Developing the tissue viability seating guidelines

Background: Costs for the prevention and management of pressure ulcers have increased significantly with limited published advice from health and social care organisations on seating and preventing pressure ulcers. At the request of the UK Tissue Viability Society the aim of the publication was to develop a practical guide for people, carers and health and social care professionals on how the research and evidence base on pressure ulcer prevention and management can be applied to those who remain seated for extended periods of time. Methods and findings: The evidence base informing the guidelines was obtained by applying a triangulation of methods: a literature review, listening event and stakeholder group consultation. The purpose was to engage users and carers, academics, clinicians, inspectorate and charities, with an interest in seating, positioning and pressure management to: gather views, feedback, stories, and evidence of the current practices in the field to create a greater awareness of the issue. Conclusion: The new guidelines are inclusive of all people with short and long-term mobility issues to include all population groups. The document includes evidence on where pressure ulcers develop when seated, risk factors, best possible seated position and what seat adjustments are required, the ideal seating assessment, interventions, self-help suggestions and key seating outcomes. The updated TVS CPGs have been informed by the best available evidence, the insights and wisdom of experts, stakeholders and people who spend extended periods of time sitting

Development and Feasibility of the Wheelchair in-Seat Activity Tracker (WiSAT) Clinical Protocol

Wheelchair users are at a higher risk for developing pressure injuries due to reduced mobility, impaired sensation, and spending a large portion of their time in the seated position. Pressure injuries can be a very costly and life threatening complication for wheelchair users. One strategy for pressure injury prevention is to complete weight shifts and pressure reliefs. Literature shows that there is a low adherence to the pressure relief and weight shift clinical guidelines by wheelchair users. The Wheelchair in-Seat Activity Tracker (WiSAT) has been developed to help wheelchair users track their in-seat movement and help aid in the prevention of developing pressure injuries. The objective of this preliminary study is to examine the WiSAT system’s potential to impact behavior using a single-subject design and evaluate the clinical protocol developed to assess the effect of the WiSAT system on in-seat movement behavior. One individual who used a manual wheelchair participated in the study. He completed two study visits and used the WiSAT system in his natural environment for 5 months. The results of his participation revealed that the WiSAT system may have an impact on in-seat behavior, but more subjects are needed to establish the WiSAT system’s effectiveness. In addition, throughout the recruitment process and the participant’s equipment trial, numerous protocol issues were discovered and resolved. The modifications and improvements made as a result of this preliminary study will reduce the extent of future problems with the WiSAT equipment as well as minimize the amount of missing data

