Love your skin - preventing and managing wounds

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Anne-Marie (0:10 - 0:44)

Hello, welcome to SpineCare's 40 Voices for 40 Years podcast - a podcast about childhood acquired spinal cord injury and dysfunction, produced by 2SER Radio on behalf of SpineCare Foundation. We'll have families join us to swap tips and share their experiences on plenty of topics. I'm the executive producer for this podcast series, Anna-Marie Reyes, at the community radio station 2SER 107.3 FM. This podcast is titled Love Your Skin, Preventing and Managing Wounds.

Harrison (0:47 - 1:22)

I'm a... uni student at the moment who's had a spinal cord injury. This will be my fifth year. I moved from Orange to Sydney to go to uni and, yep, I'm just figuring out that sort of new transition in life. Growing happens over a long period of time, so sometimes it's difficult for you to notice, but booking in a seating check at least once a year would be one good bit of advice, or even probably regularly, maybe more than that if you're going through like a growth spurt. It's really important just to be on top of that.

Anne-Marie (1:24 - 2:38)

And you just heard the voices of Harrison Crisp there, who following a life-altering mountain bike accident at year nine, left him a complete quadriplegic. He's now an accomplished scholar in engineering at one of New South Wales' top universities. 

But before that, you'll hear from guest Lis Hunter, who is a clinical nurse specialist with decades of experience in adult and pediatric spinal cord injury. Also guest Kirsty Kench. She's a senior occupational therapist with specialist skills in complex seating and wheeled mobility. Together, they provide an in-depth look at what constitutes skin wound, common causes in children and adolescents with spinal cord injury, and the essential practices of prevention to avoid skin damage.

We've called it a pressure area, injury, ulcer, sores, many names for something that has significant impacts on health and socialisation, let alone a risk to health. Can you talk us through what is a skin wound?

Kirsty (2:39 - 3:45)

Pressure injuries are formed when pressure causes localised damage to underlying skin and soft tissue. Pressure injuries are classified into the following stages... So we have stage one, which is characterized by superficial reddening of the skin that is non-blanchable. Now, this can also be present as a blue or purple area on darkly pigmented skin. And what we mean by non-blanchable is that the skin does not change color when we apply pressure. So if you press the area of discolored skin, it won't change color.

Stage two is a partial thickness skin loss, and this means that the skin is actually broken. It can also be an intact blister. It involves the top layer of the skin called the dermis, and it can involve the middle layer called the epidermis, example, a skin tear, a burn, or an abrasion. Now, a stage three is a full thickness skin loss, and it can also involve subcutaneous fat. Stage four is a full thickness skin loss with involvement of muscle or bone. And unstageable is obscured full thickness skin and tissue loss.

Anne-Marie (3:45 - 3:56)

So how does a skin wound occur? What are the more common causes? 

Kirsty

There can be many factors that can contribute to a skin wound, and one of the main causes is direct pressure on the skin. And this happens especially over a bony prominence and happens when time or over a length of time. So many people think that length of time can be quite long, but it's actually really only takes about 20 minutes for a pressure injury to occur. So it's actually not significant amount of time that can happen.These pressures can influence the internal nature of the skin in the sense that they can distort the tissue cells and also can reduce the blood supply to the area. 

Other components that can contribute to a pressure injury are sliding forces, or what many people might hear is actually shearing. So that's the term that a lot of professionals use. This is when the tissue layers are sliding against each other while there are external layers pushing up on that skin. And a really good example of this is when someone's sitting in bed and they could be sliding down the bed a little bit and the skin's being distorted while they're actually getting like sitting on a bed and the bed forces are pressing up on them.

So another issue is prolonged moisture on the skin. That's another risk factor that can be related to incontinence or sweating. Also an increase in skin temperature can have an effect on the skin and that poses a risk to develop a pressure injury. Other contributing risk factors include poor nutritional or fluid intake, a weakened immune system, or if someone's unwell or has illness. So it can be different materials in clothing and cushions can also contribute to temperature and moisture around the skin surface as well. So those materials can be worthwhile looking at.

Anne-Marie (5:35 - 5:40)

So why do kids tend to get skin wounds and what are the risk factors? Also adolescents.

