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Visualizing Tissue Strain Under the Sacrum and Coccyx in Different Supine Postures

A Case Series

Sprigle, Stephen, PhD, PT; Sonenblum, Sharon, PhD

Advances in Skin & Wound Care: June 2019 - Volume 32 - Issue 6 - p 264–271
doi: 10.1097/01.ASW.0000554445.59743.44

OBJECTIVE: To visually assess and report the influence of supine positioning and sacrum and coccyx anatomy on tissue deformation.

METHODS: A convenience sample of three participants was scanned using MRI. All participants were scanned in a supine position with a rig oriented in a flat or horizontal position and with the torso portion of the rig elevated to 30° to simulate head-of-bed elevation. Representative images were identified to visualize and depict (1) the differences in tissue thickness and deformation in response to changes in supine positioning (0° and 30°), (2) the relative displacement of the skeleton relative to the skin during 30° incline, and (3) differences in sacrococcygeal morphology.

RESULTS: The tissue thickness under the sacrum stayed the same or increased when torsos were elevated. Skeletons were displaced relative to the skin when the rig was elevated regardless of the pelvis location. Further, in the elevated position, coccyges flexed when pelvises were placed on the elevated segment but did not flex when pelvises were placed on the horizontal segment.

CONCLUSIONS: This case series is useful in defining new areas of research that can (1) identify the deformation induced by normal and frictional forces resulting from different positions of the bed chassis, (2) assess the impact of positioning the pelvis on elevated versus horizontal segments of the bed chassis, and (3) define the association between sacral and coccyx morphology and pressure ulcer occurrence in hospitalized patients.

At the Rehabilitation Engineering and Applied Research Lab, Georgia Institute of Technology, in Atlanta, Georgia, Stephen Sprigle, PhD, PT, is a Professor; and Sharon Sonenblum, PhD, is a Senior Research Scientist. Acknowledgments: The authors thank Dr John Greenhalgh and FONAR Corporation for their expertise in collecting the MRI scans and use of the scanner. Internal funding was used to support this study. The authors have disclosed no other financial relationships related to this article. Submitted August 31, 2018; accepted in revised form November 26, 2018.

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