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Pressure/Motion Feedback
to Protect Skin of Sensorimotor Impaired Elders
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Principal Investigator: Eric E. Sabelman,
PhD
Project Staff: David L. Jaffe, MS; Janice Pai, BS;
Eric L. Topp, MS; and Ruth Yap, MS
Project Category: Spinal Cord Injury and
Other
Objective: We are testing the hypothesis that a
wearable motion analysis and pressure feedback system will help prevent skin
breakdown in individuals with spinal cord injury (SCI), stroke (CVA), diabetic
neuropathy, prolonged post-surgical immobilization or extreme frailty who are
at risk for skin breakdown (i.e. pressure sores). Past projects have led to the
creation of a computerized wearable motion analysis system ("WAMAS")
for use as a diagnostic and therapeutic device in elder care.
Research Plan: Testing will be done with 12
subjects in three categories having different skin care needs: (a) SCI patients
referred by VAPAHCS Spinal Cord Injury Center, (b) frail elderly nursing
facility residents (from VAPA Long-Term Care), and (c) peripheral neuropathy
patients (from VAPA Neurology Service). Pressure relief motion data will be
collected using the WAMAS system equipped with triaxial silicon accelerometers
(± 5 g range) near the critical skin region (e.g.: trunk and head for
wheelchair pressure relief, leg for diabetic gait) with pressure sensors
embedded in clothing or cushions.
We are assembling additional sets of the 2nd-generation
WAMAS. Modules were fabricated for skin interface pressure input, tactile, and
speech outputs; work on the arm-mounted RF-linked operator unit is continuing.
Motion patterns of pressure-relief activities are scored for correct vs.
incorrect performance by dividing them into a time sequence of segments, each
with a duration and value window.
Work Accomplished: During 2002, initial and repeat
data acquisition trials were done for five Long-term Care subjects (two cannot
transfer independently, two can transfer to wheelchairs, and one can ambulate
using a walker), with the assistance of Stanford BME student Janice Pai and
Cornell summer student Jong-Min Park. The former studied rolling onto the side
while the subject is lying in bed; the latter student studied reaching tasks
while the subject is supine or with bed elevated to a semi-sitting position.
Trials with these subjects of computer-generated speech commands compared to
live voice showed acceptable equivalence in time to initiate and complete a
roll-to-side pressure relief maneuver.
Because no peripheral neuropathy subjects were referred
to the study, data acquisition and feedback trials were conducted on a cohort
of 4 Parkinson's Syndrome patients selected for frequent episodes of motor
block. WAMAS-based Parkinson's Disease diagnosis and therapy is predicated on
detecting freezing episodes and producing a stimulus signal at an appropriate
time to help unlock freezing, so as to reduce delay in initiation of the
intended motion.
Since not all 12 subjects in each category were
recruited, a no-cost extension of this project (scheduled to end 12/31/02) is
being requested so that testing can continue. Extension would facilitate
technology transfer activities, which have been increasing rapidly during the
last two months, with the aid of Stanford University Office of Technology
Licensing.
Expected Outcome: Prospective use the WAMAS as an
element of telerehabilitation systems for home health care of individuals at
risk for skin damage prompted a special session on "Emerging Role of
Telemedicine in Home Healthcare for the Elderly,"at the RESNA 25th
International Conference on Technology & Disability (July 1, 2002,
Minneapolis, MN). The session was introduced by presentation of the evolution
of the WAMAS concept from a local motion-sensing device to home-based
monitoring with remote reporting. A follow-up session at the 2003 RESNA
conference is planned.
Funding Source: VA RR&D Merit Review
Funding Status: Funded
Reprinted from the 2002 Annual Report
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