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Delmore B, Sprigle S, Samim M, Alfonso AR, Lin L, Chiu E. Does Sacrococcygeal Skeletal Morphology and Morphometry Influence Pressure Injury Formation in Adults? Adv Skin Wound Care 2022; 35:586-595. [PMID: 36264750 DOI: 10.1097/01.asw.0000874180.84660.8b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
GENERAL PURPOSE To present a study that investigated sacrococcygeal skeletal structure as a possible nonmodifiable intrinsic risk factor for pressure injury and identify possible issues caused by its morphology. TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Recognize the background information the authors considered when planning and conducting their study of sacrococcygeal skeletal structure as a possible pressure injury risk factor.2. Identify the characteristics of the two groups of study participants.3. Choose the results of the study clinicians may consider when implementing evidence-based practice.
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2
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Soppi E, Knuuti J, Kalliokoski K. Positron emission tomography study of effects of two pressure-relieving support surfaces on pressure ulcer development. J Wound Care 2021; 30:54-62. [PMID: 33439081 DOI: 10.12968/jowc.2021.30.1.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To study the pathophysiological cascade of pressure ulcer (PU) development consisting of tissue deformation, inflammation and hypoxia. METHOD In this crossover study, deformation was measured with computerised tomography (CT) linked with contact area reflecting immersion and envelopment. Inflammation and hypoxia were measured using subepidermal moisture (SEM), skin temperature and tissue perfusion with positron emission tomography. These variables were investigated under 90 minutes of pressure exposure caused by two functionally different support surfaces-a regular foam mattress and a minimum pressure air (MPA) mattress. RESULTS A total of eight healthy volunteers took part in the study. There was major tissue deformation when the participants lay on a foam mattress while the tissues retained their original shape on the MPA mattress (p<0.0001). During the pressure exposure, the skin temperature increased significantly on both support surfaces but the final temperature on the foam mattress was about 1oC higher than on the MPA mattress (p<0.0001). SEM increased on both support surfaces compared with an unexposed reference site, but the cause may be different between the two support surfaces. Tissue perfusion was lowest in the skin followed by subcutaneous tissues and highest in the muscles. The pressure exposure did not cause any substantial changes in perfusion. The results showed that tissue deformation was more pronounced, the support surface contact area (envelopment), was smaller and the skin temperature higher on the foam mattress than on the MPA mattress, without significant differences in tissue perfusion. CONCLUSION In this study, the MPA mattress support surface had mechanobiological properties that counteracted tissue deformation and thereby may prevent PUs.
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Affiliation(s)
- Esa Soppi
- Outpatient Clinic, Eira Hospital, Laivurinkatu 29, FI-00150 Helsinki, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku, Finland
| | - Kari Kalliokoski
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku, Finland
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Boyle CJ, Higgins CA. Can plantar fibroblast implantation protect amputees from skin injury? A recipe for skin augmentation. Exp Dermatol 2021; 30:1829-1833. [PMID: 34173264 DOI: 10.1111/exd.14419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/15/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
Skin injuries remain a persistent problem for users of lower-limb prostheses despite sustained progress in prosthesis design. One factor limiting the prevention of skin injuries is that skin on the residual limb is not suited to bear the mechanical loads of ambulation. One part of the body that is suited to this task is the sole of the foot. Here, we propose a novel strategy to actively augment skin's tolerance to load, increasing its resistance to mechanically induced injuries. We hypothesise that the load tolerance of skin can be augmented by autologous transplantation of plantar fibroblasts into the residual limb dermis. We expect that introducing plantar fibroblasts will induce the overlying keratinocytes to express plantar-specific keratins leading to a tougher epidermis. Using a computational finite element model of a weight-bearing residual limb, we estimate that skin deformation (a key driver of pressure ulcer injuries) could be halved by reprogramming skin to a plantar-like phenotype. We believe this strategy could yield new progress in pressure ulcer prevention for amputees, facilitating rehabilitation and improving quality of life for patients.
