Pressure Sore Prophylaxis in Elderly Patients Using Slab Foam or Customized Contoured Foam Wheelchair Cushions

Conine, Tali A.; Daechsel, Dawn; Hershler, C.

doi:10.1177/153944929301300203

Cited by 18 publications

(7 citation statements)

References 19 publications

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“…Individuals who cannot independently reposition tend to be at the greatest risk for ulcer development 10. Several studies have indicated that the use of pressure-redistributing wheelchair cushions designed to maintain tissue integrity will reduce the incidence of sitting-induced pressure ulcers 5, 11, 7, 12, 13, 14…”

Section: Introductionmentioning

confidence: 99%

“…10 Several studies have indicated that the use of pressureredistributing wheelchair cushions designed to maintain tissue integrity reduce the incidence of sitting-induced pressure ulcers. 5,7,[11][12][13][14] In a systemic review of the evidence from studies investigating interventions to prevent pressure ulcers, 4 the 59 randomized controlled trials (RCTs) selected for review enrolled a total of 13,845 patients, 2,367 (17.1%) in longterm care (LTC). Fifty-one of these studies targeted mobility (1,866 patients in LTC), five targeted nutrition, and three targeted skin health.…”

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confidence: 99%

“…The review found that many of the RCTs had important methodological limitations and that well-designed RCTs following standard criteria were needed. Four studies, 5,[12][13][14] all in LTC, have examined the effects of wheelchair cushions on pressure ulcer incidence, but these four studies were too small to detect a difference or did not control for the wheelchair to isolate the effects of the cushion.…”

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confidence: 99%

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A Randomized Clinical Trial on Preventing Pressure Ulcers with Wheelchair Seat Cushions

Brienza

Kelsey²,

Karg³

et al. 2010

J American Geriatrics Society

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Objectives To determine the efficacy of skin protection wheelchair seat cushions in preventing pressure ulcers in the elderly, nursing home population Design Clinical trial with participants assigned at random to either a skin protection or segmented foam cushion. Two hundred thirty two participants were recruited between June 2004 and May 2008 and followed for 6 months or until pressure ulcer incidence. Setting Twelve nursing homes Participants Nursing home residents’ age ≥ 65, using wheelchairs ≥6 hours/day, Braden score ≤ 18, and combined Braden activity and mobility score ≤ 5. Participants were recruited from a referred sample. Intervention All participants were provided a fitted wheelchair and randomized into skin protection (SPC) or segmented foam (SFC) cushion groups. The SPC group received an air, viscous fluid/foam, or gel/foam cushion. The SFC group received a 7.6 cm crosscut foam cushion. Measurements Pressure ulcer incidence over 6 months for wounds near the ischial tuberosities (IT ulcers) were measured. Secondary analysis was performed on combined IT and sacral/coccyx ulcers. Results One hundred eighty participants reached a study endpoint and 42 were lost to follow-up. Ten did not receive the intervention. There were 8/119 (6.7%) IT ulcers in the SFC group and 1/113 (0.9%) in the SPC group (p<0.04). In the group of combined IT and sacral/coccyx ulcers, there were 21/119 pressure ulcers (17.6%) in the SFC group and 12/113 (10.6%) in the SPC group (p=0.14). Conclusion Skin protection cushions used with fitted wheelchairs lower pressure ulcer incidence for elderly, nursing home residents and should be used to help prevent pressure ulcers.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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A Randomized Clinical Trial on Preventing Pressure Ulcers with Wheelchair Seat Cushions

Brienza

Kelsey²,

Karg³

et al. 2010

J American Geriatrics Society

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“…Previous studies have monitored interface pressures in real-time under the buttocks [18,[40][41][42][43][44][45][46][47][48], but these values have been proven to be much smaller than those from the loading situation in the muscle itself, especially near the IT [49]. Other studies have adopted a much more accurate approach, estimating stresses in the muscles under the IT using FE and complex calculations, at the cost of immediacy and portability [4,36,39].…”

Section: Introductionmentioning

confidence: 99%

Toward real-time detection of deep tissue injury risk in wheelchair users using Hertz contact theory

Agam

Gefen²

2008

JRRD

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Abstract-This study assessed the suitability of a new portable system that is based on Hertz's contact theory for evaluating internal gluteal muscle stresses under the ischial tuberosities of wheelchair users in real-time as a risk indicator for a deep tissue injury. Sitting in a wheelchair was monitored and processed with the portable system for six control subjects and five individuals with paraplegia. We compared the resultant internal peak and average muscle stresses and stress integrals over time (stress doses) of the control subjects with those of the subjects with paraplegia and validated the results against previously published subject-specific finite element (FE) stress data for the same subjects. Individuals with paraplegia were characterized by peak muscle compression stresses (mean +/-standard deviation = 109 +/-41 kPa) that were 2.4-fold higher than in control subjects (p < 0.03). A Bland-Altman comparison indicated that stresses recorded by the present system were in satisfactory agreement with previous subject-specific magnetic resonance imaging-FE analyses. We conclude that the present stress monitoring system has the potential to be a practical means for evaluating internal muscle stresses during everyday life of individuals with paraplegia.

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“…If pressure from sitting obstructs capillary blood flow, ischemia results and pressure ulcers can develop within 2 to 6 hours (Lyder, 2003;Stekelenburg, 2005). If peak pressures exceed 60 mmHg, the incidence of pressure ulcers increases (Conine et al, 1993). Pressure ulcers are most common superficial to the sacrum, coccyx and ischial tuberosities (Cuddigan et al, 2001;Richardson and Meyer, 1981).…”

Section: Introductionmentioning

confidence: 99%

Pressure Ulcer Prevention: Optimizing a Temporally Redistributing Support Interface

Peterson¹,

Healey²,

Visser³

et al. 2016

American Journal of Engineering and Applied Sciences

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Abstract:One of the most common complications from long-term wheelchair use or bed rest is pressure ulcers. Pressure ulcers have significant morbidity and are associated with high mortality. Prolonged sitting can cause high pressures in the skin and subcutaneous tissue which can lead to local ischemia and breakdown of skin. Rapid relief of pressure prevents ulcer formation. One prevention strategy is to change the temporal distribution of pressure at the interface between user and surface so that no one area is subjected to high pressures for long periods of time. While there are several dynamic interfaces in use currently, there is no definitive evidence of enhanced pressure ulcer prevention with their use. The purpose of this research was to parametrically evaluate interface array sizes, shapes and patterns for dynamic support surfaces to optimize pressure redistribution to prevent pressure ulcers. Finite element analyses, anatomical phantom deep tissue pressure measurements and interface pressure mapping were used to test various support geometries and sizes and different array spacing and patterns. Results indicate that modulating pressure in an array of supports that are equally spaced is not effective. Only interrupted pattern arrays resulted in sufficient pressure reduction. These data suggest that dynamic surface supports can be optimized based on the geometry and size of the individual supports and the pattern of the array to further reduce the likelihood of pressure ulcer formation.

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Pressure Sore Prophylaxis in Elderly Patients Using Slab Foam or Customized Contoured Foam Wheelchair Cushions

Cited by 18 publications

References 19 publications

A Randomized Clinical Trial on Preventing Pressure Ulcers with Wheelchair Seat Cushions

A Randomized Clinical Trial on Preventing Pressure Ulcers with Wheelchair Seat Cushions

Toward real-time detection of deep tissue injury risk in wheelchair users using Hertz contact theory

Pressure Ulcer Prevention: Optimizing a Temporally Redistributing Support Interface

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