Relationship between ultrasonographically low-echoic lesions under the skin, wheelchair sitting time, and interface pressure on ischial region in individuals with chronic spinal cord injury

Kawasaki, Shinji; Nishimura, Yukihide; Kamijo, Yoshi‐ichiro; Uenishi, Hiroyasu; Nakamura, Taro; Kouda, Ken; Koike, Yumi; Nakamura, Takeshi; Tajima, Fumihiro

doi:10.1080/10790268.2020.1746873

Cited by 6 publications

(2 citation statements)

References 28 publications

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“…Multiple studies have used human subjects to assess pressure redistribution performance (Swain and Peters, 1997;Kernozek and Lewin, 1998;Burns and Betz, 1999;Ferrarin et al, 2000;Ingrid Eitzen et al, 2003;Gil-Agudo et al, 2009;Hollington and Hillman, 2013;Lee et al, 2016;Kawasaki et al, 2021). Use of wheelchair users offers the most ecologically valid means to assess load distribution but is burdened with a few key limitations.…”

Section: Introductionmentioning

confidence: 99%

Procedure to categorize wheelchair cushion performance using compliant buttock models

Sprigle

Deshpande

2022

Front. Bioeng. Biotechnol.

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Purpose: Wheelchair cushion prescription often seeks to address tissue integrity in addition to other clinical indicators. Because hundreds of wheelchair cushion models are available, a benefit would result if cushions were classified in a more valid manner to help guide selection by clinicians and users. The objective of this research was to develop an approach to evaluate and classify wheelchair cushion performance with respect to pressure redistribution.Materials and methods: Two anatomically-based buttock models were designed consisting of an elastomeric shell that models overall buttock form and a rigid substructure that abstracts load-bearing aspects of the skeleton. Model shapes were based upon elliptical and trigonometric equations, respectively. Two performance parameters were defined, pressure magnitude and pressure redistribution. The pressure magnitude parameter compared internal pressure values of the test cushion to a flat foam reference material, resulting in three classifications, superior, comparable, and inferior. Surface sensors were used to distinguish cushions with high, moderate or low pressure redistribution performance. Ten wheelchair cushions were evaluated by both models using two loads that represent a range of body weights expected for 41–43 cm wide cushions.Results and Conclusion: A classification matrix is proposed using both models and performance parameters. Two cushions met criteria for the highest level of performance, and one cushion was deemed to have inadequate performance for therapeutic value. The proposed method has a sensitivity to discern differences, compatibility with different sized cushions, and a versatility in classification. As such, it stands as an improvement over existing classification approaches.

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Section: Introductionmentioning

confidence: 99%

Procedure to categorize wheelchair cushion performance using compliant buttock models

Sprigle

Deshpande

2022

Front. Bioeng. Biotechnol.

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“…In active SCIs, a PI most frequently appears in the skin over the ischial region ( 13 , 14 ). We reported that in chronic SCI patients who use wheelchairs daily, the areas with subdermal low-echoic lesions identified by ultrasonography were those with long pressure durations and high interface pressures ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

Follow-Up Study of Subdermal Low-Echoic Lesions in the Ischial Region in Wheelchair Users With Spinal Cord Injuries

et al. 2022

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Objective:To follow up patients with spinal cord injuries with subdermal low-echoic lesions in the ischial region for abnormalities after 1 year.DesignA retrospective cohort study.SettingA Japanese rehabilitation center.ParticipantsWe included patients with chronic spinal cord injuries and subdermal low-echoic lesions who underwent routine inspection and palpation examinations (n = 7).InterventionsEducation on pressure injury and instruction on pressure relief and seating was provided and the patients were followed up for abnormalities after 1 year. Self-reports were obtained on wheelchair sitting time, and interface pressure was recorded while the patients were seated on the wheelchair. Interface pressure measurements at the bilateral ischial regions were recorded with a force-sensitive application pressure mapping system.Outcome MeasuresThe primary outcome was the presence of subdermal low-echoic lesions in the bilateral ischial regions on ultrasonography at the 1-year follow-up examination. Secondary outcomes included wheelchair sitting time and interface pressure in the bilateral ischial regions.ResultsOf the 10 areas that showed subdermal low-echoic lesions on ultrasonography, nine had improved after 1 year. One area that did not improve was an open wound. At the follow-up examination, the pressure duration was reduced in all patients, and the interface pressure could be reduced in 5/7 patients.ConclusionsThis is the first study to follow up with patients having spinal cord injuries and subdermal low-echoic lesions in the ischial region using ultrasonography. The low-echoic lesions improved within 1 year by reducing the pressure duration and interface pressure. Pressure injury prevention in patients with spinal cord injuries relies on the early detection of skin abnormalities, and education and instruction to change self-management behaviors are recommended.

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Pressure Injury and Pressure Ulcers

Haesler,

Kottner

2024

Rook's Textbook of Dermatology

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Pressure ulcers are defects of the skin and/or underlying tissues that occur because of pressure or pressure in combination with shear. Pressure ulcers occur due to prolonged exposure to mechanical load that increases internal stresses and strains. Some individuals are at increased risk of developing a pressure ulcer, particularly those who are immobile. Identifying those at risk and implementing preventive strategies that address these risks are an imperative. When a pressure ulcer occurs, accurate assessment of the extent of skin and underlying tissue damage and the clinical condition of the ulcer assists in selection of appropriate wound treatments. This chapter provides an overview of the epidemiology and pathophysiology of pressure ulcers, their classification and assessment, and strategies that are used in their prevention and treatment.

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Relationship between ultrasonographically low-echoic lesions under the skin, wheelchair sitting time, and interface pressure on ischial region in individuals with chronic spinal cord injury

Cited by 6 publications

References 28 publications

Procedure to categorize wheelchair cushion performance using compliant buttock models

Procedure to categorize wheelchair cushion performance using compliant buttock models

Follow-Up Study of Subdermal Low-Echoic Lesions in the Ischial Region in Wheelchair Users With Spinal Cord Injuries

Pressure Injury and Pressure Ulcers

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