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BED SORE 2

BED SORE 2

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Published by Zymmer
a possible solution to reduce the incidence of bed sores amoung the infirmed
a possible solution to reduce the incidence of bed sores amoung the infirmed

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Published by: Zymmer on May 03, 2010
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05/28/2012

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ConfidentialPage 15/2/2010
ZYM Manufacturing Ltd.
.Ph. (604) 940-1764Cell (604) 781-8407e-mail:mjzarry@telus.netGST # 89245 1683Jan.5, 2010
A DYNAMIC OVERLAY FOR SEAT CUSHIONS AND BEDS, TO PROVIDEALTERNATING PRESSURE IN ORDER TO REDUCE THE PROBABILITY OFDEVELOPING PRESSURE SORES .(Decubitus Ulcers)By: Myron ZarryTHE PROBLEM
Bed sores, pressure sores, or decubitus ulcers all refer to the same condition, and occur atrates that are unacceptably high, given that they are 100% preventable. The currentmethods of prevention require repositioning a person in a chair every 10-15 minutes, andonce an hour for the bed ridden. This exercise is disruptive for the patient, and timeconsuming for the care giver, thus the incidence and occurrence rates listed below.-
Two thirds of pressure sores occur in patients older than 70 years.-The rate of occurrence in nursing homes is estimated to be 17-28%.-Neurologically impaired individuals have an annual incidence of 5-8%, with alifetime risk of 25-85%.-Pressure sores are listed as the direct cause of death in 7-8% of all paraplegics.-Patients over 65 years, with a hip fractures acquired pressure sores (stage 2 orhigher) at the rate of 36.1% within 32 days of hospital admission.-Patients who achieve a healed wound have a recurrence rate as high as 90%.
 Ref: Don R Revis Jr, MD, University of Florida College of Medicine. Aug 27,2009.
Many products have been produced in an attempt to deal with this affliction, yet the problems persist. The most effective products, variable pressure air beds and fluidized beds, still require the care giver to reposition the patient regularly, and they aren’trecommended for home use. These products are prone to leakage, are noisy, andexpensive.The proposed equipment is designed to eliminate the occurrence of pressure sores bymaintaining adequate capillary flows in all contacted areas of the body through shifting pressure from one area to another. This was originally suggested by R.J. Houle.
 Ref: Evaluation of Seat Devices Designed to Prevent Ischemic Ulcers in Paraplegic Patients, Arch. Phys.Med., 50:587-594 Ref: Mooney et al. “Pressure Distribution in seat Cushions” – Bulletin of Prosthetics Research
 
ConfidentialPage 25/2/2010
ETIOLOGY
It is generally agreed that the onset of pressure sores is caused by point force applied toone area over time. This results in the compression of capillary vessels, which in a periodof two hours, without relief, can lead to irreversible changes and necrosis. There is alsoan opinion that low pressure contact, without movement, leads to the same result.
 Ref: Don R Revis Jr, MD, University of Florida College of Medicine. Aug 27,2009. Ref: www.bedsores.org  (attached document)
 
THEORY OF THE SOLUTION
ASSUMPTION #1: If you’re not moving, gravity always wins.ASSUMPTION #2: Micro and/or macro motion is essential to life.I will deal with the problems presented by a seat cushion as these conditions are moresevere than encountered with a bed mattress, as far as pressure loading is concerned. KNOWN:- capillary blood pressure at the arterial limb is about 30mmHg.- equal pressure distribution over available sitting area varies between 50-70 mmHG.
 Ref: Bioastronautics Data Book NASA SP-3006 
 - there are
no cushions available
that are safe for prolonged sitting by a paralyzed person.
 Ref: Mooney et al. “Pressure Distribution in seat Cushions” – Bulletin of Prosthetics Research
 THEREFOR:- a “perfect” passive cushion will not work because the equal pressure distributionexceeds the capillary “in flow” pressure (30mmHg).SOLUTION:An active device must be designed that provides for alternating tissue bridging and pressure reduction below 30mmHg. Healthy skin will tolerate high pressures for short periods of time, if the pressurized area is lowered alternately to allow capillary “in flow”.The amplitude required for the pressure change should be low to reduce possible skindamage from friction and shear forces.The apparatus should be suitable for home and institutional use, quiet in operation, and portable for wheelchair and long flight/transport use.
ACTUAL SOLUTIONS
Over the last several months I have tried many combinations of materials and mechanicsto achieve the objectives of the theoretical solution.
Results to date:
SEATING CUSHION OVERLAY:This is composed of ¾” diameter latex tubing laid transversely on ¾” centers over theseating area. The tubing is enclosed with closed cell foam on the bottom and 1” open cell
 
ConfidentialPage 35/2/2010foam on top yielding a flexible overlay mat less than 2” thick. The tubes are alternately plumbed to form two separate and closed pneumatic circuits, which are alternately pressurized and evacuated. The relative amplitude of the adjacent tubes is ½” atmaximum pressure and vacuum. The amplitude can be changed by altering power to thesystem, or dampened with additional layers of memory foam. The cycle of alternationwill likely be every 2-10 minutes.POWER:The alternating pressurization and evacuation of the latex tubes takes energy. There areseveral routes possible to supply the required power for the device. I have used acombination of pneumatic cylinders to create the pressure differentials for experimental purposes.Most hospitals and care facilities have compressed air and/or vacuum lines plumbed intothe patient rooms. In this situation, a fairly simple arrangement of solenoids and timerswill control the cycles.The portable use of the overlay on wheelchairs, or in transport conditions (aircraft, car,etc.) which requires prolonged sitting will be powered by a12VDC pressure/vacuum pump. “Charles Austen Pumps Limited”, in the U.K., manufactures pumps that are small,quiet, and suitable for this application. The power requirements are low, and 10-12 hour operational time is achievable on a single battery charge. Most cars have a 12VDC plug-in source on the dash board and the 0.7 Amp draw is within the available supply range.The “at home” use of the apparatus would be more efficient with a 110VAC pumpavailable from the same manufacturer.DOES IT WORK?A prototype has been constructed that demonstrates the theory. The changes arenoticeable to a person of normal health, as long as the pressures are changing every 1-2seconds. At the therapeutic rate, cycling every 2-10 minutes, pressure changes areimperceptible. The adjacent tubes are evacuated and filled at the same rate, and at thesame time, so there won’t be any net motion of the patient.An assortment of pressure sensors has been constructed and placed between the personand the overlay in order to determine the actual pressures occurring while in use. Theresults indicate that alternating pressures appear to be dropping below 30 mmHg. (
 I don’t have the lab and test equipment needed for precise calibration of the testing apparatus,therefore the value stated is offered with reservation subject to further equipment development and/or independent testing.)
This pressure is below capillary “in flow” pressure and will allow blood flow to replenish oxygen and nutrients to tissue that has been exposed to pressures greater than 30mmHg in the previous cycle.Vigorous massage is not recommended in the areas of compromised skin health. The proposed system may have unforeseen beneficial effects in delaying muscular atrophy,and maintaining tissue health by increasing capillary blood flows through slow and gentle pressure changes.( I’m not sure that pressure changes every ten minutes constitutes amassage.)
 Ref: Hands For Health LLC (attached)
Medical professionals should be involved to evaluate the system and make sure that moregood, than harm, results from use of the overlay.

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