Self-Stigma and Age-Related Hearing Loss: A Qualitative Study of Stigma Formation and Dimensions.

PURPOSE: This study explored experiences of self-stigma among older persons with age-related hearing loss (ARHL) using Corrigan's conceptualization of self-stigma process formation and the attribution model as its theoretical framework. METHOD: In-depth semistructured interviews were conducted with 11 older persons (mean age = 81 years) with ARHL. RESULTS: Self-stigma was present in the lives of the participants. Analysis revealed the existence of 3 stages of self-stigma in which the 3 core dimensions of stigma (cognitive attributions: being old, stupid, and crippled; emotional reactions: shame, pity, and feeling ridiculed; and behavioral reactions: concealment, distancing, and adapting to hearing aids) were observed. Hearing devices emerged as having a significant influence on stigmatic experiences in all stages and dimensions of self-stigma. CONCLUSION: The study contributes to the theoretical and practical understanding of self-stigma regarding ARHL as well as to the understanding of the role of hearing devices in the development of this stigma.

Use of weight-bearing MRI for evaluating wheelchair cushions based on internal soft-tissue deformations under ischial tuberosities.

Deep tissue injury (DTI) is a severe type of pressure ulcer, in which damage initiates under intact skin, in soft tissues that are mechanically deformed by load-bearing bony prominences. Sitting-acquired DTI typically occurs in the gluteus muscles that could sustain deformations by the weight-bearing ischial tuberosities (ITs). No clinical method currently exists for measuring internal tissue deformations; so design and selection of wheelchair cushions are based mostly on measuring sitting pressures. Our objective was to evaluate the influence of different commercial cushions on internal soft-tissue deformations under the ITs, using weight-bearing magnetic resonance imaging (MRI). We specifically compared muscle, superficial fat, and effective (muscle and fat together) tissue deformations while subjects (n = 10) sat on four cushions (two viscoelastic and two foam) and directly on a rigid support. Deformations were maximal in muscle tissue (mean approximately 70%), twice more the amount than in fat (approximately 30%). Effective soft-tissue deformations were approximately 50% to approximately 60%. Although cushions mildly reduced muscle deformations in the order of 10%, theoretically, our interpretation suggests that this deformation level adds safe sitting time. This study demonstrated that weight-bearing MRI is applicable for evaluating wheelchair cushions and, in the future, may be a tool to systematically support cushion design and selection.

Evaluation of the effect of trunk tilt on compressive soft tissue deformations under the ischial tuberosities using weight-bearing MRI.

BACKGROUND: Deep tissue injury is the new acceptable term for deep pressure ulcers. Deep tissue injury of the buttocks is typically caused by sustained soft tissue deformations under the ischial tuberosities. Wheelchair users are at high risk, and although usually laterally tilted, the effect of tilts on tissue deformations is unknown. This has brought us to investigate buttocks tissue compressive deformations between the ischial tuberosities and skin during sitting in various body tilts, utilizing weight-bearing Magnetic resonance imaging (MRI). METHODS: Ten healthy volunteers underwent sitting MRI, in six postures including neutral with/without weight-bearing, 10 degrees and 20 degrees lateral-tilts, and 20 degrees and 40 degrees anterior tilts. Studies utilized a coronal T1-weighted sequence. Images were evaluated for thickness of tissues between the skin and the lowest point of the ischial tuberosity, of fat between the skin and the gluteus muscle and of muscle between the ischial tuberosity and fat. Measurements in weight-bearing positions were compared to the non-weight-bearing for calculation of compressive tissue deformations in each trunk tilt. Statistical analysis was obtained utilizing multiple pairwise t-tests with Bonferroni corrections. FINDINGS: Muscle and soft tissue compressive deformations, from highest to lowest, were 20 degrees -lateral-tilt (87%, 72%), lateral-10 degrees (85%, 70%), anterior-20 degrees (79%, 67%), anterior-40 degrees (74%, 64%), and neutral (72%, 59%). For the fat, highest was anterior-tilts (42%), followed by lateral-20 degrees -tilt (41%), lateral-10 degrees (39%) and neutral (35%). INTERPRETATION: For lateral tilts, the higher the angle was, the higher the compressive deformation was. However, the most profound change in compressive deformation occurred at the small angle tilts.