Pressure Ulcer Research D. Bader ´ C. Bouten ´ D. Colin ´ C. Oomens (Eds.)

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Pressure Ulcer Research

D. Bader ´ C. Bouten ´ D. Colin ´ C. Oomens (Eds.)

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Dan Bader ´ Carlijn Bouten Denis Colin ´ Cees Oomens

Pressure Ulcer Research

Current and Future Perspectives

With 76 Figures and 23 Tables

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Dan L. Bader, PhD, DSc

Queen Mary University of London Mile End Road

London E1 4NS United Kingdom

Carlijn V.C. Bouten, PhD

Eindhoven University of Technology Biomedical Engineering Department Den Dolech 2, P/O Box 513

5600 MB Eindhoven The Netherlands Denis Colin, MD Medical Director Centre de l'Arche 72650 Saint Saturnin Le Mans, France

Cees W.J. Oomens, PhD

Eindhoven University of Technology Biomedical Engineering Department Den Dolech 2, P/O Box 513

5600 MB Eindhoven The Netherlands

ISBN-10 3-540-25030-1 Springer Berlin Heidelberg New York ISBN-13 978-3-540-25030-2 Springer Berlin Heidelberg New York Library of Congress Control Number: 2005928443

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...In the morning she was asked how she had slept. ªOh, very badly!º said she. ªI have scarcely closed my eyes all night. Heaven only knows what was in the bed, but I was lying on some- thing hard, so that I am black and blue all over my body. It's horrible!º Now they knew she was really a princess because she had felt the pea right through the twenty mattresses and the twenty eider-down beds...

(Hans Christian Andersen:

The Princess & The Pea)

We dedicate this book to all the princesses and

princes in the world

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Although the clinical condition of pressure ulcers has existed since time immemorial, with evidence of its occurrence in ancient Egypt, there has been a paucity of tomes devoted to the subject. Of the few which have highlighted the scientific aspects of the topic, two edited books, ªBed Sore Biomechanicsº [1] and ªPressure Sores ± Clinical Practice and Scientific Approachº [2] were published around 30 and 15 years ago, respectively. It is interesting to note that the name of the condition has changed during this period, frombed sores to pressure sores to pressure ulcers. The current termhas been widely adopted worldwide by various organisations, such as the National Pressure Ulcer Advisory Panel (NPUAP) in the USA, the EPUAP in Europe and the Japanese Pressure Ulcer Society. Each body is committed to prevention and treatment strategies, but despite their ef- forts incidence figures remain unacceptably high. So what was our motivation for the current book? Well, we have already invested many years, with only minor success, in trying to alleviate this horrendous condition, which PamHibbs regularly described as ªthe hidden epidemic beneath the sheetsº. However, as in most walks of life, politics and monetary considerations have reared their heads. As an example, a financial audit in 1997 in the Netherlands encompassing all clinical conditions revealed that the prevention and treatment of pressure ulcers represented the fourth largest financial burden on the Dutch health service. This stimulated a wealth of ac- tivity in the Biomedical Engineering Department at the Technological Uni- versity of Eindhoven, which brought us, the editors, together. In addition, the medico-legal implications of ulcer development have stimulated the in- terests of financial managers, who run hospitals and homes, and the associated medical insurance companies. Further considerations involve conditions that previously were life threatening but now are manageable with the advances in medical technologies. This has resulted in an ever-ageing population in many countries. It is only right for every individual to de- mand an improved healthspan to match this increased lifespan. Again, technology can provide solutions, and, as researchers, we firmly believe that much can be gained from applying many of the new sciences, ranging from genomics over cellular and tissue engineering to medical imaging and computational modelling. These tools can be used to provide a clearer understanding of the mechanisms associated with the aetiology of pressure ulcers, extending beyond the conventional wisdomof the effects of pressure ischaemia alone. Ultimately, they will also be used to identify the risk

Preface

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levels of individuals and provide appropriate support systems. This was the motivation for us to bring together a number of multidisciplinary world experts, who have contributed generously to this volume.

