Contoured Foam Cushions Cannot Provide Long-term Protection Against Pressure-Ulcers for Individuals with a Spinal Cord Injury

Shoham, Naama; Levy, Ayelet; Kopplin, Kara; Gefen, Amit

doi:10.1097/01.asw.0000465300.99194.27

Cited by 18 publications

(3 citation statements)

References 34 publications

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“…The goal to support a more upright position is of great relevance; however risk factors such as high local pressures should be carefully followed over time. It is necessary to follow up interface pressure especially for the elderly, the fragile and the population with spinal cord injuries in whom mobility is impaired, skin is less elastic, subcutaneous fat is reduced, blood vessels are impaired and sensory perception is decreased [8] [9] [10] [11].…”

Section: Resultsmentioning

confidence: 99%

Wheelchair Seating: Peak Pressure Distribution in Young versus Elderly Healthy Controls

Timm¹,

Samuelsson²

2019

OJTR

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Background: People may use a wheelchair when they need assistance with mobility. Some users have to remain seated in their wheelchair for most of their awake time and for a lot of activities. The need for a well fitted and supportive wheelchair is important and, for those who use the wheelchair for many hours, peak pressure distribution is of interest to prevent pressure ulcers and discomfort. Aim: To describe how high local peak pressures may be distributed over risk areas for pressure ulcers in different wheelchair settings. Methods: Two groups of healthy adults were recruited (40 elderly and 30 younger individuals). Two standard models of manual wheelchairs were used together with two types of wheelchair cushions. Results: The elderly group had a higher peak pressure over the ischial tuberosity and increased posterior pelvic rotation in the shaped seat cushion. Both groups had higher peak pressure over the trochanter in the shaped seat cushion. Peak pressure was also higher over the coccyx for the elderly in the shaped seat cushion compared with the plain cushion; this was lower for the younger group. Discussion: The results indicate that age might influence the important physical prerequisites when fitting a wheelchair to an individual.

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Section: Resultsmentioning

confidence: 99%

Wheelchair Seating: Peak Pressure Distribution in Young versus Elderly Healthy Controls

Timm¹,

Samuelsson²

2019

OJTR

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“…21 It is therefore surprising that so little is known about the contribution of a good envelopment to lowering the level of deep tissue stress concentrations in patients who are at-risk. Whilst our published work provided important insights on this phenomenon for wheelchair cushion users, primarily by means of computational modelling methods, 5,16,[22][23][24] mattresses received less attention in the literature in general, and in our reported work in particular. Excluding a study on the contribution of minimising patient migration in bed to lowering the shear stress concentrations in deep soft tissues at the sacral region, 25 the power of advanced computational modelling was not fully utilised to…”

Section: Discussionmentioning

confidence: 99%

Computational studies of the biomechanical efficacy of a minimum tissue deformation mattress in protecting from sacral pressure ulcers in a supine position

Lustig

Gefen

2021

International Wound Journal

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Sustained soft tissue exposure to localised deformations is a trigger for the formation of pressure ulcers. Immersion and envelopment are critical benchmarks that determine comfort and the pressure ulcer risk mitigation, as they have considerable influence on tissue stress concentrations near bony prominences. In the present study, we developed a computer modelling framework for quantifying the extent by which optimal envelopment disperses tissue stress concentrations near the sacrum. To compare the risk of developing a sacral pressure ulcer while lying supine on a regular foam mattress with respect to lying on a specialised, minimum tissue deformation mattress (which closely conforms to the body contours), we used a three‐dimensional anatomically‐realistic model of the adult female buttocks. The strains and stresses in the subdermal soft tissues reached peak values of 65% and 2.4 kPa for the regular mattress, respectively, but always remained below 45% and 1.2 kPa for the minimum tissue deformation mattress, which indicates longer safe times for supine support on the latter mattress. Our work demonstrates that alleviation of localised, sustained stress concentrations through good immersion and envelopment of the support surface protects from pressure ulcers, and has the potential to relieve chronic pain which is associated with the pressure ulcer risk.

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“…Specifically, high-density foam materials are needed to maintain the shapes of foam wedges when these are subjected to bodyweight forces, and as the stiffness of a foam relates to the foam density according to a power law, the foam stiffnesses are in the order of 10seconds of kilopascals, 87 which is considerably stiffer than the supported soft tissue structures. 88 Indeed, foam cushions 89,90 and head positioners 88 have been found to provide limited immersion and envelopment, resulting in increased tissue stress concentrations under bony prominences compared with specialised surfaces such as air cellbased or shape memory structures, which are specifically designed for maximising envelopment. In addition, fatigue mechanical and thermal loading gradually breaks struts in the microstructure of foams, which softens and reduces the elastic recoil (resilience) properties of the foam.…”

Section: Foam Wedges and Gel Pads: Inexpensive But Limited In Protementioning

confidence: 99%

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

Gefen

Creehan²,

Black

2020

International Wound Journal

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An optimal position of the patient during operation may require a compromise between the best position for surgical access and the position a patient and his or her tissues can tolerate without sustaining injury. This scoping review analysed the existing, contemporary evidence regarding surgical positioning‐related tissue damage risks, from both biomechanical and clinical perspectives, focusing on the challenges in preventing tissue damage in the constraining operating room environment, which does not allow repositioning and limits the use of dynamic or thick and soft support surfaces. Deep and multidisciplinary aetiological understanding is required for effective prevention of intraoperatively acquired tissue damage, primarily including pressure ulcers (injuries) and neural injuries. Lack of such understanding typically leads to misconceptions and increased risk to patients. This article therefore provides a comprehensive aetiological description concerning the types of potential tissue damage, vulnerable anatomical locations, the risk factors specific to the operative setting (eg, the effects of anaesthetics and instruments), the complex interactions between the tissue damage risk and the pathophysiology of the surgery itself (eg, the inflammatory response to the surgical incisions), risk assessments for surgical patients and their limitations, and available (including emerging) technologies for positioning. The present multidisciplinary and integrated approach, which holistically joins the bioengineering and clinical perspectives, is unique to this work and has not been taken before. Close collaboration between bioengineers and clinicians, such as demonstrated here, is required to revisit the design of operating tables, support surfaces for surgery, surgical instruments for patient stabilisation, and for surgical access. Each type of equipment and its combined use should be evaluated and improved where needed with regard to the two major threats to tissue health in the operative setting: pressure ulcers and neural damage.

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Contoured Foam Cushions Cannot Provide Long-term Protection Against Pressure-Ulcers for Individuals with a Spinal Cord Injury

Abstract: A CFC that has been fitted at a time close to the SCI, but has not been replaced in subsequent years, substantially loses its efficacy in protecting patients from developing pressure ulcers and deep tissue injury in particular.

Cited by 18 publications

References 34 publications

Wheelchair Seating: Peak Pressure Distribution in Young versus Elderly Healthy Controls

Wheelchair Seating: Peak Pressure Distribution in Young versus Elderly Healthy Controls

Computational studies of the biomechanical efficacy of a minimum tissue deformation mattress in protecting from sacral pressure ulcers in a supine position

Critical biomechanical and clinical insights concerning tissue protection when positioning patients in the operating room: A scoping review

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