No abstract

Trunk and gluteal stimulation acutely corrects anterior/posterior IP distribution, improving regional tissue health for sacral sitters. This correction requires constant application of NMES. The potential for positive changes in tissue health would be maximized by regular NMES use incorporating weight shifting.

No abstract

A repeated-measures study of 13 adult full-time wheelchair users with spinal cord injury (SCI) was carried out to determine whether alternating-pressure air cushion (APAC) use compared with independent pressure relief (IPR) provides reliable, effective pressure relief for individuals with SCI. Bilateral mean ischial interface pressure (IP), transcutaneous oxygen tension (TcPO2), and unilateral laser Doppler blood flow were evaluated. Blood flow component contributions were determined using short-time Fourier transform (STFT)-based spectral analysis. IPR assessment was carried out at recruitment. Study participants then used an APAC for 2 wk every 3 mo for 18 mo. IPR weight-shifting decreased mean ischial IP (p < 0.05) and increased mean TcPO2 (p < 0.05). All variables rapidly returned to preintervention levels following weight-shifting except for the cardiac component of blood flow. APAC-induced weight-shifting decreased mean ischial IP (p < 0.05). Mean TcPO2 increased and was higher than for IPR. STFT analysis indicated that quiet sitting following APAC-induced weight-shifting produced a higher neurogenic component of blood flow than following IPR (p = 0.02). Thus, IPR positively affects multiple aspects of tissue health but produces transient improvements and must be repeated regularly. APAC activation dynamically and continuously alters IP distribution with more sustained positive tissue health effects.

Users with SCI were satisfied with the overall performance of the APAC tested after repeated periods of use. The majority of user's were very satisfied with APAC comfort overall. Implications for Rehabilitation Abandonment of AT may be reduced if user satisfaction is evaluated. The QUEST 2.0b is a useful and valid measure of user satisfaction with alternating pressure air cushions. In the current study cohort, users with SCI were satisfied with the performance and comfort of the APAC tested after repeated periods of use.

A study was carried out to determine whether the location of the inferior gluteal nerve could be reliably predicted using external anatomy or vascular imaging. This study was motivated by our group's development of an electrical stimulation system to provide direct gluteal stimulation in paralyzed individuals, in particular those with spinal cord injury (SCI). Pressure ulcers are a common complication for many individuals with reduced mobility. Numerous approaches have been employed to treat and prevent pressure ulcers; however no procedure or nursing care regimen has been successful in eradicating them completely. Our group seeks to prevent skin breakdown in susceptible patients by direct electrical stimulation of the paralyzed gluteal muscle, leading to improved circulation and increased muscle mass (hypertrophy) in the treated area. Currently, percutaneous electrodes are placed through an extensive probing process to select the motor point of the target muscle. We examined 15 cadaver gluteal regions to identify the relationship between the internal anatomy of the inferior gluteal artery and nerve as well as the relationship to external anatomic landmarks. The cadavers displayed variability with regard to the morphology of the branches of both nerve and artery. Furthermore, there did not appear to be any relationship between the relative positions of the nerve and artery. However, the potential target area of the proximal origin of the inferior gluteal nerve could reliably be predicted from the external bony anatomy of the lower pelvis.