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Portoghese C, Deppisch M, Sonenblum S, Samson B, Munro C, Capasso V, Call E, Black J, Brienza D. The Role of Shear Stress and Shear Strain in Pressure Injury Development. Adv Skin Wound Care 2024; 37:20-25. [PMID: 38117167 DOI: 10.1097/asw.0000000000000075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
ABSTRACT Although other patient safety indicators have seen a decline, pressure injury (PI) incidence has continued to rise. In this article, the authors discuss the role of shear stress and shear strain in PI development and describe how accurate assessment and management can reduce PI risk. They provide explanations of shear stress, shear strain, friction, and tissue deformation to support a better clinical understanding of how damaging these forces are for soft tissue. Clinicians must carefully assess each patient's risk factors regarding shear forces within the contexts of activity and mobility. The authors also provide a toolbox of mitigation strategies, including support surface selection, selection of materials that contact the individual, management of immobility using positioning techniques, and the use of safe patient handling techniques. With a clear understanding of how shear forces affect PI risk and mitigation strategies, clinicians will more accurately assess PI risk and improve PI prevention care plans, ultimately reducing PI incidence to become more aligned with other patient safety indicators.
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Affiliation(s)
- Caroline Portoghese
- Caroline Portoghese, OTR/L, ATP/SMS, is Assistive Technology Professional and Rehabilitation Consultant, Handi Medical, Saint Paul, Minnesota. Michelle Deppisch, PT, CWS, is Wound Care Consultant, Michele Deppisch PT, CWS, LLC, Hertford, North Carolina. Sharon Sonenblum, PhD, is Principal Research Scientist, George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia. Barbara Samson, OTR/L, MBA, CWS, CSPHC, is Executive Clinical Specialist, Mölnlycke Health Care, Peachtree Corners, Georgia. Cassendra Munro, PhD, RN, RNFA, CNOR, Nurse Scientist, Stanford Health Care, Office of Research, Patient Care Services, Menlo Park, California. Virginia Capasso, PhD, ANP-BC, ACNS-BC, CWS, is Advanced Practice Nurse and Nurse Scientist, Massachusetts General Hospital, Boston, Massachusetts, and Instructor in Surgery, Harvard Medical School, Boston. Evan Call, MS, CSM-NRM, is Adjunct Faculty, Weber State University, Ogden, Utah. Joyce Black, PhD, RN, FAAN, is Florence Neidfelt Professor of Nursing, University of Nebraska Medical Center, College of Nursing, Omaha, Nebraska. David Brienza, PhD, is Professor, University of Pittsburgh, Pittsburgh, Pennsylvania. The authors have disclosed no financial relationships related to this article. Submitted March 12, 2023; accepted in revised form July 5, 2023
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Jordan K, Vos-Draper T, Morrow M, Sonenblum S. The usability of two mobile health assistive technologies for wheelchair-related in-seat movement and pressure. J Rehabil Assist Technol Eng 2023; 10:20556683231211808. [PMID: 38028632 PMCID: PMC10648002 DOI: 10.1177/20556683231211808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction This study aimed to understand the degree to which two different mobile health assistive technologies, AW-Shift© and Sensoria® Mat, addressed seven constructs for managing wheelchair-related in-seat movement and pressure. Methods After using each intervention system, participants answered questions regarding the general usability and usefulness of the systems. Results System Usability Survey scores ranged from 5 (Poor) to 97.5 (Excellent), with a median response of 60.0 (Okay) for AW-Shift© and 76.3 (Good) for Sensoria® Mat. Participants reported using AW-Shift© to check areas of high pressure on their cushion, the quality of their weight shifts, and their posture significantly more often than to check the condition of their cushion or to track their movement goals. Participants reported using Sensoria® Mat to check the quality and number of weight shifts, and their posture significantly more often than to check the condition of their cushion. Conclusions The findings of this study highlight that there is no one-size-fits-all solution and that different subpopulations of wheelchair users may have different needs and preferences. Optimizing the design for specific cohorts or constructs can result in an effective product that consistently provides meaningful and accurate information about behavior and performance.
