Broda Tilt Recliner for Residents with Pressure Sores

Author: Tamara Reynolds, OTR/L
Published: 03 September 2008

Jane P. was a 64 year old woman who had COPD, claustrophobia, and decreased mobility. Because of her COPD and claustrophobia, she refused to sleep in her bed, and instead, insisted on staying up in a wheelchair all day and night. The nursing staff repeatedly documented her non-compliance for not returning to bed to relieve the pressure from her bottom. The physical therapist spent several weeks adjusting her pressure relief cushion, and adjusting other aspects of her positioning in an attempt to diminish the pressure areas that were developing on her buttock. She had limited mobility and sweated profusely. In addition, the amount of time she spent in an upright position was nearly 24 hours a day.

The physical therapist approached me and told me his dilemma of trying this particular pressure relief without good success, and asked for my input. My recommendation was to try a Broda chair. Initially, the staff refused because she was cognitively intact and able to ambulate several steps, and they felt that she was too “high level” for a Broda. Additionally, they were concerned that she may attempt to stand unassisted from the chair, and because of the case in chair rolling, she might fall to the floor. However, eventually her bottom became so inflamed that any suggestion was attempted.

The OT evaluation included a skin inspection. Her bottom was by far the worst case of pressure I had ever seen. She had a reddened area that was approximately a square foot in area, non-blanchable. The center of this was a six inch wide, deep purple area that contained multiple open areas. Her skin was too warm, and moisture was obviously an issue. In an effort to be objective and demonstrate what worked and what did not have any effect, the red area was outlined with a black marker. A Broda chair with both tilt and recline was provided as a trial chair, and adjusted to fit her short leg length. The next day, I went in to check her comfort and her skin. The reddened area had diminished by approximately 2 inches all the way around. Some of the red perimeter, now much smaller, was blanchable. The deep purple area had all faded to red. All of this happened in just one day of proper positioning. Best of all, she reported that she was much more comfortable.