Clinical Treatment of Pressure Sores with the Roho Mattress>Marilyn

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HI Marilyn :

I came across this web site on the Roho Mattress and cushion. This maybe what you wanted.

Take care

Vera

Clinical Treatment of Pressure Sores with the Roho Mattress

Kathleen Wills, RN Principal Investigator ( Free Bed Hospital and Rehabilitation Center)

Bonnie Yarger, RN, BSN, MAEd Co-author

Clinical use of the ROHO mattress resulted in complete healing of existing pressure sores, as well as maintenance of patients' skin integrity after healing. A specific group of patients at the Free Bed Hospital and Rehabilitation Center in Grand Rapids, Michigan were clinically treated with the ROHO mattress over a 12 month period. The patients selected had various neurological disorders resulting in many complicating factors, making them particularly susceptible to skin breakdown and healing difficulties. Introduction

Pressure sores are a costly and debilitating complication experienced by many rehabilitative patients. This complication can threaten the quality of a patient's life - and life itself! Development of a pressure sore can come as a shock to a newly injured person. After surviving a serious accident (spinal cord injury) or a sudden illness (cerebral vascular accident) and in the midst of coping with immobility, paralysis and the task of rehabilitation, a patient is confronted with further tragedy-“Skin Breakdown.†Patients learn very quickly that indeed, a pressure sore can be a tragic event in their life. Much has not changed in the past years about pressure sores. What has changed is an increased awareness of the very real problems they cause from interference with activities of daily living to potential life threatening infections. Fortunately, the frequency of pressure sore occurrence appears to have diminished in recent years. This is due to increased awareness and education of clients and health care personnel, improvement in medical and nursing interventions and techniques, as well as the development of innovative, effective products used in treatment. This study deals with a specific group of patients in a rehabilitation center who developed pressure sores before admission or during their hospital stay. The group of patients represented in the table and graphs were clinically treated with the ROHO mattress from January to December, 1983, at the Free Bed Hospital and Rehabilitation Center, Grand Rapids, Michigan. The ROHO mattress uses a passive surface, which addresses the problems of pressure and shear to minimize deformation. These factors contribute to pressure sore development, and the consequent role they play in healing. By minimizing these factors, the body is allowed to heal itself rapidly and maintain tissue viability. The ROHO mattress and wheelchair cushion are pneumatically operated lightweight devices consisting of flexible air cells attached to a common manifold system. All of the air cells receive the same internal air pressure. Each cell acts as a small piston and is mechanically free to conform to the shape of the immersed body, independent of how deeply a body part may be entered into the cushion. Every air cell develops a suspension force which is equal to all other air cells, generating very uniform hydrostatic pressures to the skin. Methodology

Pressure sores of varying degrees and body locations were evaluated in relation to healing time while patients were treated on the ROHO mattress. In this study, primarily quantitative factors in wound healing are reported and discussed:

Size of pressure sore at onset.

Decreasing size of pressure sore while healing.

Total healing time.

Total time of preventive treatment with ROHO mattress, i.e. maintenance of tissue viability after healing. A total of 43 cases of existing pressure sores were studied; 18 cases are represented in the accompanying tables— indicating healing while treated with the ROHO mattress. Specific diagnoses included: 14 quadriplegic, 2 paraplegic, 1 subarachnoid hemorrhage and 1 head injury. Twenty-four cases are omitted for various reasons—the most common reason was incomplete documentation, i.e. a patient was transferred out of the facility for surgery during hospitalization or discharged before healing occurred; or the area of skin breakdown was not placed on the ROHO mattress. Healing of the specific involved area was evaluated using direct observation, photographs and measurements (in centimeters). Each patient studied had a primary diagnosis, which predisposed him to the development of tissue destruction (primarily due to immobility factors). Several patients had specific predisposing factors, which played a significant role in skin breakdown (e.g., one patient weighed 330 lbs., one patient weighed 139 lbs with a height of 6'7â€.) The group of patients, exhibiting healing of pressure sores are represented in TABLE 1.

Patients are categorized according to localized area of skin breakdown.

Different categories of pressure sores may include the same patient.

Primary treatment for all clients involved the use of the ROHO mattress.

All patients were subject to the standard protocol for treatment of pressure sores at Free Bed, including any of the following:

turning every two hours

cleansing wound with normal saline or Betadine

dry dressings

brief 02 therapy directly to wound site

Categories of pressure sores included: Location No. of Cases

Scapula 3

Thorax 1

Shoulder 2

Knee 1

Ischium 1

Coccyx 5

Sacrum 1

Spinous process 1

Gluteus 1

Heel 2

Sizes of pressure sores are listed in centimeters.

