Use of Adhesive Elastic Taping for the Therapy of Medium/Severe Pressure Ulcers in Spinal Cord Injured Patients
Use of Adhesive Elastic Taping for the Therapy of Medium/Severe Pressure Ulcers in Spinal Cord Injured Patients
All patients with a significant deficiency of skin sensitivity and reduced mobility are
 potentially at risk of Pressure Ulcers (PUs), in particular the persons affected by Spinal
 Cord Injury (SCI), also due to their frequent alteration or loss of subcutaneous skin
 sensitivity. Pressure sores are one of the most common and fearful complications in SCI, with
 a severe impact on quality of life and on care health costs. They are often the cause of
 lengthening the time of hospitalization, slowing down clinical and rehabilitation programs
 and re-hospitalization.

 PUs, when arisen, heal slowly and, despite the protracted conservative medical therapies,
 sometimes they do not come to complete healing. Sometimes plastic surgery is needed, although
 even after it recurrence rates remain high.

 Further treatments have been proposed in addition to the usual medication, however they are
 characterized by a certain degree of invasiveness and are often conditioned by the
 availability of specific and sometimes expensive equipment, as well as by the presence of
 highly qualified personnel. In general, there is also a lack of good quality clinical trials
 for assessing their effectiveness and safety and they are often not decisive, especially for
 severe and recalcitrant ulcers.

 Among alternative techniques for the healing of skin ulcers in general, the adhesive elastic
 bandage, also known as "kinesio taping" and already recognized for the treatment of edema,
 hematoma and scarring, has been proposed. However, specific protocols and published studies
 are not available for PUs.

 The Montecatone Rehabilitation Institute, that hosts the largest Spinal Unit in Italy, pays
 great attention to the prevention and treatment of PUs in both acute and chronic patients.
 The rationale for the taping positioning around PUs investigated in this study is to improve
 lymphatic drainage and reactivation of the superficial bloodstream by increasing interstitial
 spaces and reducing skin and subcutaneous compression, notoriously compromised in the areas
 of onset of pressure sores. The total shortage in the literature and in user manuals of
 taping protocols for PUs supports this preliminary, exploratory, descriptive and uncontrolled
 pilot study with the primary aim of verifying the safety of a taping treatment for
 medium/severe grade PUs, "add-on" to the usual care. The choice of the ulcer sites selected
 (sacral and heel) has been affected by the feasibility of tape positioning.
All patients with a significant deficiency of skin sensitivity and reduced mobility are
 potentially at risk of Pressure Ulcers (PUs), in particular the persons affected by Spinal
 Cord Injury (SCI), also due to their frequent alteration or loss of subcutaneous skin
 sensitivity. More than one-third of individuals hospitalized in Spinal Units for
 rehabilitative treatments following a SCI develop PUs during acute hospitalization and it was
 also estimated that up to 85% of SCI persons develop at least one PU in the course of their
 lives. Pressure sores are therefore one of the most common and fearful complications in SCI,
 with a severe impact on quality of life and on care health costs. They are often the cause of
 lengthening the time of hospitalization, slowing down clinical and rehabilitation programs
 and re-hospitalization.

 PUs, when arisen, heal slowly and, despite the protracted conservative medical therapies,
 sometimes they do not come to complete healing. Sometimes plastic surgery is needed, although
 even after it recurrence rates remain high.

 Traditional treatment of PUs consists in the use of advanced dressings that may vary
 depending on the degree of staging of the lesion, its extent and the presence of clinical
 signs of necrosis and/or deep soft tissue infection. In addition to dressings, treatment
 cycles with intermittent negative pressure therapy can be indicated and the surgical approach
 (toilets + plastic reconstruction) could be reserved to chronic lesions with no response to
 traditional dressings or in the case of underlying osteomyelitis.

 Alternative treatments (e.g. electrotherapy, pulsed electromagnetic fields, ultraviolet
 light, infrared radiation, laser therapy, ultrasound, shock waves) have been proposed in
 addition to the usual medication, however they are characterized by a certain degree of
 invasiveness and are often conditioned by the availability of specific and sometimes
 expensive equipment, as well as by the presence of highly qualified personnel. In general,
 there is also a lack of good quality clinical trials for assessing the effectiveness and
 safety of such techniques that are often not decisive for healing, especially for severe and
 recalcitrant lesions.

 Among alternative techniques for the healing of skin ulcers in general, the adhesive elastic
 bandage, also known as "kinesio taping" or "neuro taping" and already recognized for the
 treatment of edema, hematoma and scarring, has been proposed. However, specific protocols and
 published studies are not available for PUs.

 The Montecatone Rehabilitation Institute hosts the largest Spinal Unit in Italy as for number
 of beds and patients admitted. In addition to the intensive rehabilitation of SCI patients,
 great attention is paid to the prevention and treatment of PUs in both acute and chronic
 patients, involving physicians, physiotherapists and nurses. Some Physical Therapists of the
 Hospital are trained and experienced in the use of adhesive elastic bandage for various
 neuromuscular applications and a physiotherapy/nursing team has conceived, under medical
 supervision, the taping protocol for the PUs therapy proposed in this study. The rationale
 for such a taping positioning around PUs is to improve lymphatic drainage and reactivation of
 the superficial bloodstream by increasing interstitial spaces and reducing skin and
 subcutaneous compression, notoriously compromised in the areas of onset of pressure sores.
 Therefore, it is considered that, thanks to the normalization of blood and lymphatic flow,
 the proposed protocol may have a facilitating action to heal such lesions, especially if they
 are severe and recalcitrant to normal therapies.

 The total shortage in the literature and in user manuals of taping protocols for PUs supports
 this preliminary, exploratory, descriptive and uncontrolled pilot study with the primary aim
 of verifying the safety of a taping treatment for medium/severe grade PUs, "add-on" to the
 usual care. The choice of the ulcer sites selected (sacral and heel) has been affected by the
 feasibility of tape positioning.
Inclusion Criteria:

 -  Spinal cord injury of any aetiology (traumatic and non-traumatic) and any neurological
 level, both complete and incomplete, occurred at least 3 months before;

 -  Pressure ulcer occurred at least 1 month before;

 -  Pressure ulcer staged III or IV, according to the National Pressure Ulcer Advisory
 Panel and European Pressure Ulcer Advisory Panel (NPUAP/EPUAP) classification;

 -  Pressure ulcer located in sacral or heel region;

 -  Pressure ulcer with cleansed bottom;

 -  Stable clinical conditions;

 -  Cognitive integrity and full collaboration of the subject.

 Exclusion Criteria:

 -  Ulcerative skin lesion not due to pressure;

 -  Pressure ulcer with frank signs of infection or suggestive of underlying
 osteomyelitis;

 -  Eczema and/or irritated and/or psoriatic skin around the pressure ulcer;

 -  Ongoing deep venous thrombosis;

 -  Known allergy to elastic adhesive tape;

 -  Ongoing neoplasia;

 -  Uncompensated diabetes with signs of peripheral vasculopathy;

 -  Evidence of peripheral polyneuropathy;

 -  Circulatory problems (e.g. severe lower limb artery disease);

 -  Significant respiratory problems (e.g. with ongoing assisted ventilation);

 -  Ongoing sepsis;

 -  Ongoing severe clinical instability;

 -  Ongoing oral anticoagulant therapy;

 -  Ongoing pregnancy.