Reliability and clinical utility of the Pliance X for measuring pressure at the interface of pressure garments and burn scars in children

A Novel Force-Sensing Smart Textile: Inserting Silicone-Embedded FBG Sensors into a Knitted Undergarment

A number of textile-based fiber optic sensors have recently been proposed for the continuous monitoring of vital signs. However, some of these sensors are likely unsuitable for conducting direct measurements on the torso as they lack elasticity and are inconvenient. This project provides a novel method for creating a force-sensing smart textile by inlaying four silicone-embedded fiber Bragg grating sensors into a knitted undergarment. The applied force was determined within 3 N after transferring the Bragg wavelength. The results show that the sensors embedded in the silicone membranes achieved enhanced sensitivity to force, as well as flexibility and softness. Additionally, by assessing the degree of FBG response to a range of standardized forces, the linearity (R2) between the shift in the Bragg wavelength and force was found to be above 0.95, with an ICC of 0.97, when tested on a soft surface. Furthermore, the real-time data acquisition could facilitate the adjustment and monitoring of force during the fitting processes, such as in bracing treatment for adolescent idiopathic scoliosis patients. Nevertheless, the optimal bracing pressure has not yet been standardized. This proposed method could help orthotists to adjust the tightness of brace straps and the location of padding in a more scientific and straightforward way. The output of this project could be further extended to determine ideal bracing pressure levels.

Mechanomodulation of Burn Scarring Via Pressure Therapy

Significance: The physical and psychological sequalae of burn injuries account for 10 million disability-adjusted life years lost annually. Hypertrophic scarring (HSc) after burn injury results in reduced mobility, contracture, pain, itching, and aesthetic changes for burn survivors. Despite the prevalence of scarring and the number of scar therapies available, none are highly effective at preventing HSc after burn injury. Recent Advances: Recent studies modulating the mechanical environment surrounding incisional and excisional wounds have shown off-loading of tension to be a powerful strategy to prevent scar formation. Preclinical studies applying force perpendicular to the surface of the skin or using a combination of pressure both circumferentially and perpendicularly have shown substantial reductions in scar thickness and contraction after burn injury. Critical Issues: Though pressure therapy is highly effective in preclinical studies, outcomes in clinical studies have been variable and may be a result of differing therapy protocols and garment material fatigue. A recent adult clinical study reported a significant reduction in pressure after 1 month of use and significant reduction between 1 and 2 months of use, resulting in below therapeutic doses of pressure applied after only 1 month of use. Future Directions: To enhance efficacy of pressure garments, new low-fatigue materials must be developed for use in standard garments or garments must be redesigned to allow for adjustment to compensate for the loss of pressure with time. Additionally, measurements of applied pressure should be performed routinely during clinic visits to ensure that therapeutic doses of pressure are being delivered.

Longitudinal Evaluation of Pressure Applied by Custom Fabricated Garments Worn by Adult Burn Survivors

Custom fabricated pressure garments (PGs) are commonly used to prevent or treat hypertrophic scars (HSc) after burn injury. However, there is minimal scientific evidence quantifying pressure after standard measurement and fitting techniques. Adult burn survivors whose HSc was treated with PGs were recruited. Trained fitters, blinded to study locations and results, took the garment measures. Once the PGs arrived and were fitted, baseline pressure measures at HSc and normal skin (NS) sites were determined using the Pliance X® System. Pressure readings were repeated at 1, 2, and 3 months. The mean baseline pressure was 15.3 (SD 10.4) at HSc and 13.4 (SD 11.9) at NS sites. There was a significant reduction during the first month at both sites (P = .0002 HSc; P = .0002 NS). A multivariable linear regression mixed model, adjusting for garment type, baseline pressure, and repeated measures, revealed further reduction at HSc sites between 1 and 2 months (P = .03). By 3 months, the mean pressure reduced to 9.9 (SD 6.7) and 9.15 (SD 7.2) mm Hg at HSc and NS sites, respectively. At each time point, the pressure was higher at HSc compared with NS but was significantly different only at 1 month (P = .01). PGs were worn ≥12 hr/d 7 d/wk. PGs that apply 15 to 25 mm Hg pressure significantly improve HSc; however, immediately after fitting newly fabricated PGs, the average pressure was at the bottom of the recommended range and by 1 month was significantly below. Clinicians are likely underestimating the dosage required and the significant pressure loss within the first 2 months.