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Affiliation(s)
- Kathleen Jordan
- Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Tamara Vos-Draper
- Program in Occupational Therapy, University of Minnesota, Minneapolis, MN, USA
| | - Melissa Morrow
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA
| | - Sharon Sonenblum
- Department of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Abstract
OBJECTIVE To assess pressure ulcer (PU) risk in persons with mobility impairments using a large data set to identify demographic, laboratory, hemodynamic, and pharmacologic risk factors. METHODS The cohort of interest was persons with disabilities who have mobility impairments and are diagnostically at risk of PUs. To define this cohort, diagnoses that qualify patients for skin protection wheelchair cushions were used. Data were obtained from the Cerner Health Facts data warehouse. Two cohorts were defined: persons with and without a history of PUs. Analysis included descriptive statistics and multivariate logistic regression modeling. Variables retained in the model were identified using LASSO, gradient boosting, and Bayesian model averaging. MAIN RESULTS The resulting cohorts included more than 87,000 persons with a history of PUs and more than 1.1 million persons who did not have a PU. The data revealed seven disability groups with the greatest prevalence of PUs: those with Alzheimer disease, cerebral palsy, hemiplegia, multiple sclerosis, paraplegia/quadriplegia, Parkinson disease, and spina bifida. Ulcers in the pelvic region accounted for 82% of PUs. Persons with disabilities who were male or black had a greater prevalence of PUs. Physiologic risk factors included the presence of kidney or renal disease, decreased serum albumin, and increased serum C-reactive protein. CONCLUSIONS The results indicate that, although persons with disabilities can exhibit a wide functional range, they remain at risk of PUs and should be evaluated for proper preventive measures, including support surfaces and wheelchair cushions.
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Affiliation(s)
- Stephen Sprigle
- Stephen Sprigle, PhD, PT, is Professor, Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, in Atlanta, Georgia. Douglas McNair, MD, PhD, is Senior Advisor, Global Health - Analytics Innovation, Bill and Melinda Gates Foundation, in Seattle, Washington. Sharon Sonenblum, PhD, is Principal Research Engineer, Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, in Atlanta, Georgia. The authors have disclosed no financial relationships related to this article. Submitted August 30, 2019; accepted in revised form October 1, 2019
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Barbareschi G, Sonenblum S, Holloway C, Sprigle S. Does the setting matter? Observing wheelchair transfers across different environmental conditions. Assist Technol 2020; 34:326-333. [PMID: 32897816 DOI: 10.1080/10400435.2020.1818328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The setting in which wheelchair transfers are performed can affect the difficulty and the risks associated with completion. This article presents results from an observational study involving 13 wheelchair users performing independent transfers across four settings. The aim is to understand how the environment affects how different types of independent transfers are performed. Descriptive analysis was performed alongside an objective assessment using the Transfer Assessment Instrument (TAI). The perceived difficulty reported after each transfer was also collected. Two participants exhibited radically different transferring techniques in different scenarios. Additionally, the transferring scenario was found to significantly affect the perceived difficulty of sitting transfers (toilet 2.17 ±.88; bed 1.47 ±.65, p =.001; car 1.63 ±.82, p =.012) and standing transfers (car 3.5 ±.71; bed 1 ± 0, p =.03; toilet 1 ± 0, p =.03), and the TAI score attributed to sitting pivot with use of a transfer board (couch 4.3 ±.88; bed 6.93 ± 1.29, p =.022; car 7.13 ± 1.32, p =.018). Overall, environmental constraints can lead to major technique changes and, more often, to different positioning of hands and feet which could impact the transfer's biomechanics.
