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Cheng ESW, Lai DKH, Mao YJ, Lee TTY, Lam WK, Cheung JCW, Wong DWC. Computational Biomechanics of Sleep: A Systematic Mapping Review. Bioengineering (Basel) 2023; 10:917. [PMID: 37627802 PMCID: PMC10451553 DOI: 10.3390/bioengineering10080917] [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: 06/30/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Biomechanical studies play an important role in understanding the pathophysiology of sleep disorders and providing insights to maintain sleep health. Computational methods facilitate a versatile platform to analyze various biomechanical factors in silico, which would otherwise be difficult through in vivo experiments. The objective of this review is to examine and map the applications of computational biomechanics to sleep-related research topics, including sleep medicine and sleep ergonomics. A systematic search was conducted on PubMed, Scopus, and Web of Science. Research gaps were identified through data synthesis on variants, outcomes, and highlighted features, as well as evidence maps on basic modeling considerations and modeling components of the eligible studies. Twenty-seven studies (n = 27) were categorized into sleep ergonomics (n = 2 on pillow; n = 3 on mattress), sleep-related breathing disorders (n = 19 on obstructive sleep apnea), and sleep-related movement disorders (n = 3 on sleep bruxism). The effects of pillow height and mattress stiffness on spinal curvature were explored. Stress on the temporomandibular joint, and therefore its disorder, was the primary focus of investigations on sleep bruxism. Using finite element morphometry and fluid-structure interaction, studies on obstructive sleep apnea investigated the effects of anatomical variations, muscle activation of the tongue and soft palate, and gravitational direction on the collapse and blockade of the upper airway, in addition to the airflow pressure distribution. Model validation has been one of the greatest hurdles, while single-subject design and surrogate techniques have led to concerns about external validity. Future research might endeavor to reconstruct patient-specific models with patient-specific loading profiles in a larger cohort. Studies on sleep ergonomics research may pave the way for determining ideal spine curvature, in addition to simulating side-lying sleep postures. Sleep bruxism studies may analyze the accumulated dental damage and wear. Research on OSA treatments using computational approaches warrants further investigation.
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Affiliation(s)
- Ethan Shiu-Wang Cheng
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Department of Electronic and Information Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Derek Ka-Hei Lai
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Ye-Jiao Mao
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Timothy Tin-Yan Lee
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - Wing-Kai Lam
- Sports Information and External Affairs Centre, Hong Kong Sports Institute, Hong Kong
| | - James Chung-Wai Cheung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong
- Research Institute for Sports Science and Technology, The Hong Kong Polytechnic University, Hong Kong
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Liu S, Beillas P, Ding L, Wang X. PIPER adult comfort: an open-source full body human body model for seating comfort assessment and its validation under static loading conditions. Front Bioeng Biotechnol 2023; 11:1170768. [PMID: 37324425 PMCID: PMC10267746 DOI: 10.3389/fbioe.2023.1170768] [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: 02/21/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: In this paper we introduce an adult-sized FE full-body HBM for seating comfort assessments and present its validation in different static seating conditions in terms of pressure distribution and contact forces. Methods: We morphed the PIPER Child model into a male adult-sized model with the help of different target sources including his body surface scans, and spinal and pelvic bone surfaces and an open sourced full body skeleton. We also introduced soft tissue sliding under the ischial tuberosities (ITs). The initial model was adapted for seating applications with low modulus soft tissue material property and mesh refinements for buttock regions, etc. We compared the contact forces and pressure-related parameters simulated using the adult HBM with those obtained experimentally from the person whose data was used for the model development. Four seat configurations, with the seat pan angle varying from 0° to 15° and seat-to-back angle fixed at 100°, were tested. Results: The adult HBM could correctly simulate the contact forces on the backrest, seat pan, and foot support with an average error of less than 22.3 N and 15.5 N in the horizontal and vertical directions, which is small considering the body weight (785 N). In terms of contact area, peak, and mean pressure, the simulation matched well with the experiment for the seat pan. With soft tissue sliding, higher soft tissue compression was obtained in agreement with the observations from recent MRI studies. Discussion: The present adult model could be used as a reference using a morphing tool as proposed in PIPER. The model will be published openly online as part of the PIPER open-source project (www.PIPER-project.org) to facilitate its reuse and improvement as well as its specific adaptation for different applications.
