Review of assistive devices for the prevention of pressure ulcers: an engineering perspective

PURPOSE

Pressure ulcers (PUs) are prevalent among immobile bed or wheelchair-reliant individuals who experience prolonged sedentary positions. Pressure relief and frequent repositioning of body posture help to mitigate complications associated with PUs. Adherence with regular repositioning is difficult to maintain due to nursing labour shortages or constraints of in-home caregivers. Manual repositioning, transferring, and lifting of immobile patients are physically demanding tasks for caregivers. This review aimed to explore and categorize these devices, discuss the significant technical challenges that need addressing, and identify potential design opportunities.

MATERIALS AND METHODS

In this review, a literature search was conducted using PubMED, Science Direct, Google Scholar and IEEE Xplore databases including studies from 1995 until Feb 2023 with keywords such as pressure ulcer, assistive device, pressure relief, repositioning, transfer, etc. Both commercial and research-level devices were included in the search.

RESULTS

142 devices or technologies were identified and classified into four main categories that were further subcategorized. Within each category, the devices were investigated in terms of their mechanical design, actuation methods, control strategies, sensing technologies, and level of autonomy. Limitations of current technologies are design complexity, lack of patient comfort, and a lack of autonomy requiring caregivers frequent intervention.

CONCLUSIONS

Several devices have been developed to help with prevention and mitigation of PUs. There remain challenges that hinder the widespread accessibility and use of current technologies. Advancements in assistive technologies for pressure ulcer mitigation could lie at the intersection of robotics, sensors, perception, user-centered design, and autonomous systems.

Investigation of Needle Characteristics Using an Animal Model for Improved Outcomes in Anterior Chamber Paracentesis

Background/Aims: The current standard of care to perform an anterior chamber paracentesis involves the use of a multipurpose market needle and syringe. The use of standard needles for this purpose may result in injury to the patient due to increased force with insertion and increased globe displacement during the procedure. This research investigates the current market needle characteristics and the impact of each needle characteristic on force. Methods: Several comparative trials were conducted to evaluate the needles. Needle characteristics of interest were gauge, primary bevel angle, number of bevels in the lancet, and needle hub geometry. Measurements of corneal insertion forces were made using a synthetic thermoplastic polyurethane medium, and bovine and porcine models. Needle safety was investigated with corneal abrasion experiments. Results: Reduced insertion force was observed with lower lancet primary angle. There was no difference based on the number of bevels in the lancet. Rounded hub geometry had minimal distribution to the corneal epithelium. Conclusions: Needle characteristics impact the force needed for needle insertion into the tissue. Since higher force can lead to increased risk and less efficiency during the procedure, reducing this force may improve the outcomes of the procedure. Needle entry can be reduced by designing an improved needle that includes a lower gauge and reduced primary angle of the lancet.