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Affiliation(s)
- Colin J Boyle
- Department of Bioengineering, Imperial College London, London, UK.,Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire A Higgins
- Department of Bioengineering, Imperial College London, London, UK
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Wu FL, Zheng Z, Ma Y, Weng K, Liao F, Jan YK. Effects of cycle periods and pressure amplitudes of alternating pressure on sacral skin blood flow responses. J Tissue Viability 2020; 29:264-268. [PMID: 32978042 DOI: 10.1016/j.jtv.2020.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are no guidelines on selecting alternating pressure (AP) configurations on increasing sacral skin blood flow (SBF). AIM The specific aims were to compare different cycle periods and pressure amplitudes of AP on sacral SBF responses in healthy people to establish the efficacy and safety of the protocols. METHODS Two studies were tested, including the cycle period study (8 2.5-min vs 4 5-min protocols) and the pressure amplitude study (75/5 vs 65/15 mmHg protocols). Sacral SBF was measured using laser Doppler flowmetry (LDF) in 20 participants. AP loads were randomly applied using an indenter through the rigid LDF probe. Each protocol included a 10-min baseline, 20-min AP and 10-min recovery periods. A 30-min washout period was provided. The SBF response was normalized to the baseline SBF of each condition of each participant. RESULTS For the cycle period study, the 4 5-min cycle protocol partially restored more SBF than the 8 2.5-min cycle protocol at the low-pressure phase (0.87 ± 0.04 vs 0.71 ± 0.03, p < 0.05) and at the high-pressure phase (0.25 ± 0.03 vs 0.19 ± 0.03, p < 0.05). For the pressure amplitude study, the 75/5 mmHg protocol partially restored more sacral SBF than the 65/15 mmHg protocol at the low-pressure phase (0.87 ± 0.1 vs 0.25 ± 0.03, p < 0.05) but not at the high-pressure phase (0.23 ± 0.02 vs 0.21 ± 0.02, non-significant). CONCLUSION This study demonstrated that 1) a cycle period of 5 min was better than 2.5 min and 2) a pressure amplitude of 75/5 mmHg was better than 65/15 mmHg. The finding provides insights for selecting the AP configurations for increasing SBF.
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Affiliation(s)
- Fu-Lien Wu
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Zhi Zheng
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Yinyin Ma
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Kaixiang Weng
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Fuyuan Liao
- Department of Biomedical Engineering, Xi'an Technological University, Xi'an, China
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
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Worsley PR, Crielaard H, Oomens CWJ, Bader DL. An evaluation of dermal microcirculatory occlusion under repeated mechanical loads: Implication of lymphatic impairment in pressure ulcers. Microcirculation 2020; 27:e12645. [DOI: 10.1111/micc.12645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Peter R. Worsley
- Clinical Academic Facility School of Health Sciences Faculty of Environmental and Life Sciences University of Southampton Southampton UK
| | - Hanneke. Crielaard
- Clinical Academic Facility School of Health Sciences Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- Department of Biomedical Engineering Eindhoven University of Technology Eindhoven The Netherlands
| | - Cees W. J. Oomens
- Department of Biomedical Engineering Eindhoven University of Technology Eindhoven The Netherlands
| | - Dan L. Bader
- Clinical Academic Facility School of Health Sciences Faculty of Environmental and Life Sciences University of Southampton Southampton UK
- Department of Biomedical Engineering Eindhoven University of Technology Eindhoven The Netherlands
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Bramley JL, Worsley PR, Bostan LE, Bader DL, Dickinson AS. Establishing a measurement array to assess tissue tolerance during loading representative of prosthetic use. Med Eng Phys 2020; 78:39-47. [PMID: 32035813 DOI: 10.1016/j.medengphy.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 01/17/2020] [Accepted: 01/26/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In the early stages of rehabilitation after primary amputation, residual limb soft tissues have not been mechanically conditioned to support load and are vulnerable to damage from prosthetic use. There is limited quantitative knowledge of skin and soft tissue response to prosthetic loading. METHODS An in-vivo protocol was developed to establish suitable measures to assess tissue tolerance during loading representative of early prosthesis use. Ten participants without amputation one participant with trans-tibial amputation were recruited, and pressure applied to their calf in increments from 20 to 60 mmHg. Measurements were recorded at relevant skin sites including interface pressures, transcutaneous oxygen (TCPO2) and carbon dioxide (TCPCO2) tensions and inflammatory biomarkers. FINDINGS At the maximum cuff pressure, mean interface pressures were between 66 and 74 mmHg, associated with decreased TCPO2 values. On the release of pressure, the ischaemic response was reversed. Significant upregulation (p < 0.05) in inflammatory biomarker IL-1α and its antagonist IL-1RA were observed at all sites immediately following loading. INTERPRETATION The protocol was successful in applying representative prosthetic loads to lower limb tissues and monitoring the physiological response, both in terms of tissue ischemia and skin inflammation. Results indicated that the measurement approaches were sensitive to changes in interface conditions, offering a promising approach to monitor tissue status for people with amputation.
