Pressure injuries are costly to the healthcare system and mostly preventable, yet incidence rates remain high. Recommendations for improved care and prevention of pressure injuries from the Joint Commission revolve around continuous monitoring of prevention protocols and prompts for the care team. The E-scale is a bed weight monitoring system with load cells placed under the legs of a bed. This study investigated the feasibility of the E-scale system for detecting and classifying movements in bed which are relevant for pressure injury risk assessment using a threshold-based detection algorithm and a K-nearest neighbor classification approach. The E-scale was able to detect and classify four types of movements (rolls, turns in place, extremity movements and assisted turns) with > 94% accuracy. This analysis showed that the E-scale could be used to monitor movements in bed, which could be used to prompt the care team when interventions are needed and support research investigating the effectiveness of care plans.
More than 2 million people in the United States use a wheelchair for mobility. These Americans not only rely on their assistive technology to complete simple, daily tasks, but they also depend on functional and accessible sidewalks to do so. Although the Americans with Disabilities Act Accessibility Guidelines established by the Access Board provide suggestions for pathways, they are subjective and not measurable. This ambiguity results in public pathways with many bumps and cracks, which can lead to harmful whole body vibrations (WBVs) for wheelchair users. WBVs with a root mean squared (RMS) value greater than 1.6 m/s2 for more than a 1-h period may result in back and neck pain or muscle fatigue. For the development of a standard for surface roughness, subjective and objective information needs to be gathered and analyzed. Sixty-one subjects were recruited to travel over nine simulated wooden surfaces with varying roughnesses that were modeled after outdoor surfaces. A subset of the subjects also traveled over six outdoor surfaces. With the use of their own chairs, subjects traveled over each surface while accelerometers recorded vibrations at the seat, footrest, and backrest. After they traveled over each surface, subjects were asked to fill out a short questionnaire on the acceptability of each surface. The vibrations were converted to RMS accelerations. Both RMS accelerations and subject surface ratings were compared with surface roughness. As surface roughness increased, RMS accelerations increased, and subject surface ratings decreased. Some surfaces generated RMS accelerations above the 1.6 m/s2 threshold; this result suggested that some sidewalks caused harmful vibrations to wheelchair users.
Regular weight monitoring is known to help with weight management, which is an important part of maintaining a healthy, active lifestyle. Unfortunately, weight monitoring is challenging for wheelchair users because the few scales that are available are expensive and very large. Consequently, wheelchair users typically learn their weight at infrequent visits to their healthcare providers, which likely contributes to higher prevalence of obesity-related health risks among this population. In this article, we describe the design and development of the Embedded Scale, or E-Scale, which is a bed-integrated bodyweight measuring system that allows a user to measure and track their weight. The E-Scale team followed a standard product development approach to build the E-Scale prototype. Bench testing results indicate that the performance of the prototype is on par with commercially available wheelchair scales (capacity = 1,200 lbs, accuracy = 1.73 lbs, and precision = ± 0.35 lbs over one-fourth rated capacity). Institutional Review Board (IRB)-approved focus groups with 20 Veterans who use wheelchairs for mobility were conducted to gather feedback about the design, which was very positive. Development and testing results suggests the E-Scale technology is feasible and may provide a valuable tool to help wheelchair users manage their weight.
Individuals who use wheelchairs (WCs) frequently navigate over pathways with obstacles (e.g., bumps or curb descents) or terrain that is extremely rough. Surface characteristics such as roughness can have an effect on comfort and variables associated with bodily injury. Understanding these relationships can be helpful to ensure safe and comfortable access to all public and private pathways. This article reviews existing research related to the topics of surface roughness effects on WC user's bodies, surface roughness measurement techniques, and design guidelines and exposure limits that attempt to ensure pathways are safe and passable. These findings are discussed along with opportunities to improve them. Using a broad literature search, it was found that several measurement and analysis techniques exist to characterize surface roughness related to automobile roadways, but they have not been systematically applied to WC use over pedestrian pathways. The roughness measurement approach that appears most relevant and adaptable for sidewalks are rolling profilers. Commercially available devices could be recalibrated or adapted to measure pedestrian pathways. IRI and ride-quality analysis techniques appear most relevant and could also be adapted. Any analysis technique that uses profiles of surfaces should focus on frequencies and wavelengths that are most applicable to WC riders.
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