Key Components Related to Pressure Injury Formation: An Initial Investigation Into Pressure Distribution and Blood Perfusion Responses in Wheelchair Users

Soft tissue around bony prominences in the buttocks and back are high risk areas prone to the development of pressure injuries. From a clinical perspective, prevention of pressure injuries all together is the ideal situation. Unfortunately, prevalence rates still reach 47% with recurrence rates even higher. The goals of this study were to evaluate the effects of a series of wheelchair movements, some that currently exist in commercial wheelchairs and some new, on interface pressures and perfusion under the buttocks. 27 chair positions were obtained by varying back recline, seat pan tilt, and articulation of two supports along the back. Although back recline is commonly taught by therapists to be used as a pressure relieving posture, results indicated an increase in pressures under the ischial tuberosities and sacral areas in reclined positions. Articulation of the back supports produced changes in posture moving from an "erect" to "slouched" position. These movements successfully shifted pressures across back regions. Seat pan tilt was effective in shifting pressures off the ischial tuberosity regions. Additionally, in a portion of the participants, seat pan tilt consistently increased perfusion under the ischial tuberosity region. The findings of this research suggest that movements other than back recline should be considered to more effectively alter interface pressures, particularly in high-risk regions like the sacrum and ischial tuberosities.

MORPHOMETRIC PARAMETERS AND FEATURES OF THE TOPOGRAPHY OF HUMAN PERINEAL BODY

In modern specialized literature, there is practically no information about the shape, size and topography of one of the most important formations of the perineum - of the perineal body. Knowledge of the anatomical aspects of the structure and location of the perineal center would allow in the future to reduce the postoperative complications associated with unintentional damage. The question of the morphology of the perineal body and associated muscles in clinical practice in obstetric traumatism remains relevant. The aim of the study was to study the morphometric parameters and features of the topography of the human perineal body. The objects of the study were 50 autopsy cases of people aged 60-87 years, 25 of each sex, who died from causes not related to the pathology of the pelvic organs. In each case, the perineal body, location of its center and associated muscles were identified. Methods of classical anatomical preparation, description and statistical analysis were used in the work. As a result of the work, five forms of the perineal body were identified: cruciform, «hourglass», triangular, round, polygonal. There were also cases where it was not possible to determine the shape of the intersection of the fibers. For men, the most common triangular shape, for women - the shape of an «hourglass». In most cases in which the shape of the intersection of the fibers was determined, there were clearly identifiable tendon fibers, that is, the tendinal center of the perineal body was present. The average area of ​​the tendinal center of the perineal body in women was 0.99±0.47 cm², and in men 0.94±0.32 cm². The ratio of cases of displacement of the tendinal center towards the right or left ischial tuberosities is almost equal to 10 cases towards the right ischial tuberosity and 11 cases towards the left. When evaluating the pubo-coccygeal asymmetry, in most cases with a triangular shape, there is a sharp displacement towards the apex of the coccyx. Also, the authors found that the average area of ​​the tendinal center of the perineal body is larger in women than in men. Thus, the human perineal body has a variety of forms, according to the authors, associated not only with the embryological features of the development of the muscles of the perineum, but also with the lifestyle, a history of diseases and surgical interventions in the area of ​​the tendinal center of the perineal body.

NON-CONTACT BODY CONDITION SCORE OF DAIRY COWS BASED ON TOF-TECHNOLOGY

The paper presents the results of applying the body condition score (BCS) least squares algorithm used to assess the body condition of dairy cows with a 3D ToF camera. The authors propose a method for collecting field data on the body condition of dairy cows in industrial milk production using a 3D ToF camera. The camera was installed at a height of 2200 mm from the floor at an angle of 5° towards the sacrum. Four areas of the body of 34 dairy cows were examined: the ischial tuberosities, the roundness of the maclugs, the sacral ligament, and the caudal ligament. Data were collected during milking. 136 images were processed. Digital data were processed in three types of images: in the RGB-D color spectrum, Point Cloud and binary. The assessment took into account five groups of fatness: 1 - lean; 2 - thin; 3 - well-fed; 4 - very well-fed; 5 - obese dairy cow. The resulting images were analyzed using software developed in the Matlab environment. The results of the algorithm were compared with the expert assessment of four specialists. According to the results of the BCS assessment of the algorithm, the fatness scores of groups 1 and 5 coincided with the opinion of experts with a probability of 73 and 67%, in groups 2, 3, 4 the coincidence was 61, 52 and 55%, respectively. The authors suppose that the inaccuracy in determining the fatness of groups 2, 3 and 4 is associated with their implicit differences. It is concluded that of all the BCS groups, the system more accurately determines the fatness of cows of groups 1 and 5, as well as from three image options (Point cloud 3D, RGB-D, binary) RGB-D most accurately determined the fatness of cows.