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Affiliation(s)
- J L Bramley
- Bioengineering Science Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Highfield Campus, University Rd, Southampton SO17 1BJ, UK
| | - P R Worsley
- Skin Health Research Group, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - L E Bostan
- Skin Health Research Group, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - D L Bader
- Skin Health Research Group, Faculty of Environmental and Life Sciences, University of Southampton, UK
| | - A S Dickinson
- Bioengineering Science Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Highfield Campus, University Rd, Southampton SO17 1BJ, UK.
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What Lies Beneath: Why Some Pressure Injuries May Be Unpreventable for Individuals With Spinal Cord Injury. Arch Phys Med Rehabil 2019; 100:1042-1049. [DOI: 10.1016/j.apmr.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/05/2018] [Accepted: 11/09/2018] [Indexed: 11/22/2022]
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8
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Karg P, Ranganathan VK, Churilla M, Brienza D. Sacral skin blood flow response to alternating pressure operating room overlay. J Tissue Viability 2019; 28:75-80. [DOI: 10.1016/j.jtv.2019.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/05/2019] [Accepted: 03/15/2019] [Indexed: 11/26/2022]
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Bridges E, Whitney JD, Burr R, Tolentino E. Reducing the Risk for Pressure Injury During Combat Evacuation. Crit Care Nurse 2018; 38:38-45. [PMID: 29606674 DOI: 10.4037/ccn2018223] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Combat casualties undergoing aeromedical evacuation are at increased risk for pressure injuries. The risk factors pressure and shear are potentially modifiable via solutions appropriate for en route care. OBJECTIVES To compare transcutaneous oxygen levels and skin temperatures in healthy participants under offloaded (side lying) and loaded (supine or supine with 30° backrest elevation) under 4 conditions: control (no intervention), Mepilex sacral and heel dressings, LiquiCell pad, and Mepilex plus LiquiCell. METHODS Participants were randomly assigned to 4 groups according to ideal body weight. Backrest positions were randomized. Transcutaneous oxygen level and temperature were measured on the sacrum and the heel; skin interface pressure was measured with an XSensor pressure imaging system. Measurements were obtained for 5 minutes at baseline (offloaded), 40 minutes with participants supine, and 15 minutes offloaded. RESULTS In the 40 healthy participants, interface pressure, transcutaneous oxygen level, and skin temperature did not differ between the 4 groups. Peak interface pressures were approximately 43 mm Hg for the sacrum and 50 mm Hg for the heel. Sacral transcutaneous oxygen level differed significantly between unloaded (mean, 79 mm Hg; SD, 16.5) and loaded (mean, 57 mm Hg; SD, 25.2) conditions (P < .001) in a flat position (mean, 85.2 mm Hg; SD, 13.6) and with 30° backrest elevation (mean, 66.7 mm Hg; SD, 24.2) conditions (P < .001). Results for the heels and the sacrum were similar. Sacral skin temperature increased significantly across time (approximately 1.0°C). CONCLUSIONS The intervention strategies did not differ in prevention of pressure injuries.
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Affiliation(s)
- Elizabeth Bridges
- Col (Ret) Elizabeth Bridges, USAF, NC, is a professor at the University of Washington School of Nursing and a clinical nurse researcher at the University of Washington Medical Center, Seattle, Washington. .,JoAnne D. Whitney is a professor, University of Washington School of Nursing, the Harborveiw endowed professor in critical care nursing, and a research scientist at Harborview Medical Center, Seattle, Washington. .,Robert Burr is a research professor at the University of Washington School of Nursing. .,Ernesto Tolentino is a research scientist at the University of Washington School of Nursing.
