Dynamic sitting to prevent pressure ulcers in spinal cord injured

At present, clinical interventions and research efforts are not fully successful in defining the risk of pressure ulcer development and as such in eventually preventing pressure ulcers. As a result, the prevalence and incidence values of pressure ulcers remain unacceptably high. It is common sense that healthy subjects do not develop pressure ulcers due to a dynamic variation in sitting posture. This dynamic sitting behavior can be identified and used as a reference values for the optimal sitting behavior of individuals that use a wheelchair and are at risk of developing pressure ulcer. The main research question that has been answered in this thesis is if imposing dynamic sitting behavior by means of the Dynasit chair in Spinal Cord Injured individuals results in elevated tissue viability? \ud In order to define a reference values for the sitting behavior of spinal cord injured individuals, an analysis of healthy sitting behavior has been performed. It was found that healthy subjects change their sitting posture at least every eight minutes. To impose this dynamic sitting behavior on spinal cord injured individuals, the Dynasit chair has been developed. The Dynasit chair is an experimental sitting device developed to investigate the effects of different sitting postures, alternating tuberal support and pelvic orientations on the (sub-) cutaneous tissue viability. Two studies on healthy subjects demonstrated the positive effect of actuation with the Dynasit chair on the tissue load. Regarding the main research question of this thesis, a study performed in 10 male spinal cord injured individuals, confirmed the ability of the Dynasit chair to impose dynamic sitting behavior, based on healthy sitting behavior, in spinal cord injured individuals. This imposed dynamic sitting behavior resulted in significant elevation of the (sub-) cutaneous tissue oxygenation. This elevated tissue oxygenation implies that due to the dynamic sitting, the wheelchair user can sit for prolonged periods of time without tissue breakdown

Analysis of healthy sitting behavior: Interface pressure distribution and subcutaneous tissue oxygenation

Pressure ulcers are a large problem in individuals who use a wheelchair for their mobility and have limited trunk stability and motor function. Because no relation between interface pressure and pressure ulcer development has been established and no clinical threshold for pressure ulcer development can be given, looking at the sitting behavior of nondisabled individuals is important. Nondisabled individuals do not develop pressure ulcers because they continuously shift posture. We analyzed the sitting behavior of 25 nondisabled male subjects by using a combination of interface pressure measurement and subcutaneous tissue oxygenation measurement by means of the Oxygen to See. These subjects shifted posture on average 7.8 +/- 5.2 times an hour. These posture shifts were merely a combination of posture shifts in the frontal and sagittal plane. Subcutaneous oxygen saturation increased on average 2.2% with each posture adjustment, indicating a positive effect of posture shifts on tissue viability. The results of this study can be used as a reference for seating interventions aimed at preventing pressure ulcers. Changing the sitting load at least every 8 minutes is recommended for wheelchair users

Effecten van dualisering in het HBO

The economic recession in the 1980s constituted a reason to revise vocational education\ud in the Netherlands. There was a search for new forms of learning in context, with\ud authentic tasks in the real world, which had the explicit goal of bringing theory and\ud practice closer together. This combination of learning and working was said to better\ud prepare learners for the future and to guarantee effective training and a powerful learning\ud environment. Business and industry would acquire custom-designed people, ‘just in time,\ud just enough’.\ud This combination of learning and working is referred to by the term dualisering, (which is a\ud dual programme of work and study). It was assumed that integration of learning at the\ud workplace and working under an employment contract, with reflective learning moments\ud at school, would provide an effective learning environment for the development of\ud professional skills. Within higher professional education (HPE, in Dutch: HBO) many\ud forms and variants of learning while working and working while learning gradually\ud emerged. A distinction can be drawn, for example, between ‘apprenticeship’ and\ud ‘internship’, in which the student either follows a dual track or undertakes a work\ud placement respectively. The work placement component seems to have increased in size\ud over the past few years to such an extent that it has become comparable with the dual\ud system.\ud Since the 1990s various initiatives have been undertaken in the Netherlands to promote\ud the dual programme of work and study through experiments within higher professional\ud education. Their design has varied from first-year full-time training followed by sixmonthly\ud periods of ‘school’ learning alternated with periods of working (CooP), to the\ud entire training programme of three days a week working and two days undertaking study\ud activities (Gilde-HBO). Currently, colleges of higher professional education are free to\ud design their own dual training programme. However, as part of a dual track, the\ud relationship between student, company and institute must be regulated by means of an\ud employment contract or training-employment contract. This means that dual students are\ud employees at the company, whereas non-dual students come into contact with the world\ud of work through work placements. Dual students were therefore believed to learn more\ud effectively what it takes to work in a specific profession. Furthermore, they would acquire\ud the more generic and specific skills necessary to perform a job and would be better\ud trained in profession-related skills, such as problem-oriented working and flexibility

Estimating qualitative parameters for assessment of body balance and arm function in a simulated ambulatory setting

Continuous daily-life monitoring of balance control and arm function of stroke survivors in an ambulatory setting, is essential for optimal guidance of rehabilitation. In a simulated ambulatory setting, balance and arm function of seven stroke subjects is evaluated using on-body measurement systems (Xsens MVN Biomech and the Xsens Instrumented Force Shoes). Ethical approval for this study was obtained. Qualitative parameters of body balance and arm function are estimated and compared with the results of a generally accepted clinical balance assessments (e.g. Berg Balance Scale and Fugl-Meyer)