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Smart- e -Pants : Intermittent Electrical Stimulation for the Prevention of Pressure Ulcers Chester Ho, MD Head and Associate Professor Division of Physical Medicine & Rehabilitation Department of Clinical Neurosciences University of Calgary Calgary , Canada. - PowerPoint PPT Presentation
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Smart-e-Pants: Intermittent Electrical Stimulation for the Prevention of Pressure Ulcers
Chester Ho, MDHead and Associate Professor
Division of Physical Medicine & RehabilitationDepartment of Clinical Neurosciences
University of CalgaryCalgary, Canada
2
AIHS Team in Smart Neural Prostheses:
Neuroscientists, Engineers, Cell Biologists, Computer Scientists, Neurosurgeons, Physiatrists, Biostatisticians
Principal Investigators
Project SMART
Objectives
• To describe the scope of problems with pressure ulcers
• To review the use of intermittent electrical stimulation in the prevention of pressure ulcer
• To discuss the design of Smart-e-Pants and its feasibility testing
WHAT IS A PRESSURE ULCER?
Definition
• A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated*.
*National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel
Stage IV Pressure Ulcer
Big problem? Yes!
• US prevalence data by hospital setting:– acute hospital: 3-11% (9.2% in a study of 148
acute care hospitals) (Meeham 1990)
– rehabilitation hospital: 6-40% – skilled nursing facility. 5-26%– home care: 20%– hospice: 13%
Expensive problem? Yes!
• Cost of care: $9.1 – 11.6 billions spent per year in US (ARHQ)
• CMS not paying for hospital-acquired stage III or IV pressure ulcers since Oct 2008
Are they avoidable?
• Incidence not decreasing in US• Expert consensus – most are avoidable but some are
not (Black 2011)
• Many risk factors are reversible – therefore important to explore reversible factors
• Current prevention techniques are passive and do not aim to actively reverse any underlying tissue health risks… so what can we do?
SMART-E-PANTSIntermittent Electrical Stimulation (IES)
• Proof-of-principle established in short-term experiments in animals (rats) and human volunteers (intact, spinal cord injured): Increasing tissue oxygenation Redistributing pressure around bony prominences Increasing muscle mass
Using Intermittent Electrical Stimulation as a Means of Prevention
How Smart-e-Pants Works
(b)
(a)left
right
left
right
sustained train of pulses during stimulus ON
bursts of pulses during stimulus ON
simultaneous left-right activation
alternating left-right activation
left
right
left
right
sustained train of pulses during stimulus ON
bursts of pulses during stimulus ON
left
right
left
right
left
right
left
right
sustained train of pulses during stimulus ON
bursts of pulses during stimulus ON
simultaneous left-right activation
alternating left-right activation
Gluteus Maximus
Ischial tuberosity
Gluteus maximusmotor point
Gluteus Maximus
Ischial tuberosity
Gluteus maximusmotor point
(b)
(a)left
right
left
right
sustained train of pulses during stimulus ON
bursts of pulses during stimulus ON
simultaneous left-right activation
alternating left-right activation
left
right
left
right
sustained train of pulses during stimulus ON
bursts of pulses during stimulus ON
left
right
left
right
left
right
left
right
sustained train of pulses during stimulus ON
bursts of pulses during stimulus ON
simultaneous left-right activation
alternating left-right activation
Gluteus Maximus
Ischial tuberosity
Gluteus maximusmotor point
Gluteus Maximus
Ischial tuberosity
Gluteus maximusmotor point
“ON”“OFF”
10 minutes10 sec
“ON”
Intermittent Electrical stimulation (IES) is delivered to muscles at risk (i.e. gluteus maximus) through surface electrodes Muscle contractions are elicited every 10 minutes for 10 seconds; 12 hours per day
Patent pending
Electrodes and Stimulator
Stimulator Belt
Electrodes
Application
Smart-e-pants
Patent pending
SMART-E-PANTS FEASIBILITY STUDY
Objectives of Smart-e-Pants Feasibility Study:
1. Test Smart-e-Pants safety, stability, ease of use and acceptability by both caregivers and end-users
2. Evaluate feasibility of implementing Smart-e-Pants in: Acute care setting (Foothills Medical Centre, Calgary, AB) Rehabilitation hospital (Glenrose Rehabilitation Hospital,
Edmonton, AB) Long-term care facility (Allen Gray Continuing Care,
Edmonton, AB)
Time to Apply and Remove Electrodes vs. Smart-e-Pants
LTCF - ERH - ERH - GANR - EANR - G
Care Facility
Stability of Muscle Contraction
Care Facility
Care Facility
Skin Response to Electrodes
Patient Response to Smart-e-Pants
• Intermittent electrical stimulation may prevent pressure ulcers.
• Smart-e-Pants are an acceptable intervention for the prevention of pressure ulcers (for both caregivers and patients).
• While on the Smart-e-Pants protocol we have not had any patient developing pressure ulcers or other significant adverse events.
Conclusions
Next Steps
• Further enhancement of stimulator• Clinical testing in at-risk populations
Smart-e-Pants Team Calgary Sean Dukelow, MD Chester Ho, MD Robyn Warwaruk Rogers, RN
Dukelow Lab Jennifer Semrau, PhD Sonja Findlater, BSc OT
Acknowledgment
Smart-e-Pants Team EdmontonVivian Mushahwar. PhD
Ming Chan, MD
Richard Stein, PhD
Su Ling Chong, BSc, PT
Alisa Ahmetovic, BEng.
Ryan Somer, BSc OT
Dana Schnepf, RN BN
Glen Isaacson
Thank you!
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