Kirsty (5:41 - 6:16)

One of the common things we see is a lot of the children wear orthotics. So they may wear an AFO, which is an ankle foot orthosis. So that can rub on the skin. Shoes, depending on the types of shoes, seams in the clothing, zips, and lack of compliance with pressure relieving routine. We know kids can be impulsive and they like to do what they like to do and sometimes they just probably aren't as good at being compliant with their pressure relieving because they just want to have fun and be with their friends.

Some factors also to think about are that children are growing and their body changes shape and they get heavier and bigger. So it's really recommended, highly recommended, for the kids to have regular checks with their equipment therapist and to check any supportive equipment is meeting their needs because their needs keep changing as they keep changing and growing. However, kids are actually similar to adults in the sense that they can get pressure injuries in similar places on the sit bones on the bottom, back of the pelvis, and on the heels. So they're still similar areas and this is because it's still the bony prominences pushing down those surfaces in sitting and lying. 

So the Agency for Clinical Innovation, ACI website, can be a helpful tool for families to use. They have a pressure injury prevention toolkit and that has some information that can be really helpful for families to refer. I guess one of the risks for kids could be heat burn from sliding on play equipment, playing on the ground on different surfaces, and having limited insight into the implications of having impaired sensation as they grow and limited experience. They could get too close to a heater or they could get sunburn and these things could result in a skin breakdown and lead to a potential pressure injury.

Anna-Marie (7:37 - 7:43)

So let's move on to prevention, Kirsty. How important is correct assistive technology for prevention of injury?

Kirsty (7:45 - 9:16)

Yeah, equipment's really important in reducing chances of pressure injuries. And once again, it's really good to talk to your therapist and one who's trained in seating to assist with the equipment and seating. An assessment called a MAT assessment. So outside just the equipment, it's really good to go through a MAT assessment and this can help the therapist determine the child's postural tendencies and what's happening with all their muscles and their bone structures and determine strategies of how to apply that to the equipment and how to reduce pressure. A lot of research can also go into the cushion shape and design and the materials cushions are made from. So for equipment, cushions can be made from foam, gel and air or a combination. So looking at the correct materials is also worthwhile looking at. 

There are factors such as tilt in wheelchairs that can reduce the chances of pressure relief. And for people in power chairs, research states that it's best to be in a tilt of greater than 30 degrees to have some form of pressure relief. However, it's not until about 65 degrees that you actually get significant pressure taken off the body. And 65 degrees is a really a long way back sitting in a chair. So it's good for people to spend some time getting used to see if they can get to that angle or at least part that angle. So it's quite a long way back. Other important equipment could include pressure relieving mattresses, shower commodes that have good pressure relieving cushions as well.

Anna-Marie (9:16 - 9:20)

And I suppose establishing good habits of daily skin checks is key.

Lis (9:21 - 10:19)

Absolutely. So you're totally correct there, Anna-Marie. So part of a nurse's role is to educate the family, especially the parents, empowering the parents to have confidence as part of day-to-day routine. And depending on the age of the child, also making it part of their day-to-day routine so they can actually take responsibility and be a bit more independent with that as they get older. So I normally recommend head-to-toe check when either having the bath or the shower. And for the parents, if they notice anything, they take a photo.

So we have a baseline of what that looks like. And also recommend checking skin morning and night, so obviously that they've been asleep. And then at night, once they've been out during the day, either in their chair or they've been dressed in different clothes, they've had their shoes on. And that BD skin check, which means twice a day, bi-daily, is in line with the Agency for Clinical Innovation. 

Kirsty

It's really good to get pressure relief regularly as well. A good way to relieve pressure when sitting in a manual wheelchair is for the person to lean forward and to rest on their knees. And this is really good for about two minutes. And if people can do this, or children, adults as well, but we're focusing on the kids, it's best to be done every 15 to 30 minutes during the day, which is quite a lot, just resting forward for two minutes and doing that every 15 to 30 minutes. A power chair user can still use these ratios, still use that about two minutes every 15 to 30, but use it in the tilt function. So they're actually going back into that 35 to 65 degree tilt. 