The accuracy and precision of interface pressure measuring devices: A systematic review

INTRODUCTION

Interface pressure measuring devices are used to assess the pressures exerted by compression. Their performance, however, has not been considered as a contributing factor to reported inconsistences in the application of compression. A systematic review was undertaken to investigate the performance of commercially available devices used to measure interface pressure.

METHODS

Six databases were searched identifying 17 devices, grouped into five sensor categories.

RESULTS

A range of methodologies assessed the devices' accuracy and precision, including method of pressure application, device calibration and type of surface used. No sensor category outperformed the others, however some individual sensors showed higher accuracy and/or precision compared to others. Two major factors influenced the performance of a number of sensors: the amount of applied pressure and the calibration method used.

CONCLUSION

Inconsistences in the application of compression may reflect, in part, issues related to accuracy and precision of the devices used to assess compression.

Comparison between the portable pressure measuring device and PicoPress® for garment pressure measurement on hypertrophic burn scar during compression therapy

PURPOSE

The current standard treatment for hypertrophic scars following burn injury is pressure garment therapy. The experimenters developed the novel portable pressure measuring device using silicon piezoresistive sensors. As PicoPress® is the most accurate (i.e., lowest variation and error) manometric sensor for pressure measurement, we sought to compare and examine the accuracy of the novel device regarding in vitro pressure measurements at the hypertrophic scar-pressure garment interface.

METHODS

The novel device was designed to operate in non-corrosive media, such as air. The device can use up to six pressure sensing points and was developed to adjust the number of pressure sensors according to the size of the scar. Pressure measurements were acquired through a readout circuit consisting of an analog-to-digital converter, a microprocessor, and a Bluetooth transmission module for wireless data transmission to an external device. All signals were converted into mean pressure expressed in millimeters of mercury (mmHg). The mean pressure values measured by the sensors were compared to those obtained from PicoPress®. 55 garment pressures recordings were obtained from the sensors over this study conducted in 2018-February 2020. We then analyzed the test-retest reliability using the intraclass correlation coefficients (ICC). PicoPress® was also employed in the same pressure garments for obtaining similar measurements. A two way random effects model ICC with 95% confidence intervals was used to compare the mean pressure values obtained from the silicon piezoresistive sensors to the PicoPress® measurements.

RESULTS

The test-retest reliability of the pressure sensors was close to the acceptable level for clinical use regarding stationary interface pressure measurement (ICC = 0.99, 95% CI 0.990-0.997). The mean pressure obtained from the silicon piezoresistive pressure sensors showed an accordance with the measurements from PicoPress® (ICC = 0.97, 95% CI 0.947-0.985).

CONCLUSION

The novel device may present a viable alternative to PicoPress® for garment pressure measurements. In addition, the novel device improves adaptability to the hypertrophic scar shape and size. Complementary characteristics such as wireless transmission to an external device may allow burn patients to continuously wear the device for real-time measurements during pressure garment therapy, thus improving existing devices including PicoPress®.

A Novel Bespoke Hypertrophic Scar Treatment: Actualizing Hybrid Pressure and Silicone Therapies with 3D Printing and Scanning

The treatment of hypertrophic scars (HSs) is considered to be the most challenging task in wound rehabilitation. Conventional silicone sheet therapy has a positive effect on the healing process of HSs. However, the dimensions of the silicone sheet are typically larger than those of the HS itself which may negatively impact the healthy skin that surrounds the HS. Furthermore, the debonding and displacement of the silicone sheet from the skin are critical problems that affect treatment compliance. Herein, we propose a bespoke HS treatment design that integrates pressure sleeve with a silicone sheet and use of silicone gel using a workflow of three-dimensional (3D) printing, 3D scanning and computer-aided design, and manufacturing software. A finite element analysis (FEA) is used to optimize the control of the pressure distribution and investigate the effects of the silicone elastomer. The result shows that the silicone elastomer increases the amount of exerted pressure on the HS and minimizes unnecessary pressure to other parts of the wrist. Based on this treatment design, a silicone elastomer that perfectly conforms to an HS is printed and attached onto a customized pressure sleeve. Most importantly, unlimited scar treating gel can be applied as the means to optimize treatment of HSs while the silicone sheet is firmly affixed and secured by the pressure sleeve.

