Related Outcome Tools

Pressure Ulcers

Pressure ulcers are a frequently observed secondary health condition observed in the spinal cord injured (SCI) population [1-4]. A pressure ulcer is a lesion on any skin surface that often results from pressure, friction or shear forces. It may start off as a red mark on the skin that becomes progressively worse and ends up as an open crater. People with SCI have lifelong increased risk of pressure ulcers due to impaired skin sensation, with the most common places being over bony prominences (bones close to the skin) like the sacrum, greater trochanters (hips), ankles, and heels. Other terms used in the literature to describe this secondary health condition include pressure sores, decubitus ulcers, skin breakdowns, and skin sores.

The prevalence of pressure ulcers has been found to be variable, but typically affects 30% of persons with SCI [2, 6]. It is estimated that up to 80% of persons with SCI will develop a pressure ulcer sometime in their lives, and 30% will experience recurrent pressure ulcers [7, 8]. Typically, most persons will develop a pressure ulcer within 5 years of their SCI [5], and the frequency of subsequent ulcers increases with the duration of injury [2].

Pressure ulcers have the potential to interfere on a number of physical, psychological, and social domains, which subsequently impact quality of life [5]. The consequences of having an ulcer can be severe, and in rare cases, result in death [9]. For instance, when the pressure ulcer is severe and not treated aggressively, it can lead to further disability such as decreased mobility and loss of independence, surgical interventions, fatal infections and amputation [10]. Having a pressure ulcer can also impact people's ability to sustain high levels of independence and/or participate in their community. Someone with recurring pressure ulcers may be unable to maintain employment, school attendance, or relationships. As well, prescribed bed rest for weeks or months may affect self-esteem and affect [9].

Despite being largely preventable, pressure ulcers continue to be a common secondary health condition with serious implications on quality of life after SCI.



Best Practice Guidelines for the Management of Pressure Ulcers are available as a downlable PDF.

Spinal Cord Essentials - is a patient education initiative which aims help people through rehabilitation following SCI.  Below are downloable PDFs of the skin care handouts.  



1. Noreau L, Proulx P, Gagnon L, Drolet M, Laramee MT. Secondary impairments after spinal cord injury: a population-based study. Am J Phys Rehabil 2000;79:526-35.

2. Johnson RL, Gerhart KA, McCray J, Menconi JC, Whiteneck GG. Secondary conditions following spinal cord injury in a population-based sample. Spinal Cord 1998;36:45-50.

3. Charlifue SW, Weitzenkamp DA, Whiteneck GG. Longitudinal outcomes in spinal cord injury: aging, secondary conditions, and well-being. Arch Phys Med Rehabil 1999;80:1429-34.

4. Hitzig SL, Tonack M, Campbell KA, McGillivray CF, Boschen KA, Richards K,Craven BC. Secondary health complications in an aging Canadian spinal cord injury sample. Am J Phys Rehabil 2008: 87; 545-55.

5. Regan M, Teasell RW, Keast D, Aubut JL, Foulon BL, Mehta S (2010). Pressure Ulcers Following Spinal Cord Injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Mehta S, Sakakibara BM, editors. Spinal Cord Injury Rehabilitation Evidence. Version 3.0

6. Whiteneck GG, Charlifue SW, Frankel HL, Fraser MH, Gardner BP, Gerhart KA et al. Mortality, morbidity, and psychosocial outcomes of person spinal cord injured more than 20 years ago. Paraplegia 1992;30:1429-34.

7. Niazi Z, Salzberg C, Byrne D, Viehbeck M. Recurrence of Initial Pressure Ulcers in Persons with Spinal Cord Injuries. Adv Wound Care 1996;21:38-42.

8. Pires M, Adkins RH. Pressure Ulcers and Spinal Cord Injury: Scope of the Problem. Top Spinal Cord Rehabil 1996;2:1-8.

9. Salzberg C, Byrne DW, Cayten CG, van Niewerburgh P, Murphy JG, Viehbeck M. A new pressure ulcer risk assessment scale for individuals with spinal cord injury. Am J Phys Med Rehabil. 1996;75 96-104.

10. Krause JS. Skin sores after spinal cord injury: relationship to life adjustment. Spinal Cord 1998;36:51-6.


Page last updated May 12, 2013

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