You can also gently shift weight to the left and the right side. So you can either go to the left and then sit there for 20 minutes, or left and right, and relieve the pressure. This could be also useful for children who have a trunk orthosis, or what we call a TLSO, because they may have troubles leaning forward and resting on their thighs in that leaning forward position. An old style used to be to lift up, lift your trunk up, use your arms and to lift up and then come back down. And that's not recommended because some people actually come back down and then they actually don't lower themselves nicely. And it can create greater, what we call, I'm using the word squishing, squishing of the tissue and that distortion of the tissue we were talking earlier on. 

That's really better just to go left and right sides or leaning forward if possible. And regular active movement is really quite critical as well. So this is really great for kids because they move quite often. It is a great advantage for kids. And doing the regular weight shifts are great to be able to relieve that pressure.

Lis (11:53 - 12:44)

Another thing I guess to consider is correct manual handling, which is really important. Kirstie and I have seen firsthand where sling, which is used to transfer some of our children that have the high level injuries, has been removed too quickly and it can create an abrasion on the lower limbs. And unfortunately, these abrasions can then develop into a pressure injury. So safe manual handling skills to protect the child's skin is imperative. And an example of this is when the child is doing a transfer from the bed to a manual wheelchair, that they ensure there's adequate clearance during the transfer to reduce the risk of abrasion. 

So we really want to get enough clearance under their bottom when they transfer across into the chair because we don't want their bottom or their skin to catch on anything and potentially cause damage to the tissues.

Anna-Marie(12:45 - 12:54)

So let's say a child and their parent notice a red mark like the size of a five cent piece on the outer edge of their foot that doesn't blanch. What should they do?

Lis (12:55 - 15:30)

So contact their team, whoever their community team are. So the first thing I would ask as a nurse is, do we know what's causing it? So why has that occurred? We need to work out the cause and any contributing factors. I'd probably ask them to take a photo because it's really important to get a baseline of what that looks like. Early identification is really critical. And also then we want to try and remove whatever's causing that pressure so we can start that healing process. If it's a stage two, so if it was broken and it breaks down or it breaks down and it would require dressing, you need to remove pressure from that area to promote the healing process. And then basically if it got worse, early intervention should mean it doesn't progress to a stage three or four.

But unfortunately if someone missed those first stages and it did become significant and it became a stage three or four before community nursing had got involved, they may need to go to hospital for review and... then a treatment plan would be arranged and regular community nursing would be set up to manage that wound in the community with a pressure injury prevention plan in place. A key thing to remember is once the skin's broken, even after it's healed from a pressure injury, that skin is never ever exactly the same as it was. So it's always more susceptible because once the skin has broken and healed, it's more prone and vulnerable to further breakdown. So it's really important for people to remember that.

So if a pressure injury is a stage two, which means the skin is broken, that's got to be managed to promote healing. And this is usually done by having an appropriate dressing to cover the broken skin. And we also need to pressure relieve if it's an area that is a bony prominence, we'd relieve the pressure by getting them off that. If unfortunately, if it's broken down and it's a stage three or four, which has significant pressure injuries, these would involve a hospital review, potentially a hospital admission. And then after the wound had been managed, a regular community nurse to be able to attend and manage the wound management assessment process in the community.

But it's really important to remember that once skin has broken, even after it's healed, it is always susceptible to breakdown in the future. So it's really the key message is we try and prevent the pressure injury in the first place.

Kirsty (15:30 - 16:14)

As Lis mentioned, contacting your health professionals is really important. Also, allied health professionals can also work with the medical staff that Lis mentioned and the occupational therapists and physiotherapists can look at a child's routine. And this tends to be a 24-hour routine assessment that we look at. And they look at the 24-hour routine in relation to equipment. So a 24-hour routine is looking at a child's posture and equipment across obviously the 24 hours, but it's also seven days a week. So it's trying to do a thorough assessment on all postures and equipment that a child would actually go through. And this just helps us to analyse how pressures can be created or where they may happen.

Anna-Marie (16:15 - 16:17)

Are there other factors that promote healing?

Kirsty (16:18 - 16:51)

Yes, Anna-Marie, one of the most important things is good nutrition. And this can be difficult with our young, as we know, kids can be picky eaters, but it's really important to have good nutrition to promote wound healing. Also an adequate fluid intake and maintaining the integrity of the skin. We want the skin to not be too wet. And we also want it to be not too dry, a risk factor either for further breakdown. So we can use barrier creams, suitable creams that can be directed by a medical or the nursing team to try and reduce the risk. 

