? DESCRIPTION (provided by applicant): At any given time, 25% of the 300,000 people with spinal cord injuries (SCI) in the United States will have a pressure ulcer related to sitting, and total yearly treatment costs are estimated at a staggering $6.3 billion. With ulcer recurrence rates as high as 63% and mortality rates as high as 50% when sepsis is present; there exists a critical clinical need to target prevention of ulcer development to avert serious complications including death. Seat interface pressure mapping performed in rehabilitation clinics can effectively determine appropriate equipment and positioning in a wheelchair, but translation of the information to the daily routine is often unsuccessful. An accurate, reliable, robust, and safe personal-use seating pressure system available to wheelchair users with SCI has the potential to prevent ulcers via real-time visual biofeedback, facilitate remote monitoring of skin health, and limit unnecessary medical visits. However, cost and technical barriers have precluded their availability directly to consumers thus far. The goal of this proposed project is to further the development of our prototype personal-use seating pressure monitoring system that aims to engage, empower, and motivate individuals who use wheelchairs with an SCI to prevent seating pressure ulcers. Our prototype has overcome the software-related barriers by using a web application for Smartphone operating systems and a standard WiFi connection for data transfer, and partnership allowing use of a commercially available mass-producible pressure mat positions the end product at an affordable cost. The objective of this project is to advance the development of our system by optimizing field-based system performance (Aim 1) and determining the ability of the system to elicit an improvement in pressure relieving behaviors in wheelchair users (Aim 2). The additional development proposed will ensure that the system is successful in regards to technical features and human factors that will result in a truly useful an clinically effective personal monitoring system. The rationale for this project is based on solid evidence that when patients are engaged and empowered with the right tools, they are able to manage their health with far greater success and partner with their clinical team for positive clinical outcomes.