DOWNEY — A pressure injury (or sore) is a common complication after a spinal cord injury (SCI) and can be devastating.

These injuries can develop when pressure is applied to the skin for extended periods of time. This continuous pressure reduces blood flow to the skin and underlying tissues, resulting in cell injury and death.

There are many reasons that too much pressure ends up being applied to the skin, including poorly-fitting shoes and/or braces, damaged or inappropriate wheelchair cushions, or not performing regular pressure relief activities. In individuals with SCI, even small bumps or scrapes can increase your risk.

Without early identification and proper care, pressure injuries can become so complicated that they affect muscle and bone and require surgical intervention. Individuals recovering from surgery or a chronic pressure injury usually need months to heal, during which very little time is spent out of bed.

Following doctor’s orders while at home can be challenging, but is crucial for recovery. Rancho Los Amigos National Rehabilitation Center’s own employee Charles Whitehead knows this firsthand.

After recovering from an unrelated hospitalization, he found himself extremely weak and with pressure injuries on both feet. The doctor ordered him to stay at home with his feet elevated as much as possible.

“When I returned home, I could barely move myself into the wheelchair,” explained Charles who has been battling a chronic pressure injury on his foot for well over a year. “I pride myself on being independent, but it was hard. I used my mental energy to get over the physical difficulties.”

Charles used resistive exercise bands and an arm cycle to slowly regain strength and used opportunities like doctor appointments to gradually increase his pushing. Writing music and accessing work on his computer also kept him busy while at home.

Juan Garibay, another employee of Rancho Research Institute at Rancho with an SCI, found the mental aspect most challenging during his two-year journey recovering from several pressure injury surgeries.

“Life was essentially on hold. So I used the time to reflect on where I was and where I wanted to be; setting goals for both work and school, and reading constantly. I scheduled myself each day including a maintenance program to build up my stamina again”.

He uses bands and dumb bells to exercise as well as manage his pain.

According to both Juan and Charles, connection with family and friends was key to their rehabilitation. Interaction with others made the time go faster and provided great emotional support during their recovery.

Juan cautioned, however, “Even when it’s easier to rely on other people, rely on yourself. Because at the end of the day, it’s just you.”

Nearly 80% of people with SCI will experience at least one pressure injury in their lifetime. The great news, however, is that most of them are preventable.

Being proactive in the prevention of pressure injuries is essential to staying healthy.

For wheelchair users, the best way to prevent a pressure injury is to do regular pressure relief activities that offload the skin and allow blood to circulate. To assist wheelchair users in their prevention efforts, researchers at Rancho have been developing and refining technological systems that integrate sensory information (e.g., pressure sensors) with biofeedback (e.g., visual or audio cues).

Just recently, the research team completed the initial development of the first ever IoT connected pressure sensing mat through a collaboration with a technology company, Sensoria Health Inc.

Known as the Sensoria Mat, this system consists of an artificial intelligence (AI) enabled mat and a mobile app designed to promote a good pressure relief habits for wheelchair users. The mobile app and hardware use Microsoft Azure’s cloud and IoT Central infrastructure, simplifying connectivity and usability for the user as well as providing the clinicians easy access to the information remotely.

Ultimately, the support and coaching provided by Sensoria Mat is expected to reduce the risk of getting a pressure injury or sore. Consisting of an optional hand-made cushion and a sensor-infused insert, the Sensoria Mat allows for three things to be accomplished that promote positive prevention behavior in its users: Tracking, Relieving and Analyzing.

First, the system provides the wheelchair user with the ability to track both the quantity and quality of each pressure relief activity in near real-time throughout the day. The mobile application – available for both Android and iOS smartphones – also provides feedback on correct technique and reminds the user to perform weight relief activities regularly based on a clinically prescribed protocol.

Finally, through the HIPAA compliant web based dashboard, clinicians and physical therapists also have the ability to assess their patients effort remotely without having to bring them into the clinic.

Hope. Resilience. Connection. We hear these words often, but they are not new to the Rancho community. They are often used to describe us. It is from the spirit of clinically driven innovations that the collaboration between Sensoria Health Inc. and Rancho Research Institute was established to enable patients, researchers and clinicians to collect and monitor the key metrics that need to be measured to improve the health of wheelchair users and reduce the likelihood of pressure injury development.

Especially during these times when protecting ourselves requires extended periods of isolation, we need to be mindful of both our physical and mental health: it is crucial to continue to engage in social and work activities to stay connected with others.

While we cannot replace the value of face-to face interactions, we can find new ways to stay connected and stay healthy. We believe that IoT connected assistive technologies such as the Sensoria Mat will help achieve our vision of sustained health and well-being within our community of wheelchairs users.

Philip S. Requejo is chief executive officer of the Rancho Research Institute.

Rancho hospital researchers develop mat to ease pain on wheelchair users