Abstract
Pressure ulcers are costly and life-threatening complications for people with spinal cord injury (SCI). People with SCI also exhibit differential blood flow properties in non-ulcerated skin. We hypothesized that a computer simulation of the pressure ulcer formation process, informed by data regarding skin blood flow and reactive hyperemia in response to pressure, could provide insights into the pathogenesis and effective treatment of post-SCI pressure ulcers. Agent-Based Models (ABM) are useful in settings such as pressure ulcers, in which spatial realism is important. Ordinary Differential Equation-based (ODE) models are useful when modeling physiological phenomena such as reactive hyperemia. Accordingly, we constructed a hybrid model that combines ODEs related to blood flow along with an ABM of skin injury, inflammation, and ulcer formation. The relationship between pressure and the course of ulcer formation, as well as several other important characteristic patterns of pressure ulcer formation, was demonstrated in this model. The ODE portion of this model was calibrated to data related to blood flow following experimental pressure responses in non-injured human subjects or to data from people with SCI. This model predicted a higher propensity to form ulcers in response to pressure in people with SCI vs. non-injured control subjects, and thus may serve as novel diagnostic platform for post-SCI ulcer formation.
Highlights
In the United States, it is estimated that approximately 250,000 people live with spinal cord injury (SCI)
The methodology we present in the paper may eventually be used as a novel platform to study post-SCI ulcer formation, as well as serving as a framework for other biological contexts in which agent-based models and mathematical equations can be integrated
To model a complex biological system as an Agent-Based Models (ABM), the system is divided into small computational units (‘‘agents’’), with each agent obeying a set of rules that define the behavior of this agent
Summary
In the United States, it is estimated that approximately 250,000 people live with spinal cord injury (SCI). Costly and life-threatening complications for people with SCI. The prevalence of pressure ulcers in people with SCI is estimated to range from 8% to as high as 33% [4]. Post-SCI pressure ulcers are caused by a combination of impaired sensation, reduced mobility, muscle atrophy, as well as reduced vascularity and perfusion [5]. The current consensus is that pressure alone or pressure in combination with shear force cause localized injury to the skin and/or underlying tissue, usually over a bony prominence [6]. Several pathways have been identified for pressure/shearinduced ulceration, the major one being tissue ischemia
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