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Müller R, Oette C, Oette C, Schreff L, Abel R. Sitting Pressure Measurements in Wheelchair Users-Can the Effects of Daily Relief Activities Be Depicted? SENSORS (BASEL, SWITZERLAND) 2024; 24:3806. [PMID: 38931590 PMCID: PMC11207960 DOI: 10.3390/s24123806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Seat pressure measurements in wheelchair users have been available for some time; however, repeated measurements from a commercially available pressure mat over 90 min did not differ in the pressure-loaded measurement area or the coordinates of the center of pressure, even in participants who were able to reposition themselves in the wheelchair. The question therefore arises: to what extent are there other parameters that reflect the activity of wheelchair users with the pressure mat? To investigate this, a commercial pressure mat (BodiTrak®) was used to perform the measurements of pressure of 33 adult wheelchair-dependent people with spinal cord injury after 30 and 90 min sitting on the cushion. In addition to the standard output of the pressure mat, graph-based surface analyses (calculation of the area of maximum pressure, calculation of the pressure-loaded measurement area, and pressure-area ratio) was performed retrospectively using Python 3.7. The analysis of the measurements after 30 and 90 min was performed by distinguishing the participants between those who could actively change their position (N = 24) and those who could not (N = 9). The parameters of the pressure mat and the graph-based analyses remained unchanged for active participants. In participants who were unable to actively change their position, the area of maximum pressure and the pressure-area ratio (ratio of maximum pressure area and total pressure-loaded area) increased. Significant differences between minutes 30 and 90 are only found for the pressure-area ratio. Thus, when measuring the seat pressure of wheelchair users, the pressure-area ratio should be taken into account as it reflects the daily relief activities of wheelchair users.
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Affiliation(s)
- Roy Müller
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany; (C.O.); (L.S.); (R.A.)
- Bayreuth Center of Sport Science, University of Bayreuth, Universitätsstraße 30, 95447 Bayreuth, Germany
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen, 91054 Erlangen, Germany
| | - Clara Oette
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany; (C.O.); (L.S.); (R.A.)
| | - Cedric Oette
- Hawk Intelligent Technologies GmbH, Schafäckerlein 23, 91413 Neustadt an der Aisch, Germany
| | - Lucas Schreff
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany; (C.O.); (L.S.); (R.A.)
- Bayreuth Center of Sport Science, University of Bayreuth, Universitätsstraße 30, 95447 Bayreuth, Germany
| | - Rainer Abel
- Department of Orthopedic Surgery, Klinikum Bayreuth GmbH, 95445 Bayreuth, Germany; (C.O.); (L.S.); (R.A.)
- University Hospital Erlangen, Friedrich-Alexander-University Erlangen, 91054 Erlangen, Germany
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Nasirian A, Erel V, Nuthi P, Gu Y, Allman M, Meza F, Sikka S, Wijesundara MBJ. Smart seat cushion feasibility pilot study: automated interface pressure modulation of individuals with spinal cord Injury. Disabil Rehabil Assist Technol 2024:1-10. [PMID: 38712763 DOI: 10.1080/17483107.2024.2349712] [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: 10/26/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
This study investigates the functionality and feasibility of a novel smart seat cushion system designed for wheelchair users with spinal cord injuries. The cushion, equipped with air cells that serve as both sensors and actuators, was tested on 24 participants for its real-time pressure mapping, automated pressure redistribution, and pressure offloading functions. A commercial pressure mat was concurrently used to validate the cushion's pressure modulation functions. Additionally, the perceived comfort of the cushion was evaluated using General Discomfort Assessment (GDA) and Discomfort Intensity (DIS) scores, which provided insights into participants' overall comfort and discomfort levels. Real-time pressure profiles generated by the cushion resembled commercial pressure mat readings. During tests with individuals with spinal cord injury, the cushion was able to dynamically generate and display the real-time pressure profile of a seated individual with strong precision (correlation to commercial pressure mat: r ranging from 0.76 to 0.88), providing effective input into pressure modulation functions. Pressure redistribution algorithms eliminated peak pressure and reduced the overall pressure at the interface. Pressure offloading algorithms automatically identified the regions with the highest interface pressure and subsequently relieved the pressure from those areas. User feedback showed that the cushion was comfortable after redistribution and offloading. This work demonstrated the feasibility of an advanced smart seat cushion system for wheelchair users with spinal cord injuries. The cushion was capable of redistributing pressure evenly across the seating surface, ensuring user's comfort. Additionally, it identifies and eliminates high-pressure points, further improving comfort and reducing the risk of pressure injuries.