And another area is checking on a child's wellbeing during a time of having a pressure injury. Families can be incredibly busy and this area can be easily overlooked. But where a child is in their sense of self and how they're coping with all the changes in routines, the extra medical staff that they need to go and see is also really important. Yeah, just encourage families just to have some downtime to really just spend time communicating with their child just to see how they're coping with everything and to encourage them just through the tough times.

Anna-Marie (17:24 - 17:45)

So like most other areas of daily cares, parent and carers initially take the lead on skin checks when kids are little. What's it like for kids to transition into taking ownership over this responsibility - or if the young person is old enough when they acquire their spinal cord injury, having at least a portion of that responsibility from the start?

Kirsty (17:46 - 19:46)

So that's really important. I think that unfortunately, sometimes parents want to do everything for the kids, especially when they're little. But it's really important that we motivate them to participate in all aspects of managing their spinal cord injury. So it's really important that we give them the skills and the resources. And we empower young people to take an active role in their spinal cord injury journey. And so that's really important to set them up well and give them all the information. Also encouraging the parents to participate and allow that transition gradually, so they feel that they're doing the right thing for their child. But exposure to risk is a normal part of development. 

So we don't want to frighten the kids, but we need to make them aware that this is potentially something that they're going to have to manage for the rest of their life. So how we do that is we try and do a quick head to toe, five minutes a day skin check. And this is achievable because it's quick. It can be part of your routine when after you have your shower, dry yourself. And they're more likely to comply if it's only five minutes, because it can just, you know, easily be done. Transitions and ability to start to take on their own care probably happens in that teenage age bracket, where they start to understand all the factors that can affect a pressure injury. And we provide continuing education, and so that they automatically check their own skin and make a part of their routine.

And obviously, if they identify anything, early identification is key, because we want to prevent stage two or more. And also, sometimes for the younger group, we can do age appropriate pictures or songs about body awareness for the younger ones. We can make pictures or show teenagers different diagrams so that they get a visual idea of what they're looking for. And also, if kids have different skin colours, just making them aware of the different things that are applicable to them. So I think it's really important to do an individualised plan for each child according to their needs at the time.

Anna-Marie (19:46 - 20:27)

And you just heard from guests Lis Hunter and Kirsty Kinch providing an in-depth look at what constitutes a skin wound and the essential practices of preventing it among children and adolescents with spinal cord injury. 

And now over to Harrison, who became a ducks in his local school. He's from regional Australia, who then transitioned moving to Sydney following his experience with spinal cord injury as a teenager. His direct experience of the different ways a skin can develop into an injury helped him shape a good approach in preventing it from happening further in future.

Harrison (20:29 - 22:01)

I'm a uni student at the moment who's had a spinal cord injury. This will be my fifth year. I moved from Orange to Sydney to go to uni and I'm just figuring out that sort of new transition in life. So I'm from regional New South Wales, but I've moved to Sydney for university and just navigating that transition with a spinal cord injury. I fell off a bike when I was 15 years old and spent, of course, a bit of time in Sydney recovering from that and rehab and then travelled back home to complete the rest of my school with some good support from teachers to complete my schooling. 

For me, staying healthy is the top priority and, of course, skin is number one in aspect to that just because consequences of skin injuries way outweigh just the little things you can do to save a lot of time later down the track. So for me with skin and I guess everything in general with growing with your spinal cord injury, it's seeing what you can tolerate and how your body reacts to different circumstances. So for me, that involves regular skin checks whenever I get in and out of bed, making sure that the whole back and body is covered, especially those key pressure areas, including your heels and the back of the legs and glutes and things. They're all really critical and just ways of mitigating that is if there's a little bit of redness, it's always worthwhile taking the time now to address that than paying the consequences later.

Anna-Marie

Harrison directly experienced some challenging situations which taught him many things about his daily skin maintenance. He emphasizes that it's natural to feel embarrassed as skin can break down in various parts of the body. However, preventing a skin breakdown that can then lead to potential injury far outweighs these feelings. He says that developing an open communication line and trust with your carers really helps.

