Project: Research project

Project Details


Background/Readiness: For people with a spinal cord injury (SCI) who use a wheelchair, the total yearly treatment costs for seating pressure ulcers are estimated at $6.3 billion. For the over 25,000 Veterans with SCI receiving care within the Department of Veterans Affairs healthcare system, pressure ulcers are costly, dramatically decrease their quality of life, and increase dependence on caregivers. Further, ulcer recurrence rates are as high as 70% and mortality rates are as high as 48% when sepsis is present. Current pressure management practice involves seat interface pressure mapping performed in a clinic setting to determine appropriate equipment, pressure relief recommendations, and positioning in a wheelchair. However, translation of the information to the daily routine is often unsuccessful with day-to-day uncertainty of ulceration. US Veterans with an SCI who were surveyed regarding pressure ulcer prevention indicated that the ability to perform live seat interface pressure mapping in their daily lives using a smartphone application (app) would be highly motivating in improving their pressure ulcer prevention behaviors.Hypothesis or Objective: The long-term goal of this proposal is to empower Veterans with SCI who use a wheelchair with the ability to actively participate in the daily prevention of seating-related pressure ulcers with a personal-use seat interface pressure monitoring system with integrated motivational cues and alerts. The objectives of this project are (1) to complete development of our Comprehensive Mobile Assessment of Pressure (CMAP) app with significant input from Veterans with SCI that will display live seating pressures and provide motivational cues and alerts to promote pressure-relieving behaviors and (2) to test the feasibility of the system during personal use in the free-living environment by Veterans.Specific Aims: (1) Develop a personal-use pressure mapping mobile app with integrated alerts and motivational cues. (2) Test feasibility of the personal-use pressure mapping mobile app.Study Design: During Years 1-2, development of the CMAP app will be redesigned around the needs and preferences of 20 Veterans with a SCI. The expanded system may include (1) the ability to individualize the definition of target areas (Ischial Left, Ischial Right, and Sacral regions), (2) motivational cues to promote pressure relief behaviors, and (3) alerts to the user when dangerous pressure levels are present. Veterans with an SCI will participate in an iterative design and development process utilizing qualitative research methodology to ensure end-user approval through identification of priority features, preferred design, and preliminary usability. During Year 3, six Veterans with a SCI will participate in 6 weeks of initial field-testing of the CMAP system. The main outcome measures are usage of the system and the success of the motivational cues and alert systems to increase pressure-relieving behavior performance determined by trunk motion and seating pressure map data.Impact: This project impacts the area of encouragement of 'Development, validation, and timing of promising interventions to address consequences of SCI and to improve recovery' specific to pressure ulcers. Development of our CMAP system will provide an intervention for preventing pressure ulcers, promoting improved compliance with pressure relieving behaviors, encouraging remote monitoring of seating health, and limiting unnecessary medical visits. Our mapping system has the ability to address and correct many contributors to pressure ulceration: non-adherence with pressure relieving recommendations, undetected cushion failures, caregiver inconsistency, frequent caregiver turnover, inexperienced caregivers, and caregivers that struggle with positioning the patient.Military Relevance: For thousands of military Service members and Veterans with SCI, pressure ulcers remain a significant daily concern. Pressure ulcers are costly to treat, can impact quality of life and community participation, and can be life-threatening. Our project is aimed at empowering wheelchair users with a SCI with a novel pressure monitoring system. The system will be developed with extensive input from Veterans and will be designed to promote engagement in pressure ulcer prevention in a range of users from military Service members who have recently sustained a combat-related SCI to Veterans who have a history of recurrent pressure ulcers.

Effective start/end date9/1/158/31/18


  • Congressionally Directed Medical Research Programs: $959,806.00


Explore the research topics touched on by this project. These labels are generated based on the underlying awards/grants. Together they form a unique fingerprint.