Preventing Spinal Cord Injury

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Pressure ulcers (PrUs) are a high-risk, high-volume, high-cost problem for persons with spinal cord injury (SCI). Approximately 273,000 persons are living with SCI in the United States today and approximately 12,000 new injuries occur per year [1]. Persons with SCI are at extreme risk for developing PrUs due to lack of sensation, immobility, moisture, and multiple other risk factors.2 Prevalence for PrUs in persons with SCI ranges from 14-32%, and recurrence rates have been reported to range from 31-79%.3 PrUs account for approximately one third of all VA SCI admissions and over half of all hospital days for veterans with SCI.3 The cost to manage one full-thickness ulcer can be as much as $70,0008 [JRRD paper] and over $17 billion is spent on pressure ulcer treatment annually in the United States [3]. The VA alone spends $100 million annually on just primary diagnoses of PrUs for Veterans with SCI [REF].
The National Pressure Ulcer Advisory Panel defines a PrU as localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.4 Undoubtedly, high pressure applied to an area of skin over a length of time will inevitably cause tissue damage.5,6 PrUs are most commonly found over and around bony prominences; locations where interface pressures are the greatest. The majority of PrUs are found in the gluteal and sacral regions,7 principally at the ischial tuberosities, sacrum, and coccyx. It is widely accepted that mechanical loading is the main cause of pressure ulcer formation; however, the pathophysiological responses to this loading are less agreed upon [REF].

Safe Patient Handling Equipment
Mechanical lifting technologies have been...

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...the manufacturer to measure pressures from 0-200 mmHg, with a reported accuracy of ±10%.
A modern hospital bed with low air loss technology was used for all measurements (VersaCare A.I.R., Hill-Rom, Batesville, IN). The head of bed (HOB) elevation was measured with the bed’s ball-bearing indicator located in the side rail of the bed. A wheelchair (Quickie GPV, Sunrise Medical, Fresno, CA) and cushion (Invacare Absolute, Elyria, OH) were used for all seated sling transfers. A ceiling lift system (Maxi Sky 600, ArjoHuntleigh, Addison, IL) was used in a clinical laboratory setting for all participants and slings. The lift system has a safe working load of 272 kg and a 2.3 m strap length. A standard 2-point spreader bar was used for all seated slings. The manufacturer-recommended spreader bar (either 8- or 10-point) was used for each of the respective supine slings.

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