Sensores de fibra ótica para arquiteturas e-Health

In this work, optical fiber sensors were developed and optimized for biomedical applications in wearable and non-intrusive and/or invisible solutions. As it was intended that the developed devices would not interfere with the user's movements and their daily life, the fibre optic sensors presented several advantages when compared to conventional electronic sensors, among others, the following stand out: size and reduced weight, biocompatibility, safety, immunity to electromagnetic interference and high sensitivity. In a first step, wearable devices with fibre optic sensors based in Fiber Bragg gratings (FBG) were developed to be incorporated into insoles to monitor different walking parameters based on the analysis of the pressure exerted on several areas of the insole. Still within this theme, other sensors were developed using the same sensing technology, but capable of monitoring pressure and shear forces simultaneously. This work was pioneering and allowed monitoring one of the main causes of foot ulceration in people with diabetes: shear. At a later stage, the study focused on the issue related with the appearance of ulcers in people with reduced mobility and wheelchair users. In order to contribute to the mitigation of this scourge, a system was developed composed of a network of fibre optic sensors capable of monitoring the pressure at various points of the wheelchair. It not only measures the pressure at each point, but also monitors the posture of the wheelchair user and advises him/her to change posture regularly to reduce the probability of this pathology occurring. Still within this application, another work was developed where the sensor not only monitored the pressure but also the temperature in each of the analysis points, thus indirectly measuring shear. In another phase, plastic fibre optic sensors were studied and developed to monitor the body posture of an office chair user. Simultaneously, software was developed capable of monitoring and showing the user all the acquired data in real time and warning for incorrect postures, as well as advising for work breaks. In a fourth phase, the study focused on the development of highly sensitive sensors embedded in materials printed by a 3D printer. The sensor was composed of an optical fibre with a FBG and the sensor body of a flexible polymeric material called "Flexible". This material was printed on a 3D printer and during its printing the optical fibre was incorporated. The sensor proved to be highly sensitive and was able to monitor respiratory and cardiac rate, both in wearable solutions (chest and wrist) and in "invisible" solutions (office chair).Neste trabalho foram desenvolvidos e otimizados sensores em fibra ótica para aplicações biomédicas em soluções vestíveis e não intrusivas/ou invisíveis. Tendo em conta que se pretende que os dispositivos desenvolvidos não interfiram com os movimentos e o dia-a-dia do utilizador, os sensores de fibra ótica apresentam inúmeras vantagens quando comparados com os sensores eletrónicos convencionais, de entre várias, destacam-se: tamanho e peso reduzido, biocompatibilidade, segurança, imunidade a interferências eletromagnéticas e elevada sensibilidade. Numa primeira etapa, foram desenvolvidos dispositivos vestíveis com sensores de fibra ótica baseados em redes de Bragg (FBG) para incorporar em palmilhas de modo a monitorizar diferentes parâmetros da marcha com base na análise da pressão exercida em várias zonas da palmilha. Ainda no âmbito deste tema, adicionalmente, foram desenvolvidos sensores utilizando a mesma tecnologia de sensoriamento, mas capazes de monitorizar simultaneamente pressão e forças de cisalhamento. Este trabalho foi pioneiro e permitiu monitorizar um dos principais responsáveis pela ulceração dos pés em pessoas com diabetes: o cisalhamento. Numa fase posterior, o estudo centrou-se na temática relacionada com o aparecimento de úlceras em pessoas com mobilidade reduzida e utilizadores de cadeiras de rodas. De modo a contribuir para a mitigação deste flagelo, procurou-se desenvolver um sistema composto por uma rede de sensores de fibra ótica capaz de monitorizar a pressão em vários pontos de uma cadeira de rodas e não só aferir a pressão em cada ponto, mas monitorizar a postura do cadeirante e aconselhá-lo a mudar de postura com regularidade, de modo a diminuir a probabilidade de ocorrência desta patologia. Ainda dentro desta aplicação, foi publicado um outro trabalho onde o sensor não só monitoriza a pressão como também a temperatura em cada um dos pontos de análise, conseguindo aferir assim indiretamente o cisalhamento. Numa outra fase, foi realizado o estudo e desenvolvimento de sensores de fibra ótica de plástico para monitorizar a postura corporal de um utilizador de uma cadeira de escritório. Simultaneamente, foi desenvolvido um software capaz de monitorizar e mostrar ao utilizador todos os dados adquiridos em tempo real e advertir o utilizador de posturas incorretas, bem como aconselhar para pausas no trabalho. Numa quarta fase, o estudo centrou-se no desenvolvimento de sensores altamente sensíveis embebidos em materiais impressos 3D. O sensor é composto por uma fibra ótica com uma FBG e o corpo do sensor por um material polimérico flexível, denominado “Flexible”. O sensor foi impresso numa impressora 3D e durante a sua impressão foi incorporada a fibra ótica. O sensor demonstrou ser altamente sensível e foi capaz de monitorizar frequência respiratória e cardíaca, tanto em soluções vestíveis (peito e pulso) como em soluções “invisíveis” (cadeira de escritório).Programa Doutoral em Engenharia Físic

A REVIEW OF FACTORS, SEATING DESIGN, AND SHAPE CAPTURE METHODS FOR REDUCING PRESSURE INJURY RISK

This dissertation in the form of three papers ready for submission to peer-reviewed journals is submitted toward the requirements of the PhD in Health Related Sciences program at Virginia Commonwealth University. Chapter One provides an introductory overview of the project, including: (a) an overview of pressure injuries, (b) the impact of seating as an intervention, and (c) aims of the three-paper dissertation in addressing various aspects of pressure injury prevention. Each paper is unique and singular in its focus, yet all share the overlying aim of addressing pressure injury risk associated with wheelchair seating. Paper One describes the unique facilitators and barriers associated with pressure injury prevention practices among individuals with upper motor neuron lesions. Paper Two consists of a systematic review of the literature on the comparative effectiveness of various wheelchair seat cushions in reducing pressure injuries. Paper Three presents the results of a pilot study of a unique shape-capture method for custom-fitted wheelchair cushions conducted by the student researcher

The Effectiveness and Use of Seat Tilt, Backrest Recline, and Seat Elevation in Adult Powered Wheelchair Users