A case study on interface pressure pattern of two garment orthoses on a child with cerebral palsy

Many studies have shown that medical compression products produce different levels of interface pressure during the usage of the products. However, limited studies have explored the pattern of interface pressure exerted by orthotic garments. This case study aimed to investigate the pattern of interface pressure exerted by two types of orthotic garments on a child with cerebral palsy. A 13-year-old child diagnosed with ataxic spastic diplegia cerebral palsy has difficulty to perform sit-to-stand motion even with a walking frame due to his truncal ataxia. A TheraTogsTM orthosis and a Dynamic Lycra® Fabric Orthosis (DLFO) were prepared for the child. The child’s sit-to-stand ability without and with the usage of orthoses was recorded using five sit-to-stand tests. The garments’ interface pressure was measured using F-scan (9811E) and F-scan 6.5.1 version software. The pressure was recorded when the child was in sitting position and performing sit-to-stand-to-sit motion. Overall, the child completed the five sit-to-stand test duration within 2.53 ± 0.04 s and 2.51 ± 0.09 s with the usage of TheraTogsTM orthosis and DLFO, respectively. Higher pressure was exerted by Dynamic Lycra Fabric Orthosis (axillary = 122 mmHg) in contrast to TheraTogsTM orthosis (77 mmHg) when the child was in a sitting position. Lower pressure was exerted by DLFO (7 mmHg), over xiphoid level and for TheraTogsTM orthosis is 1.2 mmHg over axillary level when the child was performing sit-to-stand motion. The largest range of pressure was exerted by TheraTogsTM orthosis with a minimum pressure of 5 mmHg and a maximum pressure of 155 mmHg during sit-to-stand motion. Overall, the DLFO exerted higher mean interface pressure on the child in comparison to TheraTogsTM orthosis when the child’s body was in a sitting position wearing both upper garment and pants. Both TheraTogsTM orthosis and DLFO presented a different range of interface pressure over different body segments and activities.

Customized Fabrication Approach for Hypertrophic Scar Treatment: 3D Printed Fabric Silicone Composite

Hypertrophic scars (HS) are considered to be the greatest unmet challenge in wound and burn rehabilitation. The most common treatment for HS is pressure therapy, but pressure garments may not be able to exert adequate pressure onto HS due to the complexity of the human body. However, the development of three-dimensional (3D) scanning and direct digital manufacturing technologies has facilitated the customized placement of additively manufactured silicone gel onto fabric as a component of the pressure therapy garment. This study provides an introduction on a novel and customized fabrication approach to treat HS and discusses the mechanical properties of 3D printed fabric reinforced with a silicone composite. For further demonstration of the suggested HS therapy with customized silicone insert, silicone inserts for the finger webs and HS were additively manufactured onto the fabric. Through the pressure evaluation by Pliance X system, it proved that silicone insert increases the pressure exerted to the HS. Moreover, the mechanical properties of the additively manufactured fabric silicone composites were characterized. The findings suggest that as compared with single viscosity print materials, the adhesive force of the additively manufactured silicone and fabric showed a remarkable improvement of 600% when print materials with different viscosities were applied onto elevated fabric.

Customized Fabrication Approach for Hypertrophic Scar Treatment: 3D Printed Fabric Silicone Composite

Hypertrophic scars (HS) are considered to be the greatest unmet challenge in wound and burn rehabilitation. The most common treatment for HS is pressure therapy, but pressure garments may not be able to exert adequate pressure onto HS due to the complexity of the human body. However, the development of three-dimensional (3D) scanning and direct digital manufacturing technologies has facilitated the customized placement of additively manufactured silicone gel onto fabric as a component of the pressure therapy garment. This study provides an introduction on a novel and customized fabrication approach to treat HS and discusses the mechanical properties of 3D printed fabric reinforced with a silicone composite. For further demonstration of the suggested HS therapy with customized silicone insert, silicone inserts for the finger webs and HS were additively manufactured onto the fabric. Through the pressure evaluation by Pliance X system, it proved that silicone insert increases the pressure exerted to the HS. Moreover, the mechanical properties of the additively manufactured fabric silicone composites were characterized. The findings suggest that as compared with single viscosity print materials, the adhesive force of the additively manufactured silicone and fabric showed a remarkable improvement of 600% when print materials with different viscosities were applied onto elevated fabric.