Abstract
Objective/BackgroundDespite the fact that most people with a spinal cord injury who use a wheelchair for mobility are considered at-risk for pressure ulcer (PrU) development, there still exists a spectrum of risk amongst this group. Efforts to differentiate risk level would benefit from clinical tools that can measure or predict the buttocks response to loading. Therefore, the goal of this study was to identify how tissue compliance and blood flow were impacted by clinically-measurable risk factors in young men with SCI.MethodsBlood flow at the ischial tuberosity was measured using laser Doppler flowmetry while the seated buttock was unloaded, and loaded at lower (40–60 mmHg) and high (>200 mmHg) loads. Tissue compliance of the buttock was measured using the Myotonometer while subject were lifted in a Guldmann Net.ResultsAcross 28 participants, blood flow was significantly reduced at high loads, while no consistent, significant changes were found at lower loads. At 40–60 mmHg, blood flow decreased in participants with a pressure ulcer history and lower BMI, but stayed the same or increased in most other participants. The buttock displaced an average of 9.3 mm (2.7 mm) at 4.2 N, which represented 82% (7%) of maximum displacement. BMI was related to the amount of buttock tissue displacement while smoking status explained some of the variation in the percent of max displacement.ConclusionWide variability in tissue compliance and blood flow responses across a relatively homogeneous population indicate that differences in biomechanical risk may provide an explanation for the spectrum of PrU risk among persons with SCI.
Highlights
Pressure ulcers (PrUs) are a leading secondary complication of spinal cord injury (SCI), affecting more than 50% of people with SCI at some point in their lives. [1] The costs of pressure ulcer (PrU) extend far beyond the medical costs incurred for treatment
Despite the fact that most people with a spinal cord injury who use a wheelchair for mobility are considered at-risk for pressure ulcer (PrU) development, there still exists a spectrum of risk amongst this group
Studies have identified differences in tissue stiffness according to body mass index (BMI) and diagnosis. [9,10,11] Computational models have been used to predict the influence of individual characteristics such as body mass index, tissue stiffness and thickness on the amount of internal stress and strain that results from sitting. [12,13,14,15] [16,17,18,19,20,21,22] researchers have found significant variation in the amount of applied pressure required to occlude blood flow. [23,24,25,26] It is believed that this variation is likely to depend on individual characteristics that contribute to the tissue’s response to loading and influence a person’s biomechanical risk. [5, 27,28,29]
Summary
Pressure ulcers (PrUs) are a leading secondary complication of spinal cord injury (SCI), affecting more than 50% of people with SCI at some point in their lives. [1] The costs of PrUs extend far beyond the medical costs incurred for treatment. Other identified risk factors may impact aspects of tissue mechanics by changing the mechanical or structural characteristics of the skin and underlying tissue. These include nutrition, [32, 37, 38] edema, infection/fever, [33, 35] smoking, [37, 39] hypoalbuminemia, [34, 35] lymphopenia, [34, 35] fever, [34, 35] and continence, [31, 38] to name a few
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