Effects of Support Surface Relief Pressures on Heel Skin Blood Perfusion

Mayrovitz, Harvey N.; Sims, Nancy; Taylor, Martha C.; Dribin, Lori B.

doi:10.1097/00129334-200305000-00012

Cited by 18 publications

(14 citation statements)

References 8 publications

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“…It is widely accepted that 5-min occlusion is able to induce a maximal reactive hyperemic response 40; thus, an ischemic period was selected for 5 minutes. The duration of a reactive hyperemic response is proportional to the period of ischemic occlusion 39–42. Thus, we chose 5 minutes for assessing the efficacy of wheelchair tilt and recline on enhancing skin perfusion.…”

Section: Methodsmentioning

confidence: 99%

Effect of Wheelchair Tilt-in-Space and Recline Angles on Skin Perfusion Over the Ischial Tuberosity in People With Spinal Cord Injury

Jan

Jones

Rabadi

et al. 2010

Archives of Physical Medicine and Rehabilitation

118

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Objective-To investigate the efficacy of wheelchair tilt-in-space and recline on enhancing skin perfusion over the ischial tuberosity in wheelchair users with spinal cord injury (SCI). Design-Repeated measures, intervention and outcomes measure design. Setting-A university research laboratory.Participants-11 wheelchair users with SCI (9 men, 2 women; mean age ± standard deviation, 37.7±14.2 years; body mass index 24.7±2.6 kg/m 2 ; and duration of injury 8.1±7.5 years).Interventions-6 protocols of various wheelchair tilt-in-space and recline angles were randomly assigned to the participants. Each protocol consisted of a 5-min sitting-induced ischemic period and a 5-min wheelchair tilt-in-space and recline pressure relieving period. A participant sat in a position without tilt or recline for 5 minutes and then sat in one of 6 wheelchair tiled and reclined positions, including (1) 15° tilt-in-space and 100° recline, (2) 25° tilt-in-space and 100° recline, (3) 35° tilt-in-space and 100° recline, (4) 15° tilt-in-space and 120° recline, (5) 25° tilt-in-space and 120° recline, and (6) 35° tilt-in-space and 120° recline. A 5-min washout period (at 35° tilt-inspace and 120° recline) was allowed between protocols.Main Outcome Measures-Laser Doppler flowmetry was used to measure skin perfusion over the ischial tuberosity in response to the changes of body positions caused by performing wheelchair tilt-in-space and recline. Skin perfusion response to wheelchair tilt-in-space and recline was normalized to skin perfusion of the upright seated position (no tilt/recline).Results-When combined with 100° recline, wheelchair tilt-in-space at 35° resulted in a significant increase in skin perfusion as compared with upright seated position (no tilt/recline) © 2010 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.Correspondence to Yih-Kuen Jan, PT, PhD, Dept of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, Room 3135, Oklahoma City, OK 73117, yjan@ouhsc.edu. Reprints are not available from the author. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated. (p<0.05), while there was no significant increase in skin perfusion at 15° and 25° tilt-in-space( non significance). When combined with 120° recline, wheelchair tilt-in-space at 15°, 25°, and 35° tiltin-space all showed a significant inc...

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Section: Methodsmentioning

confidence: 99%

Effect of Wheelchair Tilt-in-Space and Recline Angles on Skin Perfusion Over the Ischial Tuberosity in People With Spinal Cord Injury

Jan

Jones

Rabadi

et al. 2010

Archives of Physical Medicine and Rehabilitation

118

View full text Add to dashboard Cite

show abstract

“…Maximum and minimum pressure [23,24] Gives no indication of the time varying nature of the pressure Average pressure [25,26] Does not communicate the extent to which pressure is periodically relieved Tissue deformation index [17] A large number of measurements are required and it is complex to calculate Pressure impulse [35,36] Non-intuitive units of measurement (mmHg h 71 ) and provides no clear idea of pressure-free time Skin temperature and humidity [58,59] Both techniques are influenced by several factors within the body and the environment Skin gas tension [42,43] False readings occur, unless the influence of direct pressure on to the electrode is diffused Pressure relief index [37,38] Requires expensive computerized equipment and useful in looking at alternating systems only Laser Doppler fluxmetry [52,53] Arbitrary units of measurement and results cannot be compared from studies using different monitors Clinical trials [5,6] Often influenced by the increased interest and enthusiasm in both staff and patients involved Figure 1. Different methods used for support surface evaluation.…”

