Developing Low Cost Automated Smart-E-Pants for the Prevention of Pressure Ulcer

Introduction :

Pressure ulcers, also called bedsores, or decubitus ulcers are regions of skin that breakdown when one sits or lying for a long time. This occurs most frequently, where bones are very close to the skin and prolonged pressure can develop. Pressure ulcers that affect the deep tissue may not be recognized until the wound is externally visible, by which time extensive injury may have occurred. These ulcers often develop from the constant pressure between the ischial tuberosities and the surrounding tissue in individuals confined to beds or wheelchairs with reduced mobility or sensation. Because they are painful and debilitating, pressure ulcers have a negative effect on physical, psychological, and social domains of quality of life. Pressure ulcers are an adverse event that also increases the risk for further adverse events, including infection, osteomyelitis (infection of the bone), sepsis, and death.

Prevalence and Patient Group :

The estimated incidence of pressure ulcers is approximately 15% in community care, 22% in mixed care, 25% in acute care, and 30% in non-acute care facilities. More than 85% of individuals with spinal cord injuries will develop a pressure ulcer at least once during their lifetime. Up to 70% of pressure ulcers develop on the hips or buttocks.

Elderly residents in nursing homes; individuals in long-term care; those with diabetes; and individuals confined to beds or wheelchairs due to spinal cord injuries, head trauma, or musculoskeletal disease are particularly at risk for developing pressure ulcers, but all patients are potentially at risk. In addition to the constant pressure, the muscle atrophy and poor tissue oxygenation associated with many of these conditions further increases the risk of developing pressure ulcers. With an aging population and rising rates of diabetes, the number of patients at risk for pressure ulcers is likely to increase.

Our Idea :

Our Smart E Pant will use the intermittent electrical stimulation (IES) to relieve accumulated pressure and improve tissue oxygenation in patients at risk for pressure ulcers. In the past, different modes of electrical stimulation have been used to promote pressure ulcer wound healing, but the Smart-e-Pants technology is intended to prevent pressure ulcers for general use. Smart-e-Pants incorporates electrodes into specially designed underwear that delivers electrical stimulation to the underlying muscles. The device consists of:

The undergarment — a cotton and Lycra fabric, similar to biking shorts, with a front zipper to accommodate patients needing catheterization, markers on the thighs to guide alignment, and belt loops for the electrode leads
The surface electrodes — two for each buttock, contained in mesh panels on the back of the pants
A small, battery-operated stimulator — housed in a pocket at the waist.

https://drive.google.com/open?id=1pzFYitVT4LMKRS-yPp9TbEHdPnzsERcA

When activated, the electrodes deliver 10 seconds of stimulation every 10 minutes, causing the gluteal muscles to contract and redistribute seating pressure. The stimulation achieves an effect similar to the subconscious fidgeting and shifts in body positioning that individuals without mobility issues make to relieve pressure. The longer period of no stimulation (measured in minutes) relative to the stimulation period (measured in seconds) minimizes muscle fatigue. In addition to redistributing pressure, the regular muscle activation improves tissue oxygenation, which also helps to prevent pressure ulcers.

https://drive.google.com/open?id=1mv3V7HOmt7RjASuMoCNpIF7OsnqMBnEP

Feasibility:

There are several existing methods including improvement of skin hygiene, frequent repositioning, specialized mattress/cushion for pressure redistribution, exercise and maximal remobilization and electrical stimulation based devices for the prevention of pressure ulcer. But these methods have some common problems. Most of them are:

• Not portable
• Very expensive, some involve costly equipment
• Require trainer or caregiver to perform
• High risk of deep tissue injury
• Show poor performance in tissue oxygenation and 
• Often require going to hospital. 

There is no automated control device that can actively perform artificial fidgeting without any caregiver help and remote control mechanism as well as cheap and self sufficient. Hence, the evolution of our idea. The limitations of the existing methods make our idea a feasible method of preventing pressure.