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 AIHS Team in Smart Neural Prostheses: Principal Investigators Project SMART Neuroscientists, Engineers, Cell Biologists, Computer Scientists, Neurosurgeons, Physiatrists, Biostatisticians 2 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 WHAT IS A PRESSURE ULCER? 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 Stage IV Pressure Ulcer 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% 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 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? Intermittent Electrical Stimulation (IES) SMART-E-PANTS 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 How Smart-e-Pants Works (a) alternating leftright activation simultaneous leftright activation left bursts of pulses during stimulus ON left left sustained train of pulses during stimulus ON right “ON” 10 minutes right alternating leftright activation simultaneous leftright activation “OFF” right “ON” sustained train of pulses during stimulus ON (a) right 10 sec bursts of pulses during stimulus ON left Patent pending (b) (b) Gluteus maximus motor point Gluteus maximus motor point Gluteus Maximus Gluteus Maximus Ischial tuberosity Ischial tuberosity 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 Electrodes and Stimulator Stimulator Electrodes Belt Application Smart-e-pants Patent pending SMART-E-PANTS FEASIBILITY STUDY Objectives of Smart-e-Pants Feasibility Study: 1. Test Smart-e-Pants safety, stability, ease of use and acceptability by both caregivers and end-users 2. 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) Time to Apply and Remove Electrodes vs. Smart-e-Pants LTCF - E RH - E RH - G ANR - E ANR - G Care Facility Stability of Muscle Contraction Care Facility Skin Response to Electrodes Care Facility Patient Response to Smart-e-Pants 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. Next Steps • Further enhancement of stimulator • Clinical testing in at-risk populations 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 Thank you!