| | - JoAnne D Whitney
- Col (Ret) Elizabeth Bridges, USAF, NC, is a professor at the University of Washington School of Nursing and a clinical nurse researcher at the University of Washington Medical Center, Seattle, Washington.,JoAnne D. Whitney is a professor, University of Washington School of Nursing, the Harborveiw endowed professor in critical care nursing, and a research scientist at Harborview Medical Center, Seattle, Washington.,Robert Burr is a research professor at the University of Washington School of Nursing.,Ernesto Tolentino is a research scientist at the University of Washington School of Nursing
| | - Robert Burr
- Col (Ret) Elizabeth Bridges, USAF, NC, is a professor at the University of Washington School of Nursing and a clinical nurse researcher at the University of Washington Medical Center, Seattle, Washington.,JoAnne D. Whitney is a professor, University of Washington School of Nursing, the Harborveiw endowed professor in critical care nursing, and a research scientist at Harborview Medical Center, Seattle, Washington.,Robert Burr is a research professor at the University of Washington School of Nursing.,Ernesto Tolentino is a research scientist at the University of Washington School of Nursing
| | - Ernesto Tolentino
- Col (Ret) Elizabeth Bridges, USAF, NC, is a professor at the University of Washington School of Nursing and a clinical nurse researcher at the University of Washington Medical Center, Seattle, Washington.,JoAnne D. Whitney is a professor, University of Washington School of Nursing, the Harborveiw endowed professor in critical care nursing, and a research scientist at Harborview Medical Center, Seattle, Washington.,Robert Burr is a research professor at the University of Washington School of Nursing.,Ernesto Tolentino is a research scientist at the University of Washington School of Nursing
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10
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Response to Letter from Abraham and colleagues, regarding “Monitoring the biomechanical and physiological effects of postural changes during leisure chair sitting”. J Tissue Viability 2018; 27:189. [DOI: 10.1016/j.jtv.2018.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 05/28/2018] [Indexed: 11/18/2022]
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11
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Saegusa M, Noguchi H, Nakagami G, Mori T, Sanada H. Evaluation of comfort associated with the use of a robotic mattress with an interface pressure mapping system and automatic inner air-cell pressure adjustment function in healthy volunteers. J Tissue Viability 2018; 27:146-152. [DOI: 10.1016/j.jtv.2018.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 06/08/2018] [Accepted: 06/09/2018] [Indexed: 02/05/2023]
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12
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Bader DL, Worsley PR. Technologies to monitor the health of loaded skin tissues. Biomed Eng Online 2018; 17:40. [PMID: 29650012 PMCID: PMC5897925 DOI: 10.1186/s12938-018-0470-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/24/2018] [Indexed: 01/18/2023] Open
Abstract
There are many situations where the skin and underlying soft tissues are compromised by mechanical loading in the form or pressure, or pressure in combination with shear. If sustained, this can lead to damage in the tissues particularly adjacent to bony prominences, resulting in chronic wounds. An array of bioengineering technologies have been adopted to assess the integrity of loaded soft tissues. This paper aims to review these approaches for the quantification, simulation and early detection of mechanically-induced skin damage. The review considers different measurements at the interface between the skin and support surface/medical device, involving pressure, shear, friction and the local microclimate. The potential of the techniques to monitor the physiological response of the skin to these external stimuli including biophysical measurement devices and sampling of biofluids are critically analysed. In addition, it includes an analysis of medical imaging technologies and computational modelling to provide a means by which tissue deformation can be quantified and thresholds for tissue damage defined. Bioengineering measurement and imaging technologies have provided an insight into the temporal status of loaded skin. Despite the advances in technology, to date, the translation to clinical tools which are robust and cost effective has been limited. There is a need to adapt existing technologies and simulation platforms to enable patients, carers and clinicians to employ appropriate intervention strategies to minimise soft tissue damage.
