with you. You could also consider an alternate seat cushion such as a low-profile air cell cushion (aka roho). These can often be purchased online for less than $100. You could explore even cheaper less expensive air cushions for the flight. These wouldn’t be ideal but better than the regular airplane seat.
Time:
- The amount of time on the airplane varies depending on your destination and the number of layovers.
- Consider whether two shorter flights would be better to provide you a break in between. These might have the added benefit for you to take care of your bowel and bladder off the plane.
- If you’re driving remember to add frequent stops to your travel plans. Stopping for weight shifts, catheterization, medications, etc., maybe significant added time (probably 25% or more compared to driving straight through) But remember preventing a wound is worth it.
Weight shifts
- Relieving the pressure on your skin is the most effective way to prevent a wound. We typically recommend effective weight shifts for at least one minute every 15 minutes while you’re sitting. If you have the arm strength to do a push up in your chair, just set an alarm on your phone and don’t forget to do it every 15 minutes on the plane.
- If you can’t do a push up on the chair (perhaps you’re someone that usually tilts back in your wheelchair), you may need to practice frontward or sideways leaning. Leaning forward in an airplane or a car may not be possible unless you get those first-class tickets. Remember when you’re leaning to the side you need to get your bottom almost off the chair for it to be effective. If you don’t do this regularly it’s probably further than you think. It may be helpful to enlist a friend or caregiver to help (or at least let them know you’ll need a space next to them on the plane to lean).
- If you’re driving and can’t do weight shifts in the car, you must stop frequently at rest stops. Again, it will seem like a lot of effort, but it’s worth preventing a life-changing wound.
Bowel and bladder continence
- Can you catheterize on an airplane or in a car? Maybe but probably not. Most people need to catheterize every four to six hours to avoid having accidents. If your trip is shorter than yes, consider catheterizing when they start boarding.
- Longer flights are more complicated. Some people will place an indwelling catheter (aka foley) just for the flight or for their trip to avoid having bladder accidents on the go. If you’ve never used this kind of catheter or don’t have someone to take care of it or change it, you might need to talk to your doctor beforehand. Indwelling catheters have risks such as UTI’s, but they are pretty reliable to avoid accidents they can damage your skin.
- Sitting in a soiled diaper for longer periods can lead to skin breakdown. However, if your skin is robust and your doctor approves of reflex voiding (letting yourself have accidents when your bladder fills up), this might be OK for a short trip.
- For short trips you can cut back on your fluid intake before you travel. If you sometimes take medication to relax your bladder this would be a good time to use it. Talk to your doctor if you’re not sure if medication is right for you.
General Health
- Many things can make you predisposed to having a wound. Travel is a time when you’re at risk for illness, eat poorly, sleep less, and stress more. Because you can’t prevent these things on your trip, consider how you can optimize your health before you leave. Eat healthy, get good sleep, and avoid getting sick as best you can.
- Smoking always makes wounds worse. Even if you don’t have any skin problems consider cutting back before and during your trip (and after too!). If you take medication to support your blood pressure, make sure you have it with you on the plane.
- If you have chronic swelling in your legs, perhaps now is the time to get it under control. You can wear the inconvenient stockings, take breaks to put your feet up, watch your diet, and take your medicines.
- If you get sick before your trip, it might be in your best interest to postpone. That would be a sad outcome after all your hard work getting ready, but safety first. And remember to always get the trip insurance for airline tickets!
After you arrive:
Now that you’ve gotten off the plane and arrived at the hotel (or your family’s spare room), the risk of wounds isn’t over, sadly. Before you travel, think about where you will sleep and how you will get around. Consider how you can replicate your home setup. Can you bring your air mattress? Is there room for our caregiver? Once again, planning pays dividends.
Traveling can be a struggle, but the experiences are worth the effort. Planning ahead is the most important part. Consider the best method of travel for you and what steps need to be taken before you go.