This study examined how adults use power wheelchair seat features such as seat tilt, backrest recline, and seat elevation, during typical daily activities. A Seat Feature Data Logger (SFDL) was attached to 11 subject's wheelchairs for 10-14 days to gather data regarding daily usage of the wheelchair and these features. Subjects occupied their wheelchairs for 12.0 ± 3.0 hours per day and transferred in/out of their wheelchairs 5.0 ± 5.3 times per day. An average of 0.7 ± 1.5 hours per day was spent in an upright position. The tilt feature was accessed 18.4 ± 14.4 times per day for 8.5 ± 5.2 hours per day, and recline was accessed 11.5 ± 8.4 times per day for 8.6 ± 4.6 hours per day. Tilt and recline were used in combination for a total of 4.8 ± 4.6 hours per day. Subjects accessed the seat elevation feature 4.3 ± 4.1 times per day on average for 2.8 ± 4.6 hours day. Based on these data it was found that subjects spent significantly more time in a tilted versus an upright position (p<0.025), but that tilt was not used significantly more than recline (p=0.155) or seat elevation (p=0.046). In addition, comparison of SFDL data with pressuremapping data revealed that subjects were more likely to use small and intermediate amplitude tilt and recline angles, and positions known to result in low peak pressure were accessed more frequently and for longer durations than intermediate and high pressure positions. While subjects did not always use large angles of tilt and recline - as many clinicians recommend - these features were used frequently and their use resulted in lower peak pressures

Intelligent Sitting Posture Classifier for Wheelchair Users

In recent years, there has been growing interest in postural monitoring while seated, thus preventing the appearance of ulcers and musculoskeletal problems in the long term. To date, postural control has been carried out by means of subjective questionnaires that do not provide continuous and quantitative information. For this reason, it is necessary to carry out a monitoring that allows to determine not only the postural status of wheelchair users, but also to infer the evolution or anomalies associated with a specific disease. Therefore, this paper proposes an intelligent classifier based on a multilayer neural network for the classification of sitting postures of wheelchair users. The posture database was generated based on data collected by a novel monitoring device composed of force resistive sensors. A training and hyperparameter selection methodology has been used based on the idea of using a stratified K-Fold in weight groups strategy. This allows the neural network to acquire a greater capacity for generalization, thus allowing, unlike other proposed models, to achieve higher success rates not only in familiar subjects but also in subjects with physical complexions outside the standard. In this way, the system can be used to support wheelchair users and healthcare professionals, helping them to automatically monitor their posture, regardless physical complexions.This work was supported in part by the Ministry of Science and Innovation-StateResearch Agency/Project funded by MCIN/State Research Agency(AEI)/10.13039/501100011033 under Grant PID2020-112667RB-I00,in part by the Basque Government under Grant IT1726-22, and in part by the Predoctoral Contracts of the Basque Government under Grant PRE-2021-1-0001 and Grant PRE-2021-1-021

Biomechanics of pressure ulcer in body tissues interacting with external forces during locomotion

2009-2010 > Academic research: refereed > Publication in refereed journalAuthor’s OriginalPublishe

Disabil Health J

BackgroundPeople with impaired mobility (IM) disabilities have a higher prevalence of obesity and obesity-related chronic conditions; however, lifestyle interventions that address the unique needs of people with IM are lacking.ObjectiveThis paper describes an adapted evidence-based lifestyle intervention developed through community-based participatory research (CBPR).MethodsIndividuals with IM, health professionals, disability group representatives, and researchers formed an advisory board to guide the process of thoroughly adapting the Diabetes Prevention Program Group Lifestyle Balance (DPP GLB) intervention after a successful pilot in people with IM. The process involved two phases: 1) planned adaptations to DPP GLB content and delivery, and 2) responsive adaptations to address issues that emerged during intervention delivery.ResultsPlanned adaptations included combining in-person sessions with conference calls, providing arm-based activity trackers, and adding content on adaptive cooking, adaptive physical activity, injury prevention, unique health considerations, self-advocacy, and caregiver support. During the intervention, participants encountered numerous barriers, including health and mental health issues, transportation, caregivers, employment, adjusting to disability, and functional limitations. We addressed barriers with responsive adaptations, such as supporting electronic self-monitoring, offering make up sessions, and adding content and activities on goal setting, problem solving, planning, peer support, reflection, and motivation.ConclusionsGiven the lack of evidence on lifestyle change in people with disabilities, it is critical to involve the community in intervention planning and respond to real-time barriers as participants engage in change. A randomized controlled trial (RCT) is underway to examine the usability, feasibility, and preliminary effectiveness of the adapted intervention.R25 CA057712/CA/NCI NIH HHS/United StatesU01 DD001007/DD/NCBDD CDC HHS/United States2019-04-01T00:00:00Z29129715PMC58690716076vault:2768