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Affiliation(s)
- Dan L Bader
- Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Peter R Worsley
- Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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Worsley PR, Rebolledo D, Webb S, Caggiari S, Bader DL. Monitoring the biomechanical and physiological effects of postural changes during leisure chair sitting. J Tissue Viability 2018; 27:16-22. [DOI: 10.1016/j.jtv.2017.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/16/2017] [Accepted: 10/06/2017] [Indexed: 12/12/2022]
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14
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Chai C, Sadou O, Worsley P, Bader D. Pressure signatures can influence tissue response for individuals supported on an alternating pressure mattress. J Tissue Viability 2017; 26:180-188. [DOI: 10.1016/j.jtv.2017.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 05/03/2017] [Accepted: 05/09/2017] [Indexed: 01/10/2023]
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15
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Scheel-Sailer A, Frotzler A, Mueller G, Annaheim S, Rossi RM, Derler S. Biophysical skin properties of grade 1 pressure ulcers and unaffected skin in spinal cord injured and able-bodied persons in the unloaded sacral region. J Tissue Viability 2017; 26:89-94. [DOI: 10.1016/j.jtv.2016.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/04/2016] [Accepted: 11/05/2016] [Indexed: 12/27/2022]
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Go EJ, Lee SH. Effects on sitting pressure distribution during the application of different cushions and anterior height wedges. J Phys Ther Sci 2017; 29:390-393. [PMID: 28356617 PMCID: PMC5360996 DOI: 10.1589/jpts.29.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 11/18/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate interface pressure redistribution
in healthy volunteers when applying different cushions and anterior wedge heights.
[Subjects and Methods] This study included 36 healthy individuals in their 20s. The peak
and mean pressures were measured by applying different cushions and anterior wedge
heights. The results were analyzed by using a one-way analysis of variance and post-hoc
analysis. [Results] The peak and mean pressures were statistically significant based on
the cushion types and anterior wedge height. The peak pressure was at its highest and
lowest when sitting on a 6-cm anterior wedge and a foam cushion, respectively. The mean
pressure was greatest when sitting on a 6-cm anterior wedge of a firm surface and smallest
when sitting on a 5 cm foam cushion. [Conclusion] This study shows that the most effective
method for pressure redistribution was sitting on a 5 cm foam cushion without an anterior
wedge.
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Affiliation(s)
- Eun-Ji Go
- Department of Occupational Therapy, Soonchunhyang University Graduate School, Republic of Korea
| | - Sang-Heon Lee
- Department of Occupational Therapy, College of Medical Science, Soonchunhyang University: 22 Soonchunhyang ro, Shinchang-myeon, Asan-si, Republic of Korea
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Worsley PR, Parsons B, Bader DL. An evaluation of fluid immersion therapy for the prevention of pressure ulcers. Clin Biomech (Bristol, Avon) 2016; 40:27-32. [PMID: 27794259 DOI: 10.1016/j.clinbiomech.2016.10.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals with impaired mobility can spend prolonged periods on support surfaces, increasing their risk of developing pressure ulcers. Manufacturers have developed mattresses to maximise contact area. The present study evaluated both the biomechanical and physiological responses to lying postures on a Fluid Immersion Simulation mattress. METHODS Seventeen healthy participants were recruited to evaluate the mattress during three prescribed settings of immersion (high, medium and low). Parameters reflecting biomechanical and physiological responses, and the microclimate were monitored during three postures (supine, lateral and high-sitting) over a 90minute test session. Transcutaneous oxygen and carbon dioxide gas responses were categorised according to three criteria and data were compared between each condition. FINDINGS Results indicated that interface pressures remained consistent, with peak sacral values ranging from 21 to 27mmHg across all immersion settings and postures. The majority of participants (82%) exhibited minimal changes in gas tensions at the sacrum during all test conditions. By contrast, three participants exhibited decreased oxygen with increased carbon dioxide tensions for all three immersion settings. Supine and high sitting sacral microclimate values ranged between 30.1-30.6°C and 42.3-44.5% for temperature and relative humidity respectively. During lateral tilt there was a reduction of 1.7-2.5°C and 3.3-5.3% in these values. The majority of participants reported high comfort scores, although a few experienced bottoming out during the high-sitting posture at the high immersion setting. INTERPRETATION Fluid Immersion Simulation provides an intelligent approach to increase the support area. Further research is required to provide evidence based guidance on the use of personalised support surfaces.
