Development of Technologies to Increase In-Seat Movement to Prevent Sitting-Acquired Pressure Injuries in Wheelchair Users

SUMMARY/ABSTRACT Adults with Alzheimer?s disease are at an increased risk of developing pressure injuries (commonly known as pressure ulcers). In a recent study by PI Sonenblum, 7% of adults with Alzheimer?s disease from a large EMR- based cohort study developed pressure injuries, and Alzheimer?s disease was the mobility related disability with the highest prevalence of pressure injuries behind spinal cord injury and spina bifida. Pressure injuries lead to high healthcare costs, further disability, decreased quality of life, pressure injury pain in older adults, and can result in death when sepsis is present. Wheelchair use is responsible for 36% to 50% of pressure injuries, and wheelchair use is common among adults with Alzheimer?s both living at home or in assisted living facilities. Further, the latest NPIAP/EPUAP guidelines highlight that older adults with Alzheimer?s disease and its related dementias continue to be under-assessed and under-treated for pressure injuries and related symptoms. Thus, there exists a need to improve the way we care for patients with Alzheimer?s disease who use wheelchairs to better prevent seating-acquired pressure injuries. A key component for the prevention of pressure injuries is minimizing prolonged pressure under the sacral, ischial, and sacrococcygeal areas through movement and shifting of the body. Our team has developed two novel technologies that provide feedback to increase body movement to prevent pressure injuries. Both systems (WiSAT and AW-Shift) utilize advanced sensors placed either under or atop a wheelchair cushion that communicate to a mobile application (app) that can be viewed by the wheelchair user and/or caregiver on a smart phone or tablet. The systems provide feedback to the user to motivate the performance of pressure relieving behaviors. Our current NIH funded project is testing the effectiveness of the two systems to improve pressure-reducing in-seat body movement in adults with spinal cord injury and related disorders. Both systems have gone through an extensive user- centered design process with wheelchair users without significant cognitive disability, and the systems have been tailored for personal use by the wheelchair user. We propose that these systems could have a significant role in improving the management the skin health of adults with Alzheimer?s disease who use or sit in wheelchairs for long periods of time. However, both systems need to be tailored to the needs of adults with Alzheimer?s disease and/or their caregivers. We propose to perform a thorough needs assessment of key stakeholders followed by a tailoring of the system to user needs. Finally, we will perform usability testing of both systems in the target population to determine the user experience and guide further development and testing.