Amyotrophic lateral sclerosis (ALS) is a rare neurodegenerative disorder that develops due to a loss of motor neurons, which are nerve cells that control voluntary muscle movement such as eating and speaking.
There are several complications that can develop as a result of ALS, one of which is bedsores, also known as pressure sores or decubitus. A recent study from Taiwan showed that patients with ALS have a higher risk of developing bedsores, and that this risk is particularly high among women (particularly those over 50) and young patients.
Bedsores are formed due to inflammation of the skin from being in the same position for too long, which prevents normal blood circulation to the area of skin that is under pressure. The longer the area of skin is under pressure, the more likely the skin in that position will slough off and eventually die from the poor circulation.
As ALS patients have progressive motor disability, particularly in the later stages of the disease, patients that become bed-bound may become vulnerable to the development of bedsores as they often cannot turn away from the area under pressure.
There are ways to prevent and treat bedsores. However, it is important to identify them early on to initiate therapy. These are the following things that caregivers should know about bedsores, how to prevent them and how to treat them:
- Bedsores can be life threatening. Specifically, dangerous bacteria can gain access to the blood stream of the patient through a pressure sore. If this occurs, the patient may have to undergo amputation of a limb or experience some other severe deformity. It can also lead to a life-threatening infection called sepsis.
- Bedsores can further limit mobility for patients with ALS, who already suffer from severe mobility issues.
- Bedsores can cause intense pain, be very foul smelling and embarrassing for patients.
- Bedsores begin as reddened areas (due to inflammation). This is the initial warning that therapy should be started.
- Extra padding can help prevent bedsores: specialty mattress such as those with foam padding can help prevent the onset of bedsores as that helps keep the body off areas of pressure, particular at night. Extra padding on chairs or wheelchairs for patients can also help.
- A healthy diet can help prevent bedsores: a diet that includes adequate protein and carbohydrates is necessary for prevention of bedsores. Multi-vitamins should also be used to supplement nutritional intake.
- Treatment of the bedsore depends on whether it is a clean wound or infected. If it is clean, then the sore is is treated with daily dressing changes and complete offloading from the area of injury. No pressure can be applied to the bedsore until the wound has healed. If the wound is infected, then it is treated with a type of surgery in which the dead tissue is removed. Then, once the wound is clean, the physicians will make use of multiple wound dressings to facilitate healing.
- Caregivers can help prevent the onset of bedsores by carefully assessing the backside and buttocks of bed-bound ALS patients every night, and take note of any changes with regards to redness of those areas. It is important to document any changes, which can include taking pictures of the initial redness as photos can help assess whether the wound is improving or worsening.
- Prolonged time spent in water can worsen bedsores. Therefore, doctors recommend that patients should limit their baths to no more than three times a week, with each bath lasting no longer than five minutes. Furthermore, the temperature of the bath should be lukewarm, so as not to aggravate any wounds. Addition of bath oil can also help. After the patient has showered, it is important to dry using soft patting motions rather than swift motions. Lastly, application of a moisturizer immediately after bathing can also help improve bedsores. The moisturizer should be reapplied multiple times throughout the day.
- Improper lifting and turning (such as during sleep) can cause skin tears, which leads to the development of pressure injuries. These can be avoided by using sheets to help shift the body’s position.
- Skin-on-skin contact can also lead to skin tears. Therefore, caregivers should make sure that the patient wears long sleeves and stockings, which can help reduce these incidents.
- If a wound develops, it is important to just use normal saline to clean the wound as opposed to hydrogen peroxide or Dakin’s Solution as these products can lead to death of healthy tissue and worsen the healing process. Once the wound has been cleaned, it is important to measure the wound weekly to assess whether its healing or worsening. The wound should be treated using properly recommended dressings and the wounds should be checked daily.
- Caregivers should make sure that the wound is not covered with stool or moisture.
- Caregivers should limit the amount of time that a patient stays stationary, whether it be lying in bed or sitting in a chair, to 30 minute intervals. This can help prevent the buildup of pressure.
- While most bedsores can be managed through an outpatient treatment, if the caregiver notices any sudden changes such as the development of fever or odor coming from the wound, the patient’s condition might have worsened and the patient may need to be transported to the emergency department of a hospital.