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Affiliation(s)
- Aida Nasirian
- The University of TX at Arlington Research Institute, Fort Worth, TX, USA
| | - Veysel Erel
- The University of TX at Arlington Research Institute, Fort Worth, TX, USA
| | - Pavan Nuthi
- The University of TX at Arlington Research Institute, Fort Worth, TX, USA
| | - Yixin Gu
- The University of TX at Arlington Research Institute, Fort Worth, TX, USA
| | - Melissa Allman
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Faith Meza
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Seema Sikka
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
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González-Cely AX, Diaz CAR, Callejas-Cuervo M, Bastos-Filho T. Optical fiber sensors for posture monitoring, ulcer detection and control in a wheelchair: a state-of-the-art. Disabil Rehabil Assist Technol 2024; 19:1773-1790. [PMID: 37439135 DOI: 10.1080/17483107.2023.2234411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND In the last ten years, the design and implementation of Optical Fiber Sensors (OFS) in biomedical applications have been discussed, with a focus on different subareas, such as body parameter monitoring and control of assistive devices. MATERIALS AND METHODS A scoping review was performed including scientific literature (PubMed/Scopus, IEEE and Web of Science), patents (WIPO/Google Scholar), and commercial information. RESULTS The main applications of OFS in the rehabilitation field for preventing future postural diseases and applying them in device controllers were discussed in this review. Physical characteristics of OFS, different uses, and applications of Polymer Optical Fiber pressure sensors are mentioned. The main postures used for posture monitoring analysis when the user is sitting are normal position, crooked back, high lumbar pressure, sitting on the edge of the chair, and crooked back, left position, and right position. Additionally, it is possible to use Machine Learning (ML) algorithms for posture classification, and device control such as Support Vector Machine, k-Nearest Neighbors, etc., obtaining accuracies above 97%. Moreover, the literature mentions wheelchair controllers and Graphical User Interfaces using pressure maps to provide feedback to the user. CONCLUSIONS OFS have been used in several healthcare applications as well as postural and preventive applications. The literature showed an effort to implement and design accessible devices for people with disabilities and people with specific diseases. Alternatively, ML algorithms are widely used in this direction, leaving the door open for further studies that allow the application of real-time systems for posture monitoring and wheelchairs control.
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Affiliation(s)
- Aura Ximena González-Cely
- Graduate Program in Electrical Engineering, Robotics and Assistive Technology Laboratory, Federal University of Espirito Santo, Vitória, Brazil
- Graduate Program in Electrical Engineering, Telecommunications Laboratory, Federal University of Espirito Santo, Vitória, Brazil
| | - Camilo A R Diaz
- Graduate Program in Electrical Engineering, Telecommunications Laboratory, Federal University of Espirito Santo, Vitória, Brazil
| | - Mauro Callejas-Cuervo
- Software Research Group, Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia
| | - Teodiano Bastos-Filho
- Graduate Program in Electrical Engineering, Robotics and Assistive Technology Laboratory, Federal University of Espirito Santo, Vitória, Brazil
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Mansouri M, Krishnan G, McDonagh DC, Zallek CM, Hsiao-Wecksler ET. Review of assistive devices for the prevention of pressure ulcers: an engineering perspective. Disabil Rehabil Assist Technol 2024; 19:1511-1530. [PMID: 37101406 DOI: 10.1080/17483107.2023.2204127] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Pressure ulcers (PUs) are prevalent among immobile bed or wheelchair-reliant individuals who experience prolonged sedentary positions. Pressure relief and frequent repositioning of body posture help to mitigate complications associated with PUs. Adherence with regular repositioning is difficult to maintain due to nursing labour shortages or constraints of in-home caregivers. Manual repositioning, transferring, and lifting of immobile patients are physically demanding tasks for caregivers. This review aimed to explore and categorize these devices, discuss the significant technical challenges that need addressing, and identify potential design opportunities. MATERIALS AND METHODS In this review, a literature search was conducted using PubMED, Science Direct, Google Scholar and IEEE Xplore databases including studies from 1995 until Feb 2023 with keywords such as pressure ulcer, assistive device, pressure relief, repositioning, transfer, etc. Both commercial and research-level devices were included in the search. RESULTS 142 devices or technologies were identified and classified into four main categories that were further subcategorized. Within each category, the devices were investigated in terms of their mechanical design, actuation methods, control strategies, sensing technologies, and level of autonomy. Limitations of current technologies are design complexity, lack of patient comfort, and a lack of autonomy requiring caregivers frequent intervention. CONCLUSIONS Several devices have been developed to help with prevention and mitigation of PUs. There remain challenges that hinder the widespread accessibility and use of current technologies. Advancements in assistive technologies for pressure ulcer mitigation could lie at the intersection of robotics, sensors, perception, user-centered design, and autonomous systems.
