Assessment of alternating-pressure air mattresses using a time-based pressure threshold technique and continuous measurements of transcutaneous gases.

Alternating-pressure air mattresses (APAMs) are used increasingly for the prevention and treatment of pressure sores. Laboratory evaluation techniques have centred largely on interface pressure (IP) measurement, typically analysing discrete maximum and minimum levels, or average pressure. However, since pressure relief varies with time, a time-based analysis technique has been developed for performance assessment. IP was recorded continuously, and the duration of pressures below three thresholds (30, 20 and 10 mmHg) was calculated automatically using a computerized rig. Fifteen healthy volunteers were used to evaluate the pressure-relieving characteristics of four APAMs, including one overlay. Results indicated significant differences (P < 0.001) between products when durations below the 20 and 10 mmHg thresholds were analysed, showing that some devices were only capable of momentarily relieving pressure. Maximum contact pressures on the sacrum were significantly lower (P < 0.0001) on devices whose inflation pressure was adjusted according to subject's body mass. This technique could assist in the selection of alternating or dynamic surfaces of any description with further clinical validation.

A change for the better? Measuring improvements in upgraded alternating-pressure air mattresses.

This study used measurements of interface pressure over time (the pressure relief index) to investigate improvements made to two alternating-pressure air mattresses. Two older models, the Nimbus 2 (Huntleigh Technology) and Pegasus Airwave (Pegasus Egerton), were compared with two new versions, the Nimbus 3 and Cairwave systems, respectively. Pressure relief was improved in seven out of 12 areas in the Nimbus 3 system, and in four out of 12 areas in the Cairwave. Significant differences in pressure relief index measurements at the heel between the Nimbus 3 and Cairwave products may explain the former's better clinical outcomes in this area, but superior pressure relief index performance at the sacrum did not predict better clinical outcomes. Therefore, different levels of pressure relief may be needed at different body sites. Individual practitioners must decide whether these improvements merit list price increases of 11% and 15%, respectively, and whether other features justify a 20% price difference between the two new systems.

Dimensional change in muscle as a control signal for powered upper limb prostheses: a pilot study.

The vast majority of externally powered prostheses are controlled from the myoelectric signal, measured at the skin surface using socket-located electrodes. This signal has been well researched and sophisticated signal processing methods developed. Nevertheless, the inherent properties of the signal, such as its broad bandwidth and low voltage amplitude, make its use less than straightforward in the control of low frequency activity such as powered prosthetic hand movement. This paper reports on a pilot study of an alternative, a signal derived from dimensional change in muscle. A new socket-located sensor was designed to measure dimensional change in muscle, the linearised output of which is termed the myokinemetric (MK) signal. This was used in a series of tasks aimed at investigating the potential for its use in upper-limb prosthesis control. Six amputee subjects were tested, of whom one was a regular user of the myoelectric hand, one had some experience, and four had little or no previous experience of controlling devices using their residual limb. Data is presented on the problems of shift in signal range with time and socket donning and doffing and on the ability of subjects to control the amplitude of the signal. The results show that subjects were able to control the magnitude of the MK signal to a significant degree, with typical errors averaging 0.1-0.3 mm, around 10% of the signal range. The principal problem encountered was the shift in signal with time and socket donning and doffing.