Harrison  (22:31 - 26:10)

For me, I probably had three instances of fairly problematic skin conditions. Two of those were burns and one of them was a pressure injury caused by my seat pressure deflating and I just hadn't noticed. And they're pretty scary when they happen, but being aware of it and what to do to mitigate it is really important. For me, that comes down to regularly checking the seat pressure in the cushion. It was on my glute, which is obviously like a key pressure area. Like when you're sitting throughout the day, your whole sort of body weight is going through the glutes and the thighs through the seat cushion.

So I think it would have been over a week or so the air pressure in my seat cushion hadn't been checked, which meant that I was probably resting on the hard metal base of my chair, which would have caused the pressure injury. So it's really important checking the seat pressure for every morning and night for a few days after, just until that pressure inside the seat cushion has reached a new equilibrium after that travel. And then, yeah, as for burns and things, they just happened. Got too close to a fire, trying to stay warm, of course. It's difficult with a spinal cord injury and I just hadn't noticed that I'd been too close for too long. 

And really, this is pretty difficult to avoid, but keeping blankets on, making sure that you're not in direct flame is always wise and making sure that someone nearby can just check and make sure that your feet aren't getting too hot or your hands not too close to the fire is just key. So yeah, asking other people to help is important. And if you're ever unsure, probably just move away from the fire. Like all things with the skin, if you're not sure, it's best just to get it checked out first.

Like with the pressure injury that I had, I think I spent about eight weeks in bed after just one mistake. And it wasn't really anyone's fault, but there's large consequences to pay, unfortunately, with skin. So it's always worthwhile being on the safe side of things. Obviously, it's a bit of a private area your glute, but it's really important to make sure that area is getting checked just because that's the most likely spot you're going to get it. So even if you do feel a bit awkward asking someone to check that area for you, it's way more important because the consequence was, yeah, me spending eight weeks in bed on bedrest, having people constantly checking that area anyway. 

But in terms of recognising that I hadn't properly trained my carers to watch out for that really important skin area. So the skin checks, while they were getting done, they weren't getting done in that area. I think perhaps I was a kid, so I was probably a bit embarrassed just to ask them to check in that area. So it's really important just to communicate to your carers that that is a super important area to make sure that it's not red. It was a pressure injury that would have maybe built up over one or two days. I think it would have been sitting on it that I just hadn't been checked until one morning a carer came along and said, I think you've got a bit of an issue here. And by the time I'd hoisted back to bed and taken a photo, it was probably up to stage two or three pressure injuries, like the skin was just starting to break and degrade.

It wasn't a really good way and it definitely could have been solved with earlier intervention and a proper management strategy on that half. Yeah, I think ways to avoid it in the future is obviously getting carers to take a photo of your skin. If there's anything out of the ordinary that they haven't noticed before, or if they mentioned something that you haven't heard other carers mentioned, it's just easiest to get a photo. You can save it for later and just monitoring your skin for any changes, particularly around when you're traveling as well, just because it's new experiences and stuff.

Anna-Marie (26:10 - 26:39)

When you're traveling, there are many ways to use preventive practice to monitor any potential skin breakdown. Harrison also tries different preventive ways that he says his skin could tolerate. It's important to try out things first and work out what's suitable for you, especially when you are considering hiring equipment that can help you. Planning ahead and checking brands of products that works for you is also critical.

Harrison (26:40 - 29:42)

It's also pretty important, especially when you're travelling. When I'm traveling back to Sydney, it's important to realize the change in altitude actually affects the relative pressure inside your seat cushion, which can either bring it higher or lower, which puts you at risk of pressure injuries from that aspect. When you go to a lower altitude, your seat cushion pressure is going to deflate, which means that your bum's going to be resting on that hard steel plate on your seat pressure, which is going to end up causing you a bit of grief there. Then, of course, when you move back up in altitude, the seat cushion is going to inflate, which can also cause similar issues on your skin. 

When you're traveling, especially if you're in the car for a long period of time or you know that you're changing altitude, it's best just to check it as soon as you get to your stop and then monitor that pressure over the next few days just to make sure that it's reached a good equilibrium. I've spoken to a few other quadriplegics, and I think flying in an aeroplane, your seat cushion is going to inflate a fair bit. I think if you can bring a pump on, definitely just check the seat pressure. I know some people that when they travel, since they're not in the seat for a super long time, they don't bother checking the pressure until they've reached their destination. It does make travel difficult sometimes, but again, it really depends on what your skin can handle.