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Affiliation(s)
- Shenghui Liu
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
- Université de Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T 9406, Lyon, France
| | - Philippe Beillas
- Université de Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T 9406, Lyon, France
| | - Li Ding
- Key Laboratory of Biomechanics and Mechanobiology, Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xuguang Wang
- Université de Lyon, Université Claude Bernard Lyon 1, Université Gustave Eiffel, LBMC UMR_T 9406, Lyon, France
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Arnold N, Scott J, Bush TR. A review of the characterizations of soft tissues used in human body modeling: Scope, limitations, and the path forward. J Tissue Viability 2023; 32:286-304. [PMID: 36878737 DOI: 10.1016/j.jtv.2023.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 02/27/2023]
Abstract
Soft tissue material properties are vital to human body models that evaluate interactions between the human body and its environment. Such models evaluate internal stress/strain responses in soft tissues to investigate issues like pressure injuries. Numerous constitutive models and parameters have been used to represent mechanical behavior of soft tissues in biomechanical models under quasi-static loading. However, researchers reported that generic material properties cannot accurately represent specific target populations due to large inter-individual variability. Two challenges that exist are experimental mechanical characterization and constitutive modeling of biological soft tissues and personalization of constitutive parameters using non-invasive, non-destructive bedside testing methods. It is imperative to understand the scope and appropriate applications for reported material properties. Thus, the goal of this paper was to compile studies from which soft tissue material properties were obtained and categorize them by source of tissue samples, methods used to quantify deformation, and material models used to describe tissues. The collected studies displayed wide ranges of material properties, and factors that affected the properties included whether tissue samples were in vivo or ex vivo, from humans or animals, the body region tested, body position during in vivo studies, deformation measurements, and material models used to describe tissues. Because of the factors that affected reported material properties, it is clear that much progress has been made in understanding soft tissue responses to loading, yet there is a need to broaden the scope of reported soft tissue material properties and better match reported properties to appropriate human body models.
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Affiliation(s)
- Nicole Arnold
- Department of Mechanical Engineering, Michigan State University, 428 S Shaw Lane, Rm. 2555 Engineering Building, East Lansing, MI, 48824-1226, USA
| | - Justin Scott
- Department of Mechanical Engineering, Michigan State University, 428 S Shaw Lane, Rm. 2555 Engineering Building, East Lansing, MI, 48824-1226, USA
| | - Tamara Reid Bush
- Department of Mechanical Engineering, Michigan State University, 428 S Shaw Lane, Rm. 2555 Engineering Building, East Lansing, MI, 48824-1226, USA.
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Trebbi A, Mukhina E, Rohan PY, Connesson N, Bailet M, Perrier A, Payan Y. MR-based quantitative measurement of human soft tissue internal strains for pressure ulcer prevention. Med Eng Phys 2022; 108:103888. [DOI: 10.1016/j.medengphy.2022.103888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/27/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
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Finite Element Methods for Modeling the Pressure Distribution in Human Body–Seat Interactions: A Systematic Review. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The objective of this systematic review is to investigate the various approaches that have been undertaken in finite element analysis (FEA) of human–seat interactions and synthesize the existing knowledge. With advances in numerical simulation and digital human modeling, FEA has emerged as a powerful tool to study seating comfort and discomfort. FEA employs various biomechanical factors to predict the contact stress and pressure distribution in a particular seat design. Given the complexity of human–seat interaction, several modeling and processing steps are required to conduct realistic FEA. The steps of how to perform an FEA simulation on human–seat interactions, the different models used, the model mesh compositions, and the material properties are discussed and reviewed in this paper. This can be used as a guideline for future studies in the context of FEA of human–seat interactions.
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3D finite-element modeling of air-cell-based cushions and buttock tissues during prolonged sitting. Comput Biol Med 2022; 142:105229. [DOI: 10.1016/j.compbiomed.2022.105229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/21/2021] [Accepted: 01/06/2022] [Indexed: 11/17/2022]
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Chawla S, Deshmukh S. FEAr no more! Finite element analysis in orthodontics. JOURNAL OF THE INTERNATIONAL CLINICAL DENTAL RESEARCH ORGANIZATION 2022. [DOI: 10.4103/jicdro.jicdro_79_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhao D, Li Y, Langlois T, Chaudhuri S, Barbic J. ERGOBOSS: Ergonomic Optimization of Body-Supporting Surfaces. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2021; PP:4032-4047. [PMID: 34520357 DOI: 10.1109/tvcg.2021.3112127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Humans routinely sit or lean against supporting surfaces and it is important to shape these surfaces to be comfortable and ergonomic. We give a method to design the geometric shape of rigid supporting surfaces to maximize the ergonomics of physically based contact between the surface and a deformable human. We model the soft deformable human using a layer of FEM deformable tissue surrounding a rigid core, with measured realistic elastic material properties, and large-deformation nonlinear analysis. We define a novel cost function to measure the ergonomics of contact between the human and the supporting surface. We give a stable and computationally efficient contact model that is differentiable with respect to the supporting surface shape. This makes it possible to optimize our ergonomic cost function using gradient-based optimizers. Our optimizer produces supporting surfaces superior to prior work on ergonomic shape design. Our examples include furniture, apparel and tools. We also validate our results by scanning a real human subject's foot and optimizing a shoe sole shape to maximize foot contact ergonomics. We 3D-print the optimized shoe sole, measure contact pressure using pressure sensors, and demonstrate that the real unoptimized and optimized pressure distributions qualitatively match those predicted by our simulation.