Grades of pressure sores are listed according to the following classification:

Grade I: Superficial epidermal and dermal layers only.

Grade II: Extension into adipose tissue.

Grade III: Extension through adipose tissue to muscle.

Grade IV: Extension through muscle to bone. Results

The following Table and Graphs illustrate results of the study.

Healing of patients' existing pressure sores.

Continued maintenance of skin integrity after healing occurred. Primary treatment consisted of the ROHO mattress Table 1Pressure Sore Healing and Maintenance of Skin Integrity in Patients Treated with the ROHO Mattress Patients (by code number) Pressure sore at onset Total Healing time (weeks) Time continued on ROHO after healing with no evidence of skin breakdown (weeks) Comments

Location Size Grade

01-OM Left Scapula 0.3cm I 1 16 Patient 6'7†approximately 139 lbs.

02-OH Left Scapula 6.0cm II 9 28 Patient weight approximately 330 lbs.

01-OR Left scapula 1.5cm II 2 6 Area under long Philadelphia collar

01-OH Right Thorax 9.5cm II 9 17 Area of pressure sore under halo vest for first four weeks

Patient 6'7†approximately 139 lbs.

01-OF Right Shoulder 3.0cm I 2 8

01-OG Right Shoulder 1.7cm II 6 20 Patient 6'7†approximately 139 Lbs.

Area of pressure sore under halo vest f or four weeks, then under Philadelphia collar

02-OD Behind Left Knee 2.0cm II 7 35 Patient weight approximately 330 lbs.

01-OD Left Ischium 3.0cm II *3 4 *Area 0.5cm at third week, then area surgically closed

01-OE Coccyx 1.0cm I 1 2 Patient discharged two weeks after pressure sore healed

01-OI Coccyx 6.5cm II 10 15 Patient 6'7†approximately 139 lbs.

02-OI Coccyx 2.2cm II 5 N/A

02-OK Coccyx 0.6cm I 1 13

03-OG Coccyx 7.0cm I 3 1 Patient discharged 1 week after pressure sore healed

01-OO Sacrum 1.4cm I 1 20

04-OO Spinous Process 2.0cm II 3 N/A Area above edge of cast

02-OG Gluteal Fold * (new area superior to original wound) 4.25cm *3.0cm II 1 37 Patient weight approximately 330 lbs.

01-OA Left Heel 4.0cm I *14 N/A *Patient discharged at 14th week, pressure sore area-1.5cm

01-OB Right Heel 2.5cm I 13 N/A Patient discharged at 13th week

Graphs

Representative individual cases indicating healing of pressure sores while treated with the ROHO mattress. Patient No. 01-OH

Patient No. 02-OH

Patient No. 02-OG

Conclusion

Pressure sore healing and maintenance of skin integrity is crucial to the total rehabilitative process. A product's effectiveness can be measured quantitatively, in terms of number of weeks needed for healing of a pressure sore. The true effect, however, can be seen in a qualitative way—with the physical and psychological trauma of this potential problem reduced, an individual can be free to pursue rehabilitative goals and personal life plans. The ROHO mattress has been demonstrated as an effective treatment modality. The authors acknowledge the staff and administration at Free Bed Hospital and Rehabilitation Center, Grand Rapids, Michigan, for their assistance and cooperation in this study.REFERENCES

Klaus E. , MD and Sven Anchor Kvorning, MD: Medical Aspects of the Decubitus Ulcer, International Journal of Dermatology, June 1982, pp. 265—270.

Rollin K. , MD, L. Priest, IOTT and C. Wheatley, B Eng.: Etiological Factors in Pressure Sores: An Experimental Model, Archives of Physical Medicine and Rehabilitation, October 1981, Vol 62, No. 10, PP. 492—498.

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A. Krouskup, PE PhD, Philip C. Noble, MS, L. Garber, OTR and A. Spencer, MD, The Effectiveness of Preventative Management in Reducing the Occurrence of Pressure Sores, Journal of Rehabilitation, R & D, 1983, Vol. 20, No. 1, pp. 74—83.

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13. Staas, Jr., MD and Janet O. Lamantia, RN, Decubitus Ulcers and Rehabilitation Medicine, International Journal of Dermatology, October 1982, Vol. 2, pp. 437—444.

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R. M. Kenedi, I.M. Cowden and J.T. Scales: Bedsore Biomechanics, University Park Press, 1976.

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