I've spoken to quadriplegics that when they travel, they just use a sheepskin overlay that they just sleep on, and that seems to do their skin fine, or like an eggshell memory foam mattress. I haven't used that before just because I am particularly cautious with my skin, but yeah, it's all up to experimentation. When I travel now, I either hire a mattress there or I hire a mattress overlay from a brand that I've used before, and just making sure that it's equipment that I've used before that I can trust. I would recommend as well with travelling and hiring equipment out there is to get there early to get it set up, and also if possible, ask for an after hours number that you can call if the equipment fails, because it can happen. 

I've had a few holiday experiences where in the middle of the night, an alarm starts going off, you're not quite sure how to fix it. If you can, having a manual or having an after hours phone number that you can call if something goes wrong is always a good backup. I suppose for me, a lot of my learning has been through experience, and I have been fortunate enough that there's a few other quadriplegics in my community that have been able to just mentor me and give me a bit of advice on how they've traveled the world, and how they get by day to day, and things like that. 

Really, it's just down to what your skin can handle, and the only way to know that is just through experience. So testing, starting off being super cautious, and then eventually you can know how much time your skin can tolerate. It may be a slightly harder seat cushion or a slightly softer seat cushion. Everyone's different, so your skin's going to tolerate different things to someone else. So it's always best just to figure out what your skin can tolerate and be really cautious when you're trying new things.

Anna-Marie (29:43 - 29:59)

Keeping good regular habits in taking care of your skin goes a long way. Practices such as regular moisturising, being always hydrated, and regular monitoring for any potential skin breakdown is important. And it's essential to maintain good eating habits. It's Harrison again.

Harrison  30:03

Obviously, moisturising is always good. Moisturising your feet and hands, keeping that skin moist means that it will avoid cracking or flaking, which can, yeah, bring up issues of skin integrity. I also use a barrier foam, which I just put on the back in the back of my legs and glutes in the morning. Vitamin E cream is really good for that. And then you can get these little I always forget the name of them. These silicon patches are really good to help clear up skin injuries. So if you've got, like, a little red spot that's looking like it's going to form into a blister, you can get these. Can't feel that's it. There's a red spot in area that's a great one to use, but only in areas where I can check it regularly, because if it is being covered up, you can't actually see it.

So if I use [?Confield], I would use the extra thin ones, which means that you can see through to the pressure area. Or I'll take it off every night, just to check that skin underneath is getting better and that it's not getting worse. And then for things like burns, there's a cream called [?Flamezin] which is a good burn cream, but probably to speak to your GP at that point, if you've had a serious burner or blister, there's lots of different ways to manage skin breakdown at that stage. So overnight, I sleep on an oscillating air mattress, which is good just an extra little bit of security, and also just a good way to make sure that the carers are having a good look over all the skin at night as well when they're applying it. 

So yeah, moisturising, and that value foam has been really handy. And then, of course, yeah, staying hydrated your skin uses a lot of water, so yeah, drinking lots of water throughout the day, and having a good diet, so making sure that you're getting all the right vitamins and minerals that your body and skin needs to stay strong and healthy. Mum's [?side and] cooked meals are always very balanced for me, which is good always getting, yeah, protein at night, so steak and eating good vegetables and things like that. Moving to Sydney has been a bit of a different experience, making preparing my own meals and things, but yeah, making sure that you're getting that protein, particularly after a skin injury, your body needs that to help rebuild. And yeah, just making sure that you get in good amounts of vegetables and fiber into your diet as well. 

Anna-Marie:

Harrison also recognises that it's usually quite challenging, especially as a young person, to maintain good habits in skin care. He says that keeping his communications line open with his carers and learning to trust him has helped him cope with future challenges. 