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Gefen A, Brienza DM, Cuddigan J, Haesler E, Kottner J. Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries. Int Wound J 2021; 19:692-704. [PMID: 34382331 PMCID: PMC8874092 DOI: 10.1111/iwj.13667] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/25/2021] [Indexed: 12/25/2022] Open
Abstract
In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up‐to‐date evidence‐based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.
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Affiliation(s)
- Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - David M Brienza
- Departments of Rehabilitation Science and Technology & Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janet Cuddigan
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Haesler
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.,Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, LaTrobe University, Melbourne, Victoria, Australia.,Australian National University Medical School, Academic Unit of General Practice, Australian National University, Canberra, ACT, Australia
| | - Jan Kottner
- Charité Center 1 for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Wang X, Savonnet L, Capbern L, Duprey S. A Case Study on the Effects of Foam and Seat Pan Inclination on the Deformation of Seated Buttocks Using MRI. IISE Trans Occup Ergon Hum Factors 2021. [PMID: 34569437 DOI: 10.1080/24725838.2021.1984340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OCCUPATIONAL APPLICATIONSWe investigated the effects of seat pan inclination and foam on the deformation of the seated buttocks using an upright MRI system. From observations among four healthy males, we found that soft tissue deformation under the ischial tuberosity (IT) could be reduced not only by using a soft cushion, but also by decreasing the shear force on the seat pan surface. These results suggest that soft tissue deformation could be used as an objective measure for assessing seating discomfort and injury risk, by accounting for the effects of both contact pressure and shear. We also confirmed that the gluteus maximus (GM) muscle displaced away from the IT once seated. As peak pressure and shear are most likely located below the IT, more realistic computational human body models in this region are needed that consider muscle sliding.
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Affiliation(s)
- Xuguang Wang
- Univ-Lyon, Université Claude Bernard Lyon1, Université Gustave Eiffel, LBMC UMR_T9406, F69622, Lyon, France
| | - Léo Savonnet
- Univ-Lyon, Université Claude Bernard Lyon1, Université Gustave Eiffel, LBMC UMR_T9406, F69622, Lyon, France
| | - Loïc Capbern
- Univ-Lyon, Université Claude Bernard Lyon1, Université Gustave Eiffel, LBMC UMR_T9406, F69622, Lyon, France
| | - Sonia Duprey
- Univ-Lyon, Université Claude Bernard Lyon1, Université Gustave Eiffel, LBMC UMR_T9406, F69622, Lyon, France
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Pehnec I, Marinić-Kragić I, Vučina D. Robust evolutionary shape optimization for ergonomic excellence based on contact pressure distribution. Comput Methods Biomech Biomed Engin 2020; 23:945-958. [DOI: 10.1080/10255842.2020.1774751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Igor Pehnec
- FESB, Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture, University of Split, Split, Croatia
| | - Ivo Marinić-Kragić
- FESB, Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture, University of Split, Split, Croatia
| | - Damir Vučina
- FESB, Faculty of Electrical Engineering, Mechanical Engineering and Naval Architecture, University of Split, Split, Croatia
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Savonnet L, Duprey S, Van Sint Jan S, Wang X. Pelvis and femur shape prediction using principal component analysis for body model on seat comfort assessment. Impact on the prediction of the used palpable anatomical landmarks as predictors. PLoS One 2019; 14:e0221201. [PMID: 31454359 PMCID: PMC6711593 DOI: 10.1371/journal.pone.0221201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 08/01/2019] [Indexed: 11/19/2022] Open
Abstract
A personalized pelvis and femur shape is required to build a finite element buttock thigh model when experimentally investigating seating discomfort. The present study estimates the shape of pelvis and femur using a principal component analysis (PCA) based method with a limited number of palpable anatomical landmarks (ALs) as predictors. A leave-one-out experiment was designed using 38 pelvises and femurs from a same sample of adult specimens. As expected, prediction errors decrease with the number of ALs. Using the maximum number of easily palpable ALs (13 for pelvis and 4 for femur), average errors were 5.4 and 4.8 mm respectively for pelvis and femur. Better prediction was obtained when the shapes of pelvis and femur were predicted separately without merging the data of both bones. Results also show that the PCA based method is a good alternative to predict hip and lumbosacral joint centers with an average error of 5.0 and 9.2 mm respectively.