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Affiliation(s)
| | - Sharon Sonenblum
- Rehabilitation Engineering and Applied Research, Georgia Institute of Technology, Atlanta, Georgia, USA
| | | | - Stephen Sprigle
- Rehabilitation Engineering and Applied Research, Georgia Institute of Technology, Atlanta, Georgia, USA
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Fyffe D, Sonenblum S, Dyson-Hudson T. Personal and Cultural Factors Associated with Functional Independence in SCI. Arch Phys Med Rehabil 2019. [DOI: 10.1016/j.apmr.2019.08.308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Barbareschi G, Holloway C, Bianchi-Berthouze N, Sonenblum S, Sprigle S. Use of a Low-Cost, Chest-Mounted Accelerometer to Evaluate Transfer Skills of Wheelchair Users During Everyday Activities: Observational Study. JMIR Rehabil Assist Technol 2018; 5:e11748. [PMID: 30573447 PMCID: PMC6320409 DOI: 10.2196/11748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 01/19/2023] Open
Abstract
Background Transfers are an important skill for many wheelchair users (WU). However, they have also been related to the risk of falling or developing upper limb injuries. Transfer abilities are usually evaluated in clinical settings or biomechanics laboratories, and these methods of assessment are poorly suited to evaluation in real and unconstrained world settings where transfers take place. Objective The objective of this paper is to test the feasibility of a system based on a wearable low-cost sensor to monitor transfer skills in real-world settings. Methods We collected data from 9 WU wearing triaxial accelerometer on their chest while performing transfers to and from car seats and home furniture. We then extracted significant features from accelerometer data based on biomechanical considerations and previous relevant literature and used machine learning algorithms to evaluate the performance of wheelchair transfers and detect their occurrence from a continuous time series of data. Results Results show a good predictive accuracy of support vector machine classifiers when determining the use of head-hip relationship (75.9%) and smoothness of landing (79.6%) when the starting and ending of the transfer are known. Automatic transfer detection reaches performances that are similar to state of the art in this context (multinomial logistic regression accuracy 87.8%). However, we achieve these results using only a single sensor and collecting data in a more ecological manner. Conclusions The use of a single chest-placed accelerometer shows good predictive accuracy for algorithms applied independently to both transfer evaluation and monitoring. This points to the opportunity for designing ubiquitous-technology based personalized skill development interventions for WU. However, monitoring transfers still require the use of external inputs or extra sensors to identify the start and end of the transfer, which is needed to perform an accurate evaluation.
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Affiliation(s)
| | | | | | - Sharon Sonenblum
- Rehabilitation Engineering and Applied Research Laboratory, Georgia Institute of Technology, Atlanta, GA, United States
| | - Stephen Sprigle
- Rehabilitation Engineering and Applied Research Laboratory, Georgia Institute of Technology, Atlanta, GA, United States
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Sprigle S, Sonenblum S, Conner-Kerr T. mobilityRERC state of the science conference: individualizing pressure ulcer risk and prevention strategies. Disabil Rehabil Assist Technol 2013; 8:454-61. [DOI: 10.3109/17483107.2013.823574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The formation and underlying causes of pressure ulcers (PUs) are quite complex, with multiple influencing factors. However, by definition pressure ulcers cannot form without loading, or pressure, on tissue. Clinical interventions typically target the magnitude and/or duration of loading. Pressure magnitude is managed by the selection of support surfaces and postural supports as well as body posture on supporting surfaces. Duration is addressed via turning and weight shifting frequency as well as with the use of dynamic surfaces that actively redistribute pressure on the body surfaces. This article shows that preventative interventions must be targeted to both magnitude and duration and addresses the rationale behind several common clinical interventions--some with more scientific evidence than others.
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Affiliation(s)
- Stephen Sprigle
- Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, Atlanta, GA, USA.
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Hoenig H, Huffman K, Iezzoni L, Levy CE, Sonenblum S, Sprigle S. Motorized scooters: boon or bane? Am J Cardiol 2010; 106:601; author reply 601-2. [PMID: 20691325 DOI: 10.1016/j.amjcard.2010.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 05/17/2010] [Accepted: 05/20/2010] [Indexed: 11/25/2022]
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Carter HO, Hochwald W, Striner HE, Sonenblum S. Local Impact of Foreign Trade, a Study of Methods of Local Economic Accounting, a Staff Report. J Am Stat Assoc 1961. [DOI: 10.2307/2282300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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