(Georgia Institute of Technology, 2009-08-19)
Sonenblum, Sharon Eve
The overall goal of this research is to improve the use of seated tilt to increase function, health and quality of life for people using power wheelchairs. Specifically, the objective of this dissertation is to evaluate the biomechanical responses to seated full body tilt and their relationships to the actual use of tilt-in-space wheelchairs.
In the first phase of this study, researchers remotely monitored how 45 fulltime power wheelchair users used their tilt-in-space systems. Participants spent an average of 12.1 hours in their wheelchair each day. They spent more than 2 hours seated at positions greater than 15° and performed tilts of 5° or greater every 27 minutes, but rarely performed tilts past 30°.
Two distinct types of tilt behavior were identified: uni-modal (staying at a single position more than 80% of the time) and multi-modal (staying at a single position less than 80% of the time). Participants in the multi-modal group tilted significantly more frequently (4 times per hour) than the uni-modal group, and did not have a single typical position. Participants without sensation were more likely to exhibit uni-modal behavior.
In the second phase of this study, researchers used interface pressure measurements and laser Doppler flowmetry to study changes in localized loading and superficial blood flow at the ischial tuberosities across different amounts of tilt. Eleven participants with spinal cord injuries were studied in a laboratory setting. Results showed that biomechanical responses to tilt were highly variable. Pressure reduction at the ischial tuberosity was not present at 15°, but did occur with tilts to 30° and greater, and could be explained by the tilt position and upright pressure. Unlike pressure, blood flow increased with all tilts from an upright position, but did not increase when tilting from 15° to 30°. Only 4 of 11 participants had a considerable increase (≥10%) in blood flow at 30° tilt, whereas 9 participants did during maximum tilt (i.e., 45°-60°). Based on the results of this study, tilting for pressure reliefs as far as the seating system permits is recommended to maximize the potential for significant blood flow increases and pressure relief.
(Georgia Institute of Technology, 2006-05-22)
Prabhakara, Sandeep
Ultrasound is a valuable tool to monitor wound healing. In this report, ultrasound is used to determine the features in the B-scans that correspond to a bruise. High frequency ultrasound scans show clear and distinct features that correspond to a laceration or a late stage pressure ulcer. This is because of the extensive damage and the rupture of the epidermis in both the cases. This study assumes significance because it is an effort to find such artifacts in the ultrasound scans of bruises caused by blunt forces where the epidermis remains intact. In this study, the structure of the skin was visualized using a 20 MHz ultrasound scanner. Skin thickness and echogenicity changes may result due to blood extravasations or edema. The thickness and the echogenicity values are plotted against time to determine the trend in the variation of these parameters. We see an intraday and a daily fluctuation of skin thickness and echogenicity albeit with no distinct trend on a day to day basis or between subjects. The results also give us a good estimation of the variation observable in these parameters in the event of an injury. A snapshot analysis is also performed, which describes qualitatively the structural changes in the B-scan of the bruise site compared to the control site. There are six different types of qualitative changes which can appear in the B-scan of a bruised site compared to the control. In the event of an injury, usually, more than one of these changes is manifested in the scan of a bruise.
Skin thickness and echogenicity vary considerably due to a number of physiological factors which can seldom be controlled. Therefore, these parameters can give conclusive evidence of a bruise only if the change between a bruised region and a control region is much greater than the daily, normal variations. Snapshot analysis can help detect a bruise or a deep tissue injury. Further work involves the application of pattern recognition or face recognition algorithms to automate the detection.