Cerebral Palsy Skin Conditions and Pressure Injuries

Cerebral palsy and limited mobility come with many complications. Skin health is an important factor to consider for people with cerebral palsy, as they can be at risk for pressure injuries and skin breakdown (1).

What is a pressure injury?

A pressure injury, also called a pressure ulcer, is a type of injury to the skin. Pressure injuries are caused by blood flow being cut off to the skin when it is compressed between bone and something hard, like a seat, bed, or brace (2). They are also known as pressure sores, skin ulcers, bedsores, or decubitus ulcers.

There are four stages of severity to a pressure injury.

  • Stage 1: The skin is red and non-blanchable – if you press on the discolored spot, the color does not return to normal right away.
  • Stage 2: The skin is noticeably damaged, and the underlayer of skin (dermis) is visible. The wound is red, moist, and may be blistered.
  • Stage 3: Both the outer and underlayer of skin is damaged, exposing fat or other deep tissue. There may be dark-colored scab tissue (eschar or slough) in the wound itself.
  • Stage 4: Both the skin and tissue are badly injured or lost. Bone, ligaments, or cartilage can be seen in the wound. The wound is deep and shaped like a crater, and it may have scab tissue inside (4).

What causes a pressure injury?

Pressure injuries can develop any time pressure is maintained against the skin for an extended period of time. Due to mobility restrictions, people with cerebral palsy are at risk for pressure injuries when their skin is compressed against braces, wheelchairs, or other adaptive equipment, especially if it is improperly-sized. Children can outgrow equipment quickly, so caretakers should regularly make sure the accessories fit properly (3). A child, especially affected by cerebral palsy, will have a higher ratio of fat to lean muscle mass and therefore be more susceptible to pressure injuries (4).

The areas most at risk for pressure injuries include:

  • Elbows
  • Hips
  • Behind the knees
  • Butt
  • Feet
  • Ankles
  • Heels

Providing padding to these areas and regularly checking them can help prevent damage. Skin injuries can also develop during repositioning and transfers if there is an already sensitive area of skin, especially the sacrum (lower back), heels, and elbows (3). For very young children, the ears and the back of the head can be at risk (4).

How do you prevent pressure injuries?

Regular maintenance can prevent pressure injuries even in those at risk for them. The best ways to avoid damage from this kind of injury is to practice the following:

Move or change positions regularly. 

Remaining in the same position for a long time is the primary cause of pressure injuries, so setting reminders to move often (or for a caretaker to help change position) is key (2).

Keep skin clean and healthy. 

Pressure injuries occur more frequently with damp or dry, scaly skin. Ensuring that the skin is dry, clean, and well moisturized will avoid damage. Use a mild cleanser and a lotion containing fatty acids (5).

Maintain good nutrition. 

A healthy diet and the right amount of calories can play a large role in keeping the rest of the body in good condition. People with different types of cerebral palsy will have varied dietary needs. Someone with hypertonia or hyperactivity will need more food than someone with immobility or spastic cerebral palsy (3).

Ensure adaptive equipment is properly-sized and well-padded. 

Ill-fitting wheelchairs or braces can easily cause damage with unintended pressure points. Wheelchair users can benefit from a variety of cushion types, including gel and foam seat cushions, adjustable cushions, and powered adjustable cushions. These types of customizable cushions can significantly reduce pressure points and risk of pressure injuries (5).

Infographic summarizing the ways to prevent cerebral palsy skin conditions, pressure injuries and promote good skin health.

Nationally-recognized cerebral palsy attorneys

If your child’s cerebral palsy was caused by a birth injury, your family may be eligible for compensation to cover care, treatment, adaptive technology, and other important resources. Unfortunately, a number of families avoid medical malpractice litigation for different reasons—some fear confrontation, some feel they don’t have the financial resources, some simply feel overwhelmed, and others doubt they have a case. The best—and only—way to find out if you have a cerebral palsy case is to reach out to an attorney for a legal consultation.  An experienced cerebral palsy attorney will do a thorough investigation of the medical records and review the case with expert medical professionals to determine whether negligent care was the cause of your child’s cerebral palsy. Our firm’s case evaluations are free of charge. For that matter, if you pursue a case with ABC Law Centers: Birth Injury Lawyers, you pay nothing throughout the entire legal process unless we win. Reach out today to learn more.

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Helpful resources

  1. Barkoudah, E., MD, & Glader, L., MD. (2019, June 11). Cerebral palsy: Overview of management and prognosis (M. C. Patterson MD, FRACP, R. P. Goddeau Jr, DO, & C. Armsby MPH, Eds.). Retrieved December 1, 2020, from https://www.uptodate.com/contents/cerebral-palsy-overview-of-management-and-prognosis
  2. Southwest Institute for Families and Children with Special Needs. (n.d.). Cerebral Palsy Handout [Brochure]. Phoenix, Arizona: Author. Retrieved December 01, 2020, from https://www.medicalhomeportal.org/link/612
  3. Mccaskey, M. S., RN, DNPC, Kirk, L., RN, MSN, CWOCN, & Gerdes, C., RN. (2011). Preventing Skin Breakdown in the Immobile Child in the Home Care Setting. Home Healthcare Nurse: The Journal for the Home Care and Hospice Professional, 29(4), 248-255. Retrieved December 1, 2020, from https://journals.lww.com/homehealthcarenurseonline/Fulltext/2011/04000/Preventing_Skin_Breakdown_in_the_Immobile_Child_in.9.aspx
  4. Freundlich, K. (2017). Pressure Injuries in Medically Complex Children: A Review (P. Nathan, Ed.). Children, 4(4), 25. Retrieved December 1, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5406684/
  5. Berlowitz, D., MD, MPH. (2020, January 6). Prevention of pressure-induced skin and soft tissue injury (K. E. Schmader MD, R. S. Berman MD, A. Cochran MD, FACS, FCCM, & K. A. Collins MD, PhD, FACS, Eds.). Retrieved December 01, 2020, from https://www.uptodate.com/contents/prevention-of-pressure-induced-skin-and-soft-tissue-injury