The objective of this project is to continue the Mobility RERC´s work in defining the usage of mobility devices in everyday life. While others have address the question: how far do users travel in their wheelchairs daily?, we seek to address the question: "How do people use their wheelchairs?" This is a more complex question that requires different variables to be measured. In particular, the Mobility RERC has developed the construct of 'bouts of mobility' to better characterize how wheelchairs are used in everyday life.
The overall goal of this project is to develop an individualized pressure ulcer susceptibility model to guide clinical intervention. The specific aims of the project are to: 1) determine the quantitative relationship between pressure ulcer risk factors and the response of buttock tissue to loading in persons with SCI; 2) model the relationship between buttock tissue's response to loading and pressure ulcer development; and 3) create a clinically viable, individualized pressure ulcer susceptibility model for persons with SCI. The individualized susceptibility model will use clinical risk factors to quantitatively predict pressure ulcer outcomes by means of buttock tissue's response to loading. The model will help to establish clinically relevant, evidence-based guidelines for the selection of wheelchair cushions and turning and pressure relief schedules.
Clinical practice guidelines dictate that regular pressure reliefs (PRs) are necessary for the prevention of pressure ulcers in persons with spinal cord injuries. Currently, wheelchair users are taught to perform PRs that include both complete, dedicated PRs as well as partial relief maneuvers (i.e., squirming, slight posture changes). Previous studies have not found any association between PR behavior and pressure ulcer occurrence. However, all of these studies based pressure relief behavior on self report data that could not be confirmed and focused solely on complete reliefs. In response to the need to study PRs in a valid and relevant manner, two experiments are being conducted. The PR Technique experiment will compare the effectiveness of complete and partial PR techniques in an SCI population. The second experiment, PR Behaviors, quantifies the relationship between PU history and real-world PR behaviors in persons with spinal cord injuries.