Harrison:

It's definitely not easy, and it definitely takes some time to suggest to that, but it's just one of those things that sort of comes with a spinal cord injury. It's just something you need to get used to. You need to have put trust in your carers to look after you, and at the end of the day, it's much more worthwhile making sure that those areas are clean, are staying healthy, aren't degrading in any way, then paying the consequences for that with a month or two of bed rest. I suppose for me, initially coming out of hospital, I had a bit of a difficult experience being discharged early due to Coronavirus, which meant that I was sent home without a lot of the resources that probably would have been necessary at that point, my rehab got cut short. 

Fortunately, when I turned 16, I was old enough to return to Sydney to do a stint at the [?right already] had that was a really good experience. They have a number of information sessions that they run their weekly on things like skin, bowel and just care management and things which are really good learning experience. It's not easy by any means, but having that clear communication with your carers, making sure that they're people that you're comfortable with is critical, and building that trust, and of course, just keeping that clear line of communication, having a phone or carers phone that you can use to take photos of sites that you're concerned about so you can keep up to date on. 

It is critical, like, as much as you'd like to trust your carers, your insight is what's critical. You really need to take charge there, and ultimately, it's your responsibility to take care of your skin. And it's just one of those things that you really just need to get used to and busy, but it's important, and it's how you take care of yourself, keeps the skin super healthy, was just really important as well. 

Anna-Marie

In conclusion, Harrison suggests that keeping an open mind and asking questions really helps also. 

Harrison

Being open to the fact that while you're maturing as a person, your body is also growing and hence going through changes and, of course, keeping good connections with others goes a long way. So yeah, having those connections is really great, and always asking questions, and if you're not sure, finding those answers as well. But yeah, for me, it's come through, yeah, just growing up, maturing a bit, understanding and learning from past mistakes and activities that have put me at risk of pressure injuries or things like that. And it's pretty cool to go to just to understand the way your body is now and how it's changed to what how you may have treated it before. 

That is also a really good experience, meeting other people who are in a similar sort of state and situation... reaction to what I was a few years older than me, just to see how they were moving forward with their life, and how they were getting things set up for their home, and how they were just dealing with, yeah, the day to day. I suppose, when you're growing up with a spinal cord injury, your body's still growing and changing over that time as well. So it's really important to, yeah, get regular seating checks as well, just because as you grow, your body is going to sit in the chair in different ways, which is going to shift the way that weight is distributed across the seat cushion, across the air mattress and things like that. 

So having regular seating checks, I think that is partly what caused my pressure injury. I think my legs had grown a bit, and that had just pivoted my hips further back in my chair, which meant that there was more weight resting there throughout the day, which then, yeah, never eventually added up to quite a severe pressure injury. So, yeah, just monitoring those things, any changes in how you shift growing happens over a long period of time. So sometimes it's difficult for you to notice, but booking in a seating check at least once a year would be one good bit of advice, or even probably regularly. Maybe more than that, if you're going through like a growth spurt, is really important, just to be on top of that.

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Anna-Marie  36:13

And you just heard from Harrison crisp there. He's from regional Australia, who experienced a life-altering bike accident at the age nine, which left him a complete quadriplegic. Harrison is now a scholar in engineering and computer sciences, and has a strong ambition to make his mark in the field of quantum computing. And ending that interview.

in this week's podcast, you also heard the voices of guests Lis Hunter and Kirsty Kinch. Lis is a dedicated clinical nurse specialist with extensive experience in rehabilitation nursing, primarily focused on adult and pediatric spinal cord injury care. Lis has held the position of clinical nurse educator at dedicated spinal accommodation facilities and honed her rehabilitation skills to a specialist level at a renowned spinal rehabilitation centre in Sydney, while Kirsty is a highly experienced senior occupational therapist with expertise In pediatric and adult spinal cord injury, complex physical disability and early intervention. She has a particular passion for and proficiency in complex assistive technology, prescription pressure, injury management and manual handling. You can find out more about their expertise in the show description online.

You've been listening to SpineCare's 40 Voices for 40 Years, produced by 2SER radio. You can subscribe wherever you get your podcasts. This series is recorded in Sydney. We acknowledge the Gadigal people of the Eora nation as the traditional owners and ongoing custodians of the land where we record this podcast, we extend our respect to the traditional owners of the lands that you and our guests join us from. I'm executive producer Anna-Marie Reyes for this podcast series, and ending this week's podcast - see you in the next podcast.

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