Evaluation of Tissue Health and Interventions for the Prevention of Pressure Ulcers in Persons with Spinal Cord Injury

Persons with spinal cord injury (SCI) have atrophied muscle, leading to increased risk of developing pressure ulcers (PU). Even so, some persons with SCI are more susceptible to PUs. The thesis presents several measurements of tissue health to better understand individual differences.The gluteus maximus muscle of persons with SCI in the current study have increased intramuscular fat and decreased lean muscle which make the soft tissue around bony prominences prone to higher stress and strains. Furthermore, atrophy is more pronounced in the region of the ischial tuberosities. A relationship was found between PU history with the gluteal muscle quality/composition but not with muscle cross-sectional area (CSA).Weight redistributing cushions are prescribed to address the increased risk of developing PUs around the bony prominences. The Tissue Health Evaluation Toolbox (THEToolbox) was used to determine the impact on tissue health of independent pressure relief (IPR) on a standard cushion and weight-shifting by a dynamic cushion. The overall improvements in tissue health with use of dynamic cushion are similar though smaller in magnitude to IPR. Differences include prolonged increase in oxygenation during the weight-shifting intervention period and smaller increases in metabolic, neurogenic and myogenic contributions to blood flow during pressure relief. Sustained myogenic contributions to blood flow were observed post-intervention with use of the dynamic cushion. This could be evidence of prolonged influences to blood flow responses and different hyperemic response compared to IPR.Neuromuscular electrical stimulation (NMES) is an approach that could address both extrinsic need for periodic, sustained weight shifting and intrinsic need to improve muscle geometry and quality. It has been shown that, gluteal muscle mass increased in persons with SCI with continued use of gluteal NMES. Concurrent use of trunk and gluteal stimulation improved anterior/posterior postural misalignment for sacral sitters. The postural correction improved regional tissue health. There was a small positive impact on maximum IP gradient with improved lateral postural stability. The case for individualized care is strengthened by the increase in both intramuscular and visceral fat together with varying levels of muscle atrophy and differing physiological responses to weight shifting as observed with the THEToolbox.

Name thesis:degree_name

Doctor of Philosophy

Level thesis:degree_level

doctoral

Discipline thesis:degree_discipline

Biomedical Engineering

Grantor dc:publisher

Case Western Reserve University School of Graduate Studies

Year dc:date

2013

Author dc:creator

• Wu, Gary Anthony Auyong

Contributors dc:contributor

• Bogie, Kath

• Biomedical Engineering
• Biomedical Research
• Biomechanics
• Rehabilitation
• Pressure Ulcers
• Spinal Cord Injury
• Neuromuscular Electrical Stimulation
• Inferior Gluteal Nerve
• Gluteus Maximus
• Muscle Composition
• Tissue Health Evaluation
• THEToolbox
• Tissue oxygenation
• interface pressures
• blood flowmetry
• oximetry

Statement dc:rights

• unrestricted
• This thesis or dissertation is protected by copyright: all rights reserved. It may not be copied or redistributed beyond the terms of applicable copyright laws.

Language dc:language

English

Repository record dc:identifier

http://rave.ohiolink.edu/etdc/view?acc_num=case1365168146

OAI identifier oai:identifier

oai:etd.ohiolink.edu:case1365168146