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Affiliation(s)
- Léo Savonnet
- Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Sonia Duprey
- Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Serge Van Sint Jan
- Laboratory of Anatomy, Biomechanics and Organogenesis (LABO) of Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Xuguang Wang
- Univ Lyon, Université Claude Bernard Lyon 1, Lyon, France
- * E-mail:
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Wang X, Cardoso M, Theodorakos I, Beurier G. A parametric investigation on seat/occupant contact forces and their relationship with initially perceived discomfort using a configurable seat. ERGONOMICS 2019; 62:891-902. [PMID: 30912482 DOI: 10.1080/00140139.2019.1600050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 03/20/2019] [Indexed: 06/09/2023]
Abstract
The present work investigates the contact forces between sitters and seat as well as their correlations with perceived discomfort. Twelve different economy class aeroplane seat configurations were simulated using a multi-adjustable experimental seat by varying seat pan and backrest angles, as well as seat pan compressed surface. Eighteen males and 18 females, selected by their body mass index and stature, tested these configurations for two sitting postures. Perceived discomfort was significantly affected by seat parameters and posture and correlated both with normal force distribution on the seat-pan surface and with normal forces at the lumbar and head supports. Lower discomfort ratings were obtained for more evenly distributed normal forces on the seat pan. Shear force at the seat pan surface was at its lowest when sitters were allowed to self-select their seat-pan angle, supporting that a shear force should be reduced but not zeroed to improve seating comfort. Practitioner Summary: The effects of seat-pan and backrest angle, anthropometric dimensions and sitting posture on contact forces and perceived discomfort were investigated using a multi-adjustable experimental seat. In addition to preferred seat profile parameters, the present work provides quantitative guidelines on contact force requirement for improving seating comfort.
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Affiliation(s)
- Xuguang Wang
- a Université de Lyon , Lyon , France
- b Université Claude Bernard Lyon 1 , Villeurbanne , France
- c IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et mécanique des chocs , Bron , France
| | - Michelle Cardoso
- a Université de Lyon , Lyon , France
- b Université Claude Bernard Lyon 1 , Villeurbanne , France
- c IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et mécanique des chocs , Bron , France
| | - Ilias Theodorakos
- a Université de Lyon , Lyon , France
- b Université Claude Bernard Lyon 1 , Villeurbanne , France
- c IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et mécanique des chocs , Bron , France
| | - Georges Beurier
- a Université de Lyon , Lyon , France
- b Université Claude Bernard Lyon 1 , Villeurbanne , France
- c IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomécanique et mécanique des chocs , Bron , France
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Leung IPH, Fleming LT, Walton K, Barrans SM, Ousey K. Finite element analysis to model ischemia experienced in the development of device related pressure ulcers. Proc Inst Mech Eng H 2019; 233:745-753. [DOI: 10.1177/0954411919851387] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Isaac PH Leung
- Centre for Precision Technologies (CPT), School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - Leigh T Fleming
- Materials and Engineering Research Institute (MERI), Department of Engineering and Mathematics, Sheffield Hallam University, Sheffield, UK
| | - Karl Walton
- Centre for Precision Technologies (CPT), School of Computing and Engineering, University of Huddersfield, Huddersfield, UK
| | - Simon M Barrans
- Turbocharger Research Institute, University of Huddersfield, Huddersfield, UK
| | - Karen Ousey
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
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Microclimate: A critical review in the context of pressure ulcer prevention. Clin Biomech (Bristol, Avon) 2018; 59:62-70. [PMID: 30199821 DOI: 10.1016/j.clinbiomech.2018.09.010] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/01/2018] [Accepted: 09/04/2018] [Indexed: 02/07/2023]
Abstract
Pressure ulcers are caused by sustained mechanical loading and deformation of the skin and subcutaneous layers between internal stiff anatomical structures and external surfaces or devices. In addition, the skin microclimate (temperature, humidity and airflow next to the skin surface) is an indirect pressure ulcer risk factor. Temperature and humidity affect the structure and function of the skin increasing or lowering possible damage thresholds for the skin and underlying soft tissues. From a pressure ulcer prevention research perspective, the effects of humidity and temperature next to the skin surface are inextricably linked to concurrent soft tissue deformation. Direct clinical evidence supporting the association between microclimate and pressure ulceration is sparse and of high risk of bias. Currently, it is recommended to keep the skin dry and cool and/or to allow recovery periods between phases of occlusion. The stratum corneum must be prevented from becoming overhydrated or from drying out but exact ranges of an acceptable microclimate are unknown. Therefore, vague terms like 'microclimate management' should be avoided but product and microclimate characteristics should be explicitly stated to allow an informed decision making. Pressure ulcer prevention interventions like repositioning, the use of special support surfaces, cushions, and prophylactic dressings are effective only if they reduce sustained deformations in soft tissues. This mode of action outweighs possible undesirable microclimate properties. As long as uncertainty exists efforts must be taken to use as less occlusive materials as possible. There seems to be individual intrinsic characteristics making patients more vulnerable to microclimate effects.
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