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AIHS Team in Smart Neural Prostheses:

Smart- e -Pants : Intermittent Electrical Stimulation for the Prevention of Pressure Ulcers Chester Ho, MD Head and Associate Professor Division of Physical Medicine & Rehabilitation Department of Clinical Neurosciences University of Calgary Calgary , Canada.

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AIHS Team in Smart Neural Prostheses:

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  1. Smart-e-Pants: Intermittent Electrical Stimulation for the Prevention of Pressure UlcersChester Ho, MDHead and Associate ProfessorDivision of Physical Medicine & RehabilitationDepartment of Clinical NeurosciencesUniversity of CalgaryCalgary, Canada

  2. AIHS Team in Smart Neural Prostheses: Project SMART Principal Investigators Neuroscientists, Engineers, Cell Biologists, Computer Scientists, Neurosurgeons, Physiatrists, Biostatisticians

  3. Objectives • To describe the scope of problems with pressure ulcers • To review the use of intermittent electrical stimulation in the prevention of pressure ulcer • To discuss the design of Smart-e-Pants and its feasibility testing

  4. What is a Pressure Ulcer?

  5. Definition • A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear. A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated*. *National Pressure Ulcer Advisory Panel/European Pressure Ulcer Advisory Panel

  6. Stage IV Pressure Ulcer

  7. Big problem? Yes! • US prevalence data by hospital setting: • acute hospital: 3-11% (9.2% in a study of 148 acute care hospitals) (Meeham 1990) • rehabilitation hospital: 6-40% • skilled nursing facility. 5-26% • home care: 20% • hospice: 13%

  8. Expensive problem? Yes! • Cost of care: $9.1 – 11.6 billions spent per year in US (ARHQ) • CMS not paying for hospital-acquired stage III or IV pressure ulcers since Oct 2008

  9. Are they avoidable? • Incidence not decreasing in US • Expert consensus – most are avoidable but some are not (Black 2011) • Many risk factors are reversible – therefore important to explore reversible factors • Current prevention techniques are passive and do not aim to actively reverse any underlying tissue health risks… so what can we do?

  10. Intermittent Electrical Stimulation (IES) SMART-e-PANTS

  11. Using Intermittent Electrical Stimulation as a Means of Prevention • Proof-of-principle established in short-term experiments in animals (rats) and human volunteers (intact, spinal cord injured): • Increasing tissue oxygenation • Redistributing pressure around bony prominences • Increasing muscle mass

  12. How Smart-e-Pants Works Patent pending • Intermittent Electrical stimulation (IES) is delivered to muscles at risk (i.e. gluteus maximus) through surface electrodes • Muscle contractions are elicited every 10 minutes for 10 seconds; 12 hours per day “OFF” “ON” “ON” 10 minutes 10 sec

  13. Electrodes and Stimulator Stimulator Belt Electrodes

  14. Application

  15. Smart-e-pants Patent pending

  16. Smart-e-Pants feasibility Study

  17. Objectives of Smart-e-Pants Feasibility Study: Test Smart-e-Pants safety, stability, ease of use and acceptability by both caregivers and end-users Evaluate feasibility of implementing Smart-e-Pants in: Acute care setting (Foothills Medical Centre, Calgary, AB) Rehabilitation hospital (Glenrose Rehabilitation Hospital, Edmonton, AB) Long-term care facility (Allen Gray Continuing Care, Edmonton, AB)

  18. Time to Apply and Remove Electrodes vs. Smart-e-Pants Care Facility

  19. Stability of Muscle Contraction Care Facility

  20. Skin Response to Electrodes Care Facility

  21. Patient Response to Smart-e-Pants

  22. Conclusions • Intermittent electrical stimulation may prevent pressure ulcers. • Smart-e-Pants are an acceptable intervention for the prevention of pressure ulcers (for both caregivers and patients). • While on the Smart-e-Pants protocol we have not had any patient developing pressure ulcers or other significant adverse events.

  23. Next Steps • Further enhancement of stimulator • Clinical testing in at-risk populations

  24. Acknowledgment Smart-e-Pants Team Calgary Sean Dukelow, MD Chester Ho, MD Robyn Warwaruk Rogers, RN Dukelow Lab Jennifer Semrau, PhD Sonja Findlater, BSc OT • Smart-e-Pants Team Edmonton • Vivian Mushahwar. PhD • Ming Chan, MD • Richard Stein, PhD • Su Ling Chong, BSc, PT • Alisa Ahmetovic, BEng. • Ryan Somer, BSc OT • Dana Schnepf, RN BN • Glen Isaacson

  25. Thank you!

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