SKIN SENSATION

As a general rule, if a child has some loss of movement there will be loss of skin sensation too.

For example, a child who has no movement from mid-trunk level will generally have no feeling from that level downwards. He cannot feel anything inside (e.g. the need to go to the toilet) or outside (e.g. when something touches his leg).

For lower lesions, it is not so straightforward. Children who are able to walk fairly well seem only to lack some movement in the feet, but loss of sensation will usually be in some areas of the feet, right up the leg, and also the buttocks.

 POSSIBLE PROBLEMS

If a child is not aware of being hurt, he will not move away from danger. 

1.    BURNS

Examples:

	Sunburn on legs and feet (especially if shoes and socks are usually worn)
	Wheelchair left in hot sun. The child transferring back into a hot wheelchair may burn buttocks, legs and feet
	Hot drinks/chips held on lap
	Hot car/bus seat

N.B. Because of poor circulation and poor nerve supply, the skin is often not strong and will burn more easily than normal.

How to prevent burns:

	Wear shoes and socks and long pants where practical
	Awareness of the dangers by child and carers
	Check for hot surfaces

2.    SCRAPES

Examples

	Child crawling on rough ground (especially pool surrounds) may scrape knees, ankles and toes
	During transfers from floor to wheelchair, child may scrape body and legs on the footplates.
	During transfers from wheelchair to chair, the child may scrape buttocks (this can be a big problem if it happens repeatedly).

N.B. Any scrape or scratch may take longer to heal than in another child.

How to prevent scrapes:

	Wear shoes and socks and long pants where practical
	Wear kneepads
	Use good transferring techniques
	Awareness of dangers by child and carers

3.    PRESSURE AREAS

These are red areas of skin, caused by prolonged pressure on one area. Any red area that disappears within 30 minutes is no problem, but one which persists from day to day, needs attention.

Typical areas are:

	Buttocks and sacrum from prolonged sitting in a wheelchair
	Heels and ankles from ill-fitting or incorrectly applied splints

These can develop into very nasty sores if not treated early and effectively. They can in some cases take months or years to heal. Treatment must always involve removing the pressure.

How to prevent pressure areas:

	Regular bottom lifts for wheelchair users
	Use a sheepskin or pressure relieving cushion on wheelchair
	Take care with the surface that the child is sitting on and that there is nothing in back pockets of pants, etc.
	Regular checking of heels, ankles, etc. for red areas from splints
	Beware of problems like sand getting into splints (abrasive effect)