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.

Among individuals with acute traumatic SCI, those with high-injury severity were at an increased risk to develop pressure ulcers. Pneumonia was noted to be associated with the formation of pressure ulcers.

People with spinal cord injury (SCI) are predisposed to pressure ulcers (PU). PU remain a significant burden in cost of care and quality of life despite improved mechanistic understanding and advanced interventions. An agent-based model (ABM) of ischemia/reperfusion-induced inflammation and PU (the PUABM) was created, calibrated to serial images of post-SCI PU, and used to investigate potential treatments in silico. Tissue-level features of the PUABM recapitulated visual patterns of ulcer formation in individuals with SCI. These morphological features, along with simulated cell counts and mediator concentrations, suggested that the influence of inflammatory dynamics caused simulations to be committed to “better” vs. “worse” outcomes by 4 days of simulated time and prior to ulcer formation. Sensitivity analysis of model parameters suggested that increasing oxygen availability would reduce PU incidence. Using the PUABM, in silico trials of anti-inflammatory treatments such as corticosteroids and a neutralizing antibody targeted at Damage-Associated Molecular Pattern molecules (DAMPs) suggested that, at best, early application at a sufficiently high dose could attenuate local inflammation and reduce pressure-associated tissue damage, but could not reduce PU incidence. The PUABM thus shows promise as an adjunct for mechanistic understanding, diagnosis, and design of therapies in the setting of PU.