Section: Methodsmentioning

confidence: 99%

“…These reflected light signals are processed according to an instrumental algorithm that results in an output proportional to tissue blood perfusion [51]. Mayrovitz et al [52] have investigated the characteristics of hyperaemic reaction on the heel subjected to alternating local loading with graded magnitude and duration using an LDF probe with the Although the probe registers perfusion at only one small sample site, certain general features of the perfusion responses are useful for comparative purposes. The probe conforms to the skin surface and in a recent study [53] was used to compare APAMs.…”

Section: Laser Doppler Fluxmetrymentioning

confidence: 99%

Assessment of patient support surfaces: principle, practice and limitations

Rithalia

2005

Journal of Medical Engineering & Technology

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Pressure ulcers cause great pain and suffering to patients as well as unnecessary strain on nursing staff. Their treatment is both costly and time consuming. Every effort therefore should be directed towards their prevention. Understanding of the aetiology of pressure ulcers is still incomplete and assessment of devices aimed at prevention is difficult. Over the years, numerous parameters, including interface pressure and transcutaneous blood gas measurements, have been used to evaluate mattresses and cushions. However, the quality of the data gathered is variable and its clinical interpretation remains unsatisfactory. It could be said that the science of evaluation of support surfaces is still at a formative stage, as clinical validation of many of the approaches has yet to be carried out.

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“…A wide variety of studies provides evidence of improved quality of life for people with SCI related to physiological adaptation to exercise, both in additional rehabilitation [34][35][36][37][38][39][40] and high-level sport settings [41][42][43][44][45][46][47], as well as the relationship of these adaptations to improving certain skills with the wheelchair [48][49][50][51][52].…”

Section: Introductionmentioning

confidence: 99%

“…Jan et al explained that to further understand the efficacy of wheelchair tilt-in-space and recline for decreasing PU risk, systemic research of the efficacy of various angles of wheelchair tilt-in-space and recline on decreasing skin and muscle perfusion ischemia is needed [55]. A transient increase in skin blood flow after ischemia is regulated by a protective mechanism called reactive hyperemia [48][49][50][56][57]. Reactive hyperemia is mediated mainly by local blood flow control mechanisms [51][52] Thus, people with SCI still show a reactive hyperemic response after blood occlusion [24].…”

Section: Introductionmentioning

confidence: 99%

Physical activity and transcutaneous oxygen pressure in men with spinal cord injury

Crespo-Ruiz¹,

del-Ama²,

Díaz³

et al. 2012

JRRD

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Abstract-This pilot study proposed a method for assessing the status of vascular flow measured by transcutaneous oxygen pressure (TcPO2) in the area of the ischium in people with spinal cord injury (SCI). In a sample of 38 men (two groups: 12 physically active and 26 sedentary) with thoracic SCI, the distribution of the physiological response of the tissues under load during sitting was assessed through analysis of ischium TcPO2 values obtained by an oximeter. TcPO2 baseline, recovery time of TcPO2 after sitting (Trec), the percentage of TcPO2 (%TcPO2) of maximum pressure TcPO2, and mechanic maximal pressure (Pmax) were evaluated. Trec in the physically active group was significantly lower (p < 0.05) than in the sedentary group. Likewise, significant differences in %TcPO2 between groups (p < 0.05) were also found. We concluded that the physiological response of the tissues under an individual with SCI's own weight resulting from prolonged sitting is better in those who are physically active.

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Effects of Support Surface Relief Pressures on Heel Skin Blood Perfusion

Cited by 18 publications

References 8 publications

Effect of Wheelchair Tilt-in-Space and Recline Angles on Skin Perfusion Over the Ischial Tuberosity in People With Spinal Cord Injury

Effect of Wheelchair Tilt-in-Space and Recline Angles on Skin Perfusion Over the Ischial Tuberosity in People With Spinal Cord Injury

Assessment of patient support surfaces: principle, practice and limitations

Physical activity and transcutaneous oxygen pressure in men with spinal cord injury

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