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Abstract-Pressure ulcers remain a major source of morbidity and mortality in Veterans with neurologic impairment. Management of pressure ulcers typically involves pressure relief over skin regions containing wounds, but this can lead to loss of mobility and independence when the wounds are located in regions that receive pressure during sitting. An innovative, iterative design process was undertaken to improve prone cart design for persons with spinal cord injury and pressure ulceration. Further investigation of ways to improve prone carts is warranted to enhance the quality of life of persons with pressure ulcers.
Key words: cart, decubitus, design, iterative, pressure, pressure ulcer, prone, spinal, spinal cord injury, ulcer.
Abbreviations: SCI = spinal cord injury, VA = Department of Veterans Affairs, VAMC = VA medical center.
INTRODUCTION
Pressure ulcers frequently occur in the setting of spinal cord injury (SCI) [1-3] and can decrease quality of life, lengthen hospitalization, increase care requirements, and lead to subsequent medical complications [4-7]. A key component of managing pressure ulcers is reducing pressure in the region of the wound [8], which can involve decreased or eliminated sitting time in ischial and sacral ulcers; however, prolonged bedrest can lead to deconditioning, respiratory compromise, and significant psychosocial impact [5]. Use of traditional manual prone carts can relieve pressure on the ischium and sacrum while improving mobility and social interaction, but it has been observed that these carts frequently cause neck, shoulder, and back pain [9]. These problems have led to several attempts to develop solutions, including more ergonomically tilted carts [9] and various designs of motorized carts [10-11], as well as a recent report we published in the Journal of Rehabilitation Research and Development describing an effort to convert a power chair into a motorized prone cart that faced a variety of challenges [12]. This article describes the iterative, interdisciplinary process of developing an ergonomic, motorized, prone mobility cart over a period of several years and multiple design iterations for quality improvement of clinical care for pressure ulcers.
ITERATIVE DESIGN PROCESS AND CLINICAL OUTCOMES
The process of developing a commercial-grade, motorized, prone mobility cart began with the basic prone cart design commonly used in hospitals nationwide. Prone carts were heavily used at the Department of Veterans Affairs (VA) SCI Service in which this...