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Affiliation(s)
- Mahshid Mansouri
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Girish Krishnan
- Department of Industrial & Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Deana C McDonagh
- School of Art + Design and Beckman Institute of Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | | | - Elizabeth T Hsiao-Wecksler
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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Erel V, Nasirian A, Gu Y, Lavery L, Wijesundara MBJ. Development of Cyclic Pressure Offloading Insole for Diabetic Foot Ulcer Prevention. INT J LOW EXTR WOUND 2024:15347346241234825. [PMID: 38419569 DOI: 10.1177/15347346241234825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Introduction. The likelihood of developing a diabetic foot ulcer (DFU) during one's lifetime for individuals with diabetes mellitus is around 19% to 34%. Continuous and repetitive loading on soft tissues are the major causative factors for DFU. This paper introduces an air cell array insole designed for cyclically offloading pressure from plantar regions to reduce repetitive stress and loading on foot. Materials and Methods. The insole comprises an air cell array insole and a pneumatic control unit. The interface pressure was evaluated in static and dynamic conditions at 3 different air cell internal pressures (6.9, 10.3, and 13.8 kPa). Plantar interface pressure was measured using a commercial pressure system, and data were analyzed using paired t test. Average interface pressure and peak pressure (PP) were studied to evaluate the functionality and effectiveness of the insole. Results. The analysis of static pressure data revealed that cyclic offloading significantly (p < .05) reduced PP in 4 tested cells corresponding to big toe, metatarsal heads, and heel areas with the maximum mean difference of 12.9 kPa observed in big toe region. Similarly, dynamic pressure data analysis showed that cyclic offloading significantly (p < .05) reduced PP in these areas, with the highest mean PP reduction of 36.98 kPa in the big toe region. Discussion. Results show the insole's capability to reduce plantar pressure through cyclic offloading. Internal pressure of air cells significantly affects the overall pressure reduction and must be chosen based on the user's weight. Conclusion. Results confirm that the insole with offloading capabilities has the potential to reduce the risk of developing DFUs by alleviating the plantar stress during both static and dynamic conditions.
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Affiliation(s)
- Veysel Erel
- Biomedical Technology Division, The University of Texas at Arlington Research Institute Fort Worth, Arlington, TX, USA
| | - Aida Nasirian
- Biomedical Technology Division, The University of Texas at Arlington Research Institute Fort Worth, Arlington, TX, USA
| | - Yixin Gu
- Biomedical Technology Division, The University of Texas at Arlington Research Institute Fort Worth, Arlington, TX, USA
| | - Larry Lavery
- Department of Plastic Surgery, UT Southwestern Medical Center Dallas, Dallas, TX, USA
| | - Muthu B J Wijesundara
- Biomedical Technology Division, The University of Texas at Arlington Research Institute Fort Worth, Arlington, TX, USA
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Jia J, Gong S, Zhang A, Jiang L, Yao Y. Stiffening of the gluteal muscle increased the intramuscular stress: An in-silico implication of deep tissue injury. Heliyon 2023; 9:e13459. [PMID: 36816309 PMCID: PMC9929311 DOI: 10.1016/j.heliyon.2023.e13459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Objectives Deep tissue injury is a common form of pressure ulcers in muscle tissues under bony prominences caused by sustained pressure or shear, which has a great impact on patients with restricted mobility such as spinal cord injury. Frequent spasms in spinal cord injury patients featured by muscle stiffening may be one of the factors leading to deep tissue injury. The purpose of this study was to investigate the relationship between the gluteal muscle shear modulus and intramuscular compressive/shear stress/strain. Methods A semi-3D finite element model of the human buttock was established using COMSOL software and the acquired biomechanical data were analyzed through Pearson correlation and Spearman correlation. Results Results showed that the compressive stress, strain energy density, and average von Mises stress increased with the increase of the gluteal muscle shear modulus. Conclusion These results may indicate muscle stiffening caused by muscle spasms could lead to higher deep tissue injury development risk as well as shed light on effective treatments for relieving muscular sclerosis mechanically.