The Editors

References

1. Kenedi RM, Cowden JM, Scales JT (eds) (1976) Bed sore biomechanics. Mac- millan, London

2. Bader DL (ed) (1990) Pressure sores: clinical practice and scientific approach.

Macmillan, London VIII z Preface

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1 The Aetiopathology of Pressure Ulcers: A Hierarchical Approach . . . . 1 Carlijn Bouten, Cees Oomens, Denis Colin, Dan Bader

2 Medical Perspectives in the 21st Century . . . 11 Jeen Haalboom

3 Medico-Legal Implications . . . 23 Courtney Lyder

4 Patients at Risk for Pressure Ulcers and Evidence-Based Care

for Pressure Ulcer Prevention . . . 35 Nancy Bergstrom

5 The Measurement of Interface Pressure . . . 51 Ian Swain

6 Susceptibility of Spinal Cord-Injured Individuals to Pressure Ulcers . . 73 Kath Bogie, Dan Bader

7 Prevention and Treatment of Pressure Ulcers

Using Electrical Stimulation . . . 89 Thomas Janssen, Christof Smit, Maria Hopman

8 Biochemical Status of Soft Tissues Subjected to Sustained Pressure . 109 Dan Bader, Yak-Nam Wang, Sarah Knight, Adrian Polliack, Tim James, Richard Taylor

9 Stump±Socket Interface Conditions. . . 129 Joan Sanders

List of Contributors

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Maria Hopman

Radboud University Nijmegen Medical Centre

Department of Physiology Nijmegen

The Netherlands Tim James

Department of Clinical Biochemistry Oxford Radcliffe Hospital

Headington Oxford, OX3 1XX UK

Thomas Janssen

Faculty of Human Movement Sciences Vrije Universiteit

Van der Boechorststraat 9 1081 BT Amsterdam The Netherlands Sarah Knight Spinal Research Centre

Royal National Orthopaedic Hospital Brockley Hill

Stanmore, Middlesex, HA7 4LP UK

Courtney Lyder School of Nursing University of Virginia McLeod Hall

Charlottesville, VA 22908 USA

Charles Michel Imperial College London South Kensington Campus London, SW7 2AZ UK

Klaas Nicolay

Department of Biomedical Technology Eindhoven University of Technology P/O Box 513

Cees Oomens

5600 MB Eindhoven The Netherlands Adrian Polliack

Headington Oxford, OX3 1XX UK

Jeanine Prompers

5600 MB Eindhoven The Netherlands Joan Sanders

Bioengineering, 357962 University of Washington Seattle, WA 98195 USA

Tatsuo Shimada School of Nursing Oita University

Hasama 1-1, Oita 879-5593 Japan

Christof Smit

Rehabilitation Center Amsterdam Overtoom283

1054 HW Amsterdam The Netherlands Anke Stekelenburg Biomedical Engineering

Eindhoven University of Technology P/O Box 513

5600 MB Eindhoven The Netherlands XII z List of Contributors

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Gustav Strijkers

5600 MB Eindhoven The Netherlands Ian Swain

Department of Medical Physics

& Biomedical Engineering Salisbury District Hospital Salisbury Wiltshire, SP2 8BJ UK

Richard Taylor

Headington Oxford, OX3 9DU UK

Pankaj Vadgama

IRC in Biomedical Materials Queen Mary University of London Mile End Road

London, E1 4NS UK

Wen Wang

Medical Engineering Division Department of Engineering Queen Mary University of London Mile End Road

London E1 4NS UK

Yak-Nam Wang

Department of Bioengineering 357962, Harris 309

University of Washington Seattle, WA 98195 USA

a List of Contributors z XIII

Pressure Ulcer Research D. Bader ´ C. Bouten ´ D. Colin ´ C. Oomens (Eds.)

Pressure Ulcer Research

D. Bader ´ C. Bouten ´ D. Colin ´ C. Oomens (Eds.)

Dan Bader ´ Carlijn Bouten Denis Colin ´ Cees Oomens

Pressure Ulcer Research

Current and Future Perspectives

1 2

(Hans Christian Andersen:

The Princess & The Pea)

We dedicate this book to all the princesses and

princes in the world

Preface

Contents

List of Contributors