Pressure–time cell death threshold for albino rat skeletal muscles as related to pressure sore biomechanics

Linder-Ganz, Eran; Engelberg, S; Scheinowitz, Mickey; Gefen, Amit

doi:10.1016/j.jbiomech.2005.08.010

Cited by 180 publications

(181 citation statements)

References 19 publications

(39 reference statements)

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“…In an early study of pressure, circumferential application of 200 mmHg was established as a pain threshold relative to pressure [27]. More recently, researchers have stated that muscle cell death can occur in less than 3 to 6 hr with as little as 68 mmHg [28][29][30][31][32][33][34]. The nondisabled person experiences negligible pressure on the ischium while standing and ambulating.…”

Section: Discussionmentioning

confidence: 99%

Transfemoral sockets with vacuum-assisted suspension comparison of hip kinematics, socket position, contact pressure, and preference: Ischial containment versus brimless

Kahle

Highsmith²

2013

J Rehabil Res Dev

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Abstract-The objective of this study was to investigate the effect of brimless compared with ischial ramus containment (IRC) prosthetic sockets when using vacuum-assisted suspension (VAS) on persons with a unilateral transfemoral amputation (TFA). A randomized crossover design with a 2 d accommodation was used. People with unilateral TFA (n = 9 analyzed) were enrolled. Interventions were IRC VAS and brimless VAS sockets. Main outcome measures included coronal hip angle and vertical and lateral socket movement as measured by X-ray, skin pressure measured by Tekscan, and preference measured subjectively. The brimless design was statistically equivalent to IRC in all measured coronal hip angles and vertical and lateral socket displacement. The peak/stance mean pressure in the medial proximal aspect of the socket was 322 mmHg in the IRC compared with 190 mmHg in the brimless condition. Except for medial proximal pressure, no other measures reached statistical significance. All subjects reported the brimless design to be more comfortable than the IRC in short-term preference. Brimless VAS socket design may be a clinically viable choice for people with TFA.

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Section: Discussionmentioning

confidence: 99%

Transfemoral sockets with vacuum-assisted suspension comparison of hip kinematics, socket position, contact pressure, and preference: Ischial containment versus brimless

Kahle

Highsmith²

2013

J Rehabil Res Dev

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“…Clinical utility will also require further adjustments/improvements of the model and system, e.g., extracting the IT radius data from ultrasound rather than MRI, and large scale clinical studies, including prospective randomized clinical trials to test the predictive power of the present system in preventing or reducing the prevalence of DTI. Furthermore, in order to make concrete clinical use of this model, we must perform additional basic research to determine the stress and stress dose thresholds that may endanger the viability and integrity of muscle and other subdermal tissues [28,33,36].…”

Section: Discussionmentioning

confidence: 99%

“…The peak compression stress in muscle (P 0 ) is the stress calculated directly beneath the bone, at the center of the contact area. Stress doses on the z-axis (D z ) and r-axis (D r ) were calculated as measures of the time exposure to stress [28] by integrating the average muscle compression stresses S (z,r) over the sitting time t along the respective axes for 120 s by These values were translated into discrete calculations by dividing the ROI radius of 4 mm into 150 discrete points at which stresses were calculated and then averaged, and each average was multiplied by the time frame between samples (1 s) by where s is a discrete time step and n is a discrete point between the origin (the center of bone-muscle contact area) and the ROI boundary.…”

Section: Human Studiesmentioning

confidence: 99%

“…However, because of obvious limitations, experiments in this line have only been carried out on animal models or tissue-engineered constructs [5]. Recently, data from various experiments have been integrated to define a mathematical sigmoid pressure-time cell death threshold curve for albino rats, which are the most common animal models in use [28].…”

Section: Introductionmentioning

confidence: 99%

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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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“…In addition, the developed pressure time curves predict that pressure ulcers will develop eventually, even with optimal pressure distribution [9][10]. This prediction has been confirmed by finite element modeling (FEM) techniques, and even with equally distributed pressures at the sitting interface, high pressure peaks have been shown to occur near the bony prominence [11][12][13].…”

Section: Introductionmentioning

confidence: 91%

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

Reenalda

Geffen²,

Nederhand³

et al. 2009

JRRD

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Abstract-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.

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Pressure–time cell death threshold for albino rat skeletal muscles as related to pressure sore biomechanics

Cited by 180 publications

References 19 publications

Transfemoral sockets with vacuum-assisted suspension comparison of hip kinematics, socket position, contact pressure, and preference: Ischial containment versus brimless

Transfemoral sockets with vacuum-assisted suspension comparison of hip kinematics, socket position, contact pressure, and preference: Ischial containment versus brimless

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

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

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