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).

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).

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).

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).