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British Journal of Healthcare and Medical Research - Vol. 12, No. 1
Publication Date: February 25, 2025
DOI:10.14738/bjhmr.121.18127.
Inoue, Y., Tanaka, M., Ezure, H., Ito, J., Sasaki, A., Takaki, T., Hata, H., Takayanagi, M., & Otsuka, N. (2025). Factors Reducing Pressure
Ulcer Risk and the Importance of Care in ALS Patients: A Comprehensive Review. British Journal of Healthcare and Medical Research,
Vol - 12(1). 01-06.
Services for Science and Education – United Kingdom
Factors Reducing Pressure Ulcer Risk and the Importance of Care
in ALS Patients: A Comprehensive Review
Yuriko Inoue
Department of Anatomy,
Showa University School of Medicine, Tokyo, Japan
Mikako Tanaka
Faculty of Engineering,
Yokohama National University, Kanagawa, Japan
Hiromitsu Ezure
Department of Anatomy,
Showa University School of Medicine, Tokyo, Japan
Junji Ito
School of Nursing and Rehabilitation Sciences,
Showa University Department of Nursing, Kanagawa, Japan
Akiko Sasaki
Department of Pharmacology,
Showa University School of Medicine, Tokyo, Japan
Takashi Takaki
Center for Electron Microscopy,
Showa University School, Tokyo, Japan
Harumi Hata
Faculty of Pharmaceutical Sciences,
Teikyo Heisei University, Tokyo, Japan
Masaaki Takayanagi
Center for University-wide education,
Saitama Prefectural University, Saitama, Japan
Naruhito Otsuka
Department of Anatomy,
Showa University School of Medicine, Tokyo, Japan
ABSTRACT
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease
characterized by muscle atrophy, weakness, and loss of motor function. ALS
patients are frequently bedridden for extended periods, which typically increase
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Inoue, Y., Tanaka, M., Ezure, H., Ito, J., Sasaki, A., Takaki, T., Hata, H., Takayanagi, M., & Otsuka, N. (2025). Factors Reducing Pressure Ulcer Risk and
the Importance of Care in ALS Patients: A Comprehensive Review. British Journal of Healthcare and Medical Research, Vol - 12(1). 01-06.
URL: http://dx.doi.org/10.14738/bjhmr.121.18127.
the risk of pressure ulcers. However, clinical observations and studies indicate that
the incidence of pressure ulcers in ALS patients is lower compared to other
bedridden populations. This review examines underlying factors contributing to
this phenomenon, highlighting key elements such as "pressure redistribution
associated with muscle atrophy," "stabilized postures resulting from joint
contractures," and "intensive, individualized care from caregivers." Furthermore,
this article explores a multidisciplinary approach to pressure ulcer prevention,
incorporating aspects like nutritional management, skincare, pressure
redistribution strategies, and emerging technologies. The review also addresses
challenges specific to ALS patients and underscores the critical role of tailored care
in mitigating pressure ulcer risk.
Keywords: ALS, Pressure Ulcer Risk Reduction, Muscle Atrophy, Caregiver Education,
Nutritional Management, Advanced Technologies.
INTRODUCTION
Pressure ulcers are localized tissue injuries caused by prolonged pressure, friction, or shear
forces acting on the skin and underlying soft tissues. They represent a critical health issue
among bedridden patients, significantly impacting patients' quality of life (QOL) and increasing
medical costs【1-2】.
ALS is a progressive neurodegenerative disease characterized by motor neuron degeneration,
leading to muscle atrophy and loss of motor function. As the disease progresses, patients often
become bedridden, placing them at high risk for pressure ulcers. However, clinical observations
indicate that ALS patients have a lower incidence of pressure ulcers compared to other
bedridden patients【3】.
Figure 1 illustrates the key factors contributing to reduced pressure ulcer risk in ALS patients.
This includes pressure redistribution due to muscle atrophy, stabilized postures from joint
contractures, and comprehensive caregiver support.
Figure 1: Key factors and care methods contributing to pressure ulcer prevention in ALS
patients.
This diagram summarizes the primary factors reducing the risk of pressure ulcers in ALS
patients. It highlights three major contributors:
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British Journal of Healthcare and Medical Research (BJHMR) Vol 12, Issue 01, February-2025
Services for Science and Education – United Kingdom
1. Pressure redistribution due to muscle atrophy: Progressive muscle loss results in more
even pressure distribution across the body.
2. Stabilized postures caused by joint contractures: Joint stiffness reduces movement,
minimizing shear and friction forces.
3. Comprehensive care provided by caregivers: Regular repositioning, skin monitoring,
and nutritional support contribute to skin integrity.
Arrows indicate the interrelationship between factors and the holistic approach required for
effective prevention.
This review examines the unique factors contributing to the reduced risk of pressure ulcers in
ALS patients. Additionally, it explores comprehensive care approaches, including nutritional
management and advanced technologies, while addressing challenges and future directions in
pressure ulcer prevention.
REASONS FOR REDUCED PRESSURE ULCER RISK IN ALS PATIENTS
Pressure Redistribution Due to Muscle Atrophy
Changes in Pressure Distribution:
ALS patients experience progressive muscle atrophy throughout the body. This reduction in
muscle mass may result in pressure concentration on specific areas, but it can also promote
overall pressure redistribution across the skin surface【4】. The loss of muscle elasticity reduces
localized compression, potentially contributing to a lower risk of pressure ulcers.
Clinical Study:
Ahtiala et al. (2020) demonstrated that muscle atrophy in ALS patients facilitates pressure
redistribution across the skin, mitigating the risk of blood flow impairment【5】. Figure 2 shows
the effectiveness of various approaches to pressure ulcer prevention, with a combined strategy
demonstrating the greatest reduction in incidence.
Figure 2: Bar graph illustrating the effectiveness of comprehensive approaches to pressure
ulcer prevention.