Brightway Logo
Answers & Community for Brain Injury
Ask a QuestionAsk Question

What can be done for brain-injured, bedridden patients that have bed sores and also moderate spasticity in their legs?

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Senior physical therapist

Answer transcribed from Brightway's interview with Dr. Cristen Gordon (pt.1):


Spasticity is a very big concept. It’s when your brain is telling your muscles to turn on but doesn't really tell them to turn off. That can create a number of issues and there are a number of medicines and some exercise techniques you can use to treat it. The first thing is to figure out what the treatment that is going to work for that patient is, as far as managing the spasticity goes. However, if you're connecting that to being in bed, the thing to worry about is pressure sores. If you're laying in one position for a prolonged period of time, which is more than an hour, you are prone to having skin breakdown. The reason is when you're laying in the bed, your skin sweats even if you're not doing anything. The moisture between your skin and the sheets or the mattress of the bed creates an environment where skin doesn't thrive and starts to deteriorate. It becomes very thin and then it can even move into open wounds.


The way to combat that is to use what we would call a rolling schedule or an out-of-bed schedule. A rolling schedule just simply means if the person who is in the bed cannot move in the bed, every hour you move the patient into a different position. That means maybe they start laying on their left side and you can use pillows, and there are other devices you can use to protect the skin that's touching the bed. Use pillows to prop the patient onto their left side and after an hour, you come back and check on them. Then, you could roll them maybe laying on their back, and then after an hour, you can roll them laying on the right side. Just switch positions like that, but even being in those positions, you want to be mindful of the skin that is still touching the mattress. For example, laying on your back is probably the biggest culprit of pressure wounds because you have the most contact with the bed. There are a lot of places to worry about as far as pressure sores, but probably the main culprits are going to be the back of the shoulders, the backside of your bottom or your heels, and then your elbows. 


They make special boots, pillows, and pads that you can put on the person that's laying in the bed to help protect them. Even for some of the boots, what they do is you put your foot into the boot and it floats your feet up in the air basically so that your heels are not just laying on them on the bed. You can use pillows to keep body parts off the bed as well. A common thing you could do is put a pillow under the patient's knee so their feet are hanging in the air but being supported by the pillow underneath the knees. The reason that pillows help is that they reduce pressure on the part of the body being used. 


The other thing is friction. Maybe the person is moving in the bed but they're not necessarily able to roll themselves or completely change positions. If I'm just laying in the bed on my back and I'm moving my feet back and forth, or maybe I'm having spasms so my knee will bend and then straighten out, my heel rubs against the bed each time I do that and that can break down the skin as well. Another note I'll put in about being on your back is that a lot of times, we'll see people laying in the bed not necessarily flat. They'll have the head of the bed elevated 30 to 45 degrees. It's a very comfortable position, but it also puts a lot of pressure on your tailbone. The tailbone is very susceptible to pressure wounds, especially when you're not up and moving because you start to lose muscle very quickly, which exposes the bone to laying on the mattress. Then, the skin breaks down over those bony areas and you can get pretty severe wounds.