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Affiliation(s)
- Jingyi Jia
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, 1954 Huashan Road, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Shengbo Gong
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, 1954 Huashan Road, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Aili Zhang
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China
| | - Liping Jiang
- Nursing Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai 200092, China
| | - Yifei Yao
- School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, 1954 Huashan Road, Shanghai Jiao Tong University, Shanghai 200030, China,Corresponding author. School of Biomedical Engineering, Med-X Research Institute, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai 200030, China.
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Bogard F, Polidori G, Murer S, Maalouf C, Blancheteau Y, Quinart H, Beaumont F. Hygro-thermo-mechanical performance of wheelchair cushion technologies in the prevention of pressure ulcers and moisture-associated skin damages. Assist Technol 2023; 35:64-73. [PMID: 34185618 DOI: 10.1080/10400435.2021.1949406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
This study aims at investigating the effects of three different wheelchair cushion technologies at the patient-wheelchair interface. To this end, eight participants were recruited to remain in an unrelieved seated position on a wheelchair successively equipped with three different cushions (foam, air-cell-based and gel), for a duration of 45 min. Interface pressure, temperature (measured with infrared thermography) and relative humidity were measured at the seat interface, at different timestamps. Experimental results show that foam cushion is significantly more efficient in reducing contact peak pressure (p < .01), while the gel cushion displays higher heat evacuation capabilities. In terms of relative humidity, no significant difference is observed among the three technologies (p > .29): all of them evacuate around only 10% of the total humidity compared to the reference situation (i.e., without cushion). Besides, a complementary numerical simulation corresponding to the steady state of the patient-wheelchair structure clearly highlights the temperature volume field at the underside of the seat, which acts like a thermal barrier and contributes to heat accumulation. Besides, an air flow at the underside of the chair in motion is shown to significantly reduce heat accumulation.
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Affiliation(s)
- Fabien Bogard
- MATIM Laboratory, University of Reims Champagne Ardenne, Reims, France
- Pôle de Recherche Châlonnais, University of Reims Champagne Ardenne, Reims, France
| | | | - Sébastien Murer
- MATIM Laboratory, University of Reims Champagne Ardenne, Reims, France
| | - Chadi Maalouf
- MATIM Laboratory, University of Reims Champagne Ardenne, Reims, France
| | | | | | - Fabien Beaumont
- MATIM Laboratory, University of Reims Champagne Ardenne, Reims, France
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Mannella D, Bellusci M, Graziani F, Ferraresi C, Muscolo GG. Modelling, design and control of a new seat-cushion for pressure ulcers prevention. Proc Inst Mech Eng H 2022; 236:9544119211068908. [PMID: 35068250 DOI: 10.1177/09544119211068908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Pressure ulcers are a frequent complication in patients having limited activity and mobility (e.g., elderly people, spinal cord injury patients, people with disabilities, etc.). The aim of this work is the conceptual design, modelling and control of a new seat cushion for pressure ulcers prevention. The whole system (constituted by the seat cushion equipped with a real-time pressure mapping with closed-loop control) is designed to identify the critical points on the human skin, before pressure ulcers creation, and to be able to distribute the contact pressure between the human and cushion avoiding wound creation. The seat cushion is constituted by soft air-cells actuated by air flow. To define the shape and size of the soft air-cells, finite element simulations are carried out, analysing the internal volume reduction with external loads application to reproduce the variable stiffness. The data obtained by finite element analysis are used to simulate inflation and deflation of the soft bubble air-cells. Finally, the control systems of a single air-cell and of the whole cushion are designed and simulated. The novelty of our work consists in the conception of a seat cushion able to recognise higher and lower risk zones of pressure ulcer generation on the human skin and to provide compensation automatically. This work can therefore be considered in line with the sustainable development goals recently launched by the EU Commission.
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Affiliation(s)
- Daniele Mannella
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Piemonte, Italy
| | - Marco Bellusci
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Piemonte, Italy
| | - Francesco Graziani
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Piemonte, Italy
| | - Carlo Ferraresi
- Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Torino, Piemonte, Italy
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