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Affiliation(s)
- P R Worsley
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton SO16 6QY, UK.
| | - B Parsons
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton SO16 6QY, UK
| | - D L Bader
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton SO16 6QY, UK
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18
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Gray RJ, Worsley PR, Voegeli D, Bader DL. Monitoring contractile dermal lymphatic activity following uniaxial mechanical loading. Med Eng Phys 2016; 38:895-903. [DOI: 10.1016/j.medengphy.2016.04.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 02/18/2016] [Accepted: 04/23/2016] [Indexed: 11/25/2022]
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19
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Liu JJ, Huang MC, Xu W, Sarrafzadeh M. Bodypart localization for pressure ulcer prevention. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:766-9. [PMID: 25570071 DOI: 10.1109/embc.2014.6943703] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pressure ulcers, commonly called bedsores, are defined as injuries to the skin and underlying tissue resulting from prolonged pressure usually on bony areas of the body, such as heels and hips. In order to alleviate pressure accumulation at high-risk regions, the current practice in clinics requires caregivers to reposition their patients every two hours. This relies on the engagement of nursing services and places large burdens on the caregivers. In this study, a bedsore monitoring method using Pictorial Structure models is introduced to localize pressure distributions of the body. A pilot study including 12 subjects reveals that the proposed method enables reliable localization of bodyparts with 89.8% accuracy in common lying postures.
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20
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Features of lymphatic dysfunction in compressed skin tissues – Implications in pressure ulcer aetiology. J Tissue Viability 2016; 25:26-31. [DOI: 10.1016/j.jtv.2015.12.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/30/2015] [Accepted: 12/22/2015] [Indexed: 11/23/2022]
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21
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Lee SH, Park JS, Jung BK, Lee SA. Effects of different seat cushions on interface pressure distribution: a pilot study. J Phys Ther Sci 2016; 28:227-30. [PMID: 26957763 PMCID: PMC4756009 DOI: 10.1589/jpts.28.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/16/2015] [Indexed: 02/04/2023] Open
Abstract
[Purpose] The purpose of this study was to evaluate pressure redistribution on the
supporting area of healthy volunteers when using different cushions. [Subjects and
Methods] Twenty healthy individuals ranging in age from 19–23 years old and 20 older
adults age 60 or above participated in the study. All participants lived in urban
communities in South Korea. Group differences according to gender, age, and cushion types
were analyzed with one-way analysis of variance and post-hoc analysis. [Results]
Statistically significant differences in peak pressure and mean pressure were identified
between age, gender, and cushion types. Peak pressure and mean pressure were higher on
firm surfaces and on the air cushion than other cushion types. The pressure ratio was
lower when an air cushion was used in the buttock area and was higher when it was used
under the thighs compared to that in other conditions. [Conclusion] This study showed that
interface pressure can be distributed differently depending on what cushions are used.
Therefore, when using seat cushions, individuals should seek advice to help them choose
the appropriate cushion for their needs.
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Affiliation(s)
- Sang-Heon Lee
- Department of Occupational Therapy, College of Medical Science, Soonchunhyang University, Republic of Korea
| | - Ji-Su Park
- Department of Occupational Therapy, Soonchunhyang University Graduate School, Republic of Korea
| | - Bong-Keun Jung
- Department of Occupational Therapy, College of Medical Science, Soonchunhyang University, Republic of Korea
| | - Sung-A Lee
- Department of Occupational Therapy, College of Medical Science, Soonchunhyang University, Republic of Korea
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22
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Wu GA, Bogie KM. Effects of conventional and alternating cushion weight-shifting in persons with spinal cord injury. ACTA ACUST UNITED AC 2015; 51:1265-76. [PMID: 25629607 DOI: 10.1682/jrrd.2014.01.0009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 07/03/2014] [Indexed: 11/05/2022]
Abstract
A repeated-measures study of 13 adult full-time wheelchair users with spinal cord injury (SCI) was carried out to determine whether alternating-pressure air cushion (APAC) use compared with independent pressure relief (IPR) provides reliable, effective pressure relief for individuals with SCI. Bilateral mean ischial interface pressure (IP), transcutaneous oxygen tension (TcPO2), and unilateral laser Doppler blood flow were evaluated. Blood flow component contributions were determined using short-time Fourier transform (STFT)-based spectral analysis. IPR assessment was carried out at recruitment. Study participants then used an APAC for 2 wk every 3 mo for 18 mo. IPR weight-shifting decreased mean ischial IP (p < 0.05) and increased mean TcPO2 (p < 0.05). All variables rapidly returned to preintervention levels following weight-shifting except for the cardiac component of blood flow. APAC-induced weight-shifting decreased mean ischial IP (p < 0.05). Mean TcPO2 increased and was higher than for IPR. STFT analysis indicated that quiet sitting following APAC-induced weight-shifting produced a higher neurogenic component of blood flow than following IPR (p = 0.02). Thus, IPR positively affects multiple aspects of tissue health but produces transient improvements and must be repeated regularly. APAC activation dynamically and continuously alters IP distribution with more sustained positive tissue health effects.