Application of Goertzel Algorithm to Piezoresistive Pressure Sensing Fabric for Custom Fitting of Wheelchair Cushions

Pressure sores are a costly, painful problem for wheelchair users, caused by prolonged periods of mechanical loading. A common location of pressure sores in wheelchair users is the tissue between the ischial tuberosities and the seating surface. The pressure exerted on the tissue, or interface pressure, can be measured using piezoresistive fabric. This work demonstrates the use of the Goertzel algorithm for efficiently acquiring interface pressure data from a fabric assembly consisting of a layer of piezoresistive fabric between two layers of fabric with conducting and non-conducting stripes. The Goertzel algorithm was used to sample sums of sine waves from the conductive columns of the fabric assembly and calculate the amplitudes of each component sine wave corresponding to the local interface pressure. The Goertzel algorithm is more efficient for this application than a fast Fourier transform due to the limited number of calculated frequency bins needed for this application and more freedom in choice of sample size. The algorithm was successfully used to generate two-dimensional, 32 × 32 sensel interface pressure maps once per second. The Goertzel algorithm can be used in tandem with generated sine waves to measure interface pressure from piezoresistive fabric. Low-cost, accurate interface pressure measurements will help lessen the risk of pressure sores in wheelchair users.

Defining the medical coverage of ballistic protection to the pelvis and thigh

IntroductionPelvis, lower limb and associated genital injury caused by explosive devices was responsible for mortality and considerable long-term morbidity for the UK Armed Forces during combat operations in Afghanistan, resulting in the issue of a pelvic protection system in 2010. The aim of this current research was to determine the medical coverage of the pelvis and thigh and to define the vertical dimensions of ballistic protective material for future pelvic protection (PP).MethodCT scans from 120 male UK Armed Forces personnel were analysed to identify the anthropometric landmarks and vertical boundaries of coverage for the pelvis and thigh. Pelvic height was the vertical distance between the upper border of the iliac crest in the midaxillary plane to the most inferior point of the ischial tuberosity of the pelvis. Upper thigh height was proposed as a 100 mm fixed distance below the ischial tuberosities, enabling a tourniquet to be reproducibly applied. These distances were compared with the ballistic component of the five sizes of tier 1 PP using a paired t-test.ResultsThe vertical components of coverage measured using CT scans were all significantly less (p<0.01) compared with all five sizes of tier 1 PP; for example, the ballistic component of the smallest size of tier 1 PP measured 410 mm, which was larger than the 99th percentile male, which measured 346 mm on CT scans.ConclusionsWhile all sizes of tier 1 PP provide coverage to the pelvis and upper thigh structures, there is an opportunity to optimise future PP. For example, comparing the large size of tier 1 PP to the 50th percentile male demonstrated an opportunity to reduce the ballistic protective component by 31%. Reducing the quantity of material used will improve heat dissipation and user comfort and reduce material mass and acquisition costs.

The inception of the Bastion Protocol for trauma CT scanning

During Operation HERRICK, increasing numbers of battlefield casualties resulted in the need for innovation in the medical management of trauma. The aim of diagnostic radiology was to provide fast and accurate diagnostic information to the trauma team. The Bastion Protocol Computed Tomography (CT) Traumagram played a vital part in achieving this aim in the Joint Force Role 3 Medical Treatment Facility (R3), Camp Bastion.The CT Traumagram comprises a non-contrast CT scan of the head, followed by a biphasic intravenous contrast injection with single-pass acquisition from the Circle of Willis to the ischial tuberosities or as far down the legs as is necessary. Diagnostic CT, once a time-consuming process, became one of the major medical successes of Operation HERRICK. As a result, the Bastion Protocol, in modified forms, has been widely accepted and adopted in civilian trauma practice throughout the United Kingdom (UK). This paper aims to document the inception of the Bastion Protocol.

Riders’ perception of symmetrical pressure on their ischial tuberosities and rein contact tension whilst sitting on a static object

The horse-rider system is of great interest in understanding the mechanics involved in optimising locomotor function and performance in the ridden horse. Adult riders (n=30) attending a rider conference volunteered to take part in the study. Riders were asked to mimic riding position by positioning themselves symmetrically on their seat bones (ischial tuberosities) sitting on a (Pliance) pressure mat which was placed on a static platform. Riders were also asked to mimic even rein contact using reins with gauges which were attached to a solid wall. When satisfied that they were sitting symmetrically and had an even rein contact, pressure and rein measurements were captured for 5 s and repeated three times. A paired T Test was carried out to determine differences between left and right ischial tuberosities and rein pressures. Using a static model, this study found that the riders had significantly more pressure beneath the left ischial tuberosity (mean ± standard deviation, 3.22±1.43 N/cm2) compared to the right (2.65±1.49 N/cm2) (P=0.04) and no significant differences were observed between left (6.37±2.42 N) and right rein pressure (6.38±2.66 N) (P=0.95). Whilst sitting on a static platform, differences in ischial tuberosity pressure in adult riders were observed despite these riders’ perception that their seat was symmetrically weighted. These differences observed need to be investigated further, dynamically, to determine if there is a similar trend in the ridden situation.