People that are bedridden, or rely on wheelchairs to get around face many health risks associated with minimal mobility such as muscle atrophy and an increased risk of diabetes and cardiovascular disease. A lesser known problem that poses a major health risk for those that are bedridden or in wheelchairs is pressure ulcers, otherwise known as bed sores. Pressure ulcers are injuries to the skin that develop after extended periods of unrelieved pressure. When our skin and underlying tissues are compressed for long periods of time they do not receive adequate blood and nutrients and thus, begin to break down resulting in an ulcer. These wounds can affect any part of the body but they tend to develop around bonier areas, such as the back, sacrum (tailbone), buttocks, elbows, and heels. If left untreated, pressure ulcers could lead to cellulitis (skin and soft tissue infection) or chronic infection. Other factors that place people at risk for bed sores include low body weight, corticosteroid use, smoking, dry skin and fecal or urinary incontinence (lack of control of one’s bowel movements or urination, respectively).
In order for medical professionals to accurately prescribe a treatment regimen, the US National Pressure Ulcer Advisory Panel has created a four-stage classification system for pressure ulcers:
Stage 1: Painful, reddened skin; almost appears to be bruised. Skin is intact but at very
high risk of breaks/tears.
Stage 2: Skin breaks and forms an ulcer.
Stage 3: The ulcer spreads to deeper tissue layers and in some cases, fat may appear in the wound. Infection risks are very high.
Stage 4: Ulcers continue to spread causing severe damage to muscle, tendons, and bones
Many bed sore prevention plans heavily rely on regular cleaning and moisturization of the skin along with the patient frequently changing positions. This may, however, prove difficult for those that are bedridden as not all of them may have access to nurses or aids 24/7. Other preventative methods include the usage of special mattresses, implementation of specific diets (to ensure patients are getting the correct caloric and nutritional intake), and regular exercise.
Once an ulcer has been identified, the immediate focus of healthcare practitioners is to keep the wound clean to avoid any complications and mitigate the damage, this involves applying anti-bacterial creams or dressings to the affected area(s) and removing dead tissue from the said area(s).
A downside of many of these preventative measures is that they require nurses or aides to reposition those in wheelchairs or beds, which increases the chances of the nurses getting injured.
A research team, led by University of Alberta’s Dr. Vivian Mushahwar has invented a less intrusive treatment option called Smart-E-Pants which help prevent the formation of bed sores by generating muscle contractions that redistribute blood to compressed parts of the body.
Usually, able-bodied people readjust themselves in a subconscious effort to relieve uncomfortable pressure when seated or laying down. Although this may seem like a normal part of day-to-day activities, this practice carries greater benefits than just providing comfort as it allows blood, which carries oxygen and nutrients, to flow to the compressed areas and nourish them.
Smart-E-Pants deliver intermittent electrical stimulation (IES) to areas of the body that are exposed to prolonged periods of compression. These impulses trigger gluteal muscle contractions that redistribute pressure and improves blood flow to the muscles.
The underwear has three main parts: the undergarment, the electrodes, and the stimulator. The stimulator is an external ‘control panel’ which generates the impulses and transmits them to the electrodes which are placed within the garments. The electric currents are delivered for 10 seconds every 10 minutes, this rate is enough to improve tissue oxygenation and prevent muscle atrophy.
In a preliminary phase clinical trial involving 68 patients in various care units (e.g., intensive care, home care), the usage of electronic underwear fit well with existing caregiver healthcare routines, did not cause any detrimental side-effects to the patients, and was warmly welcomed by both patients and caregivers. Although this trial did not look into the effectiveness of the underwear, none of the participants developed pressure ulcers during the trial period. Phase II trials are currently being conducted to investigate the competence of the underwear to prevent bed sores.
Annually, the United States and Canada, respectively, spend $11 billion and $3.5 billion on bed sore hospital treatments. Based on previous trials, Smart-E-Pants can be expected to prevent about 50% of cases of bed sores (if prescribed properly) which could save the US and Canada approximately $5.5 billion and $1.8 billion dollars a year, which can be put towards other medical innovations.
“Bedsores (Pressure Ulcers).” Mayo Clinic, Mayo Foundation for Medical Education and Research, 9 Mar. 2018, www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893.
Government of Canada, Canadian Institutes of Health Research. “High-Tech Underwear Brings Big Relief, Big Savings.” CIHR, 27 Jan. 2016, www.cihr-irsc.gc.ca/e/49612.html.
Topfer, LA. Smart-e-Pants: Using Intermittent Electrical Stimulation to Prevent Pressure Ulcers [Issues in emerging health technologies, Issue 132]. Ottawa: Canadian Agency for Drugs
and Technologies in Health; 2015.