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Affiliation(s)
- Gary A Wu
- Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Cleveland, OH; Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH; and Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH
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23
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Arias S, Cardiel E, Garay L, Sanada H, Mori T, Noguchi H, Nakagami G, Rogeli P. Effects on interface pressure and tissue oxygenation under ischial tuberosities during the application of an alternating cushion. J Tissue Viability 2015; 24:91-101. [DOI: 10.1016/j.jtv.2015.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/14/2015] [Accepted: 05/22/2015] [Indexed: 02/07/2023]
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24
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Scheel-Sailer A, Frotzler A, Mueller G, Annaheim S, Rossi RM, Derler S. Challenges to measure hydration, redness, elasticity and perfusion in the unloaded sacral region of healthy persons after supine position. J Tissue Viability 2015; 24:62-70. [DOI: 10.1016/j.jtv.2015.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 12/27/2022]
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25
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Woodhouse M, Worsley PR, Voegeli D, Schoonhoven L, Bader DL. The physiological response of soft tissue to periodic repositioning as a strategy for pressure ulcer prevention. Clin Biomech (Bristol, Avon) 2015; 30:166-74. [PMID: 25541393 DOI: 10.1016/j.clinbiomech.2014.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/05/2014] [Accepted: 12/08/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Individuals who have reduced mobility are at risk of developing pressure ulcers if they are subjected to sustained static postures. To reduce this risk, clinical guidelines advocate healthcare professionals reposition patients regularly. Automated tilting mechanisms have recently been introduced to provide periodic repositioning. This study compared the performance of such a prototype mattress to conventional manual repositioning. METHODS Ten healthy participants (7 male and 3 female, aged 23-66 years) were recruited to compare the effects of an automated tilting mattress to standard manual repositioning, using the 30° tilt. Measures during the tilting protocols (supine, right and left tilt) included comfort and safety scores, interface pressures, inclinometer angles and transcutaneous gas tensions (sacrum and shoulder). Data from these outcomes were compared between each protocol. FINDINGS Results indicated no significant differences for either interface pressures or transcutaneous gas responses between the two protocols (P>0.05 in both cases). Indeed a small proportion of participants (~30%) exhibited changes in transcutaneous oxygen and carbon dioxide values in the shoulder during a right tilt for both protocols. The tilt angles at the sternum and the pelvis were significantly less in the automated tilt compared to the manual tilt (mean difference=9.4-11.5°, P<0.001). Participants reported similar comfort scores for both protocols, although perceived safety was reduced on the prototype mattress. INTERPRETATION Although further studies are required to assess its performance in maintaining tissue viability, an automated tilting mattress offers the ability to periodically reposition vulnerable individuals, with potential economic savings to health services.
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Affiliation(s)
- Marjolein Woodhouse
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK; Solent NHS Trust, Adelaide Health Centre, Western Community Hospital Campus, Millbrook, Southampton SO16 4XE, UK
| | - Peter R Worsley
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK.
| | - David Voegeli
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK
| | - Lisette Schoonhoven
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK; Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Dan L Bader
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton SO17 1BJ, UK
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26
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A Review of the Role of the Partial Pressure of Carbon Dioxide in Mechanically Loaded Tissues: The Canary in the Cage Singing in Tune with the Pressure Ulcer Mantra. Ann Biomed Eng 2014; 43:336-47. [DOI: 10.1007/s10439-014-1233-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
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27
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worsley P, Voegeli D. Back to basics: biophysical methods in tissue viability research. J Wound Care 2013; 22:434-6, 438-9. [DOI: 10.12968/jowc.2013.22.8.434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- P. worsley
- Continence technology and skin Health Cluster, Faculty of Health sciences, university of southampton, UK
| | - D. Voegeli
- Continence technology and skin Health Cluster, Faculty of Health sciences, university of southampton, UK
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