RESNA position on the application of dynamic seating.

Dynamic Seating is an intervention used as a part of a manual or power wheelchair to provide movement against resistance in response to client force. This technology can be used for various clinical applications including preventing client injury and equipment breakage; dissipating extensor forces; providing movement for sensory input, calming, and increased alertness; increasing muscle strength, trunk and head control; and other medical benefits. The purpose of this RESNA Position Paper is to provide a definition for this technology in relation to other seating and wheeled mobility technologies as well as present clinical indicators for this seating intervention including literature to substantiate these claims.

Wheelchair Seated Posture and Health Outcomes of Older Veterans in Community Living Centers.

Purpose: Nursing home residents sit in wheelchairs (WCs) for extended periods, often with slumped posture. They often experience pneumonia, pressure ulcers, and pain. This study described WC seated posture with its selected predictors and outcomes in the nursing home environment, throughout the daytime hours of 1 day.

Reliability and Criterion-Related Validity of the Seated Posture Scale.

Purpose: Earlier, we reported development and initial testing of a rapid, low burden measure of wheelchair seated posture (the Seated Posture Scale [SPS]) for research and clinical use. The purpose of this study was to test the intrarater reliability, interrater reliability, and criterion related validity of the SPS.

Design: We used a descriptive design to test and develop the instrument.

Orthotic-Style Off-Loading Wheelchair Seat Cushion Reduces Interface Pressure Under Ischial Tuberosities and Sacrococcygeal Regions.

Objective: To assess the efficacy of an off-loading wheelchair seat cushion in removing pressure from high-risk ischial tuberosities and the coccyx/sacrum in wheelchair sitting.

Design: Repeated-measures design.

Setting: Private research laboratory.

Product limit estimation for capturing of pressure distribution dynamics.

Measurement of contact pressures at the wheelchair-seating interface is a critically important approach for laboratory research and clinical application in monitoring risk for pressure ulceration. As yet, measures obtained from pressure mapping are static in nature: there is no accounting for changes in pressure distribution over time, despite the well-known interaction between time and pressure in risk estimation. Here, we introduce the first dynamic analysis for distribution of pressure data, based on the Kaplan-Meier (KM) Product Limit Estimator (PLE) a ubiquitous tool encountered in clinical trials and survival analysis.

Georgia Primary Care Providers' Knowledge of Hereditary Breast and Ovarian Cancer Syndrome.

Hereditary breast and ovarian cancer syndrome (HBOC) is an inherited condition associated with mutations in the BRCA1 or BRCA2 (BRCA) genes. Identification of individuals with HBOC requires that primary care providers understand the genetic principles required to appropriately collect family history and refer individuals for genetic evaluation. A survey was developed and administered to primary care providers in Georgia to assess their existing knowledge of HBOC and direct targeted educational efforts.

Proxy study on minimizing risk of sacral pressure ulcers while complying with ventilator-associated pneumonia risk reduction guidelines.

Bed positioning poses a subtle, yet important, tradeoff in the competing needs of hospitalized patients, particularly those susceptible to lower respiratory tract infections and/or pressure ulcers. Although it is widely held that a minimum 30° incline is necessary to mitigate risk of ventilator-acquired pneumonia, it is unclear what effect semirecumbent positioning has on the risk of pressure ulcerations. The authors test several hypotheses with the objective of elucidating the relationship between bed incline, posture, and incline, pursuant to a more evidence-based recommendation for practice in clinical care.

Prevalence of Sensor Saturation in Wheelchair Seat Interface Pressure Mapping.

Pressure mapping is a frequently used tool with great power to provide information about the forces between a patient and a wheelchair seat. One widely recognized limitation to this paradigm is the possibility of data loss due to sensor saturation. In this study, we seek to quantify and describe the saturation observed in the measurement of interface pressures of wheelchair users.

The Activities and Impact of State Programs to Address Hereditary Breast and Ovarian Cancer, 2011-2014.

In 2011, the Division of Cancer Prevention and Control (DCPC), at the United States Centers for Disease Control and Prevention (CDC), released a three-year funding opportunity announcement (FOA) for a competitive, non-research cooperative agreement. The agreement enhanced the capacities of state health departments to promote the application of best practices for evidence-based breast cancer genomics through education, surveillance, and policy activities. The FOA required that applicants focus on activities related to hereditary breast and ovarian cancer (HBOC).

Effect of tilt and recline on ischial and coccygeal interface pressures in people with spinal cord injury.

Objective: Clinicians commonly recommend that power wheelchair users with spinal cord injury perform wheelchair tilt and recline maneuvers to redistribute seating loads away from the ischial tuberosities. However, ischial pressure reduction may be accompanied by coccygeal pressure increases. Although the coccyx is among the most common sites of pressure ulcers, few studies have reported coccygeal interface pressure.

A comparison of strategies for imputing saturated pressure array data with application to the wheelchair-seating interface.

Purpose: The common responses to pressure sensor saturation are extreme: either discarding of data, or wholesale alteration of experimental protocol. Here, we test four simplistic strategies for restoring missing data due to sensor saturation, avoiding such drastic measures.

Methods: We tested these algorithms on 62 pressure maps collected from 42 individuals (20 M/22 F, 54.

Public education and targeted outreach to underserved women through the National Breast and Cervical Cancer Early Detection Program.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was established to provide low-income, uninsured, and underinsured women access to cancer screening and diagnostic services with the goal of increasing the early detection and prevention of breast and cervical cancer. Although this is a valuable resource for women who might not have the means to get screened otherwise, providing services at no cost, by itself, does not guarantee uptake of screening services. Public education and targeted outreach facilitate the critical link between public service programs and the communities they serve.

Implementing a screening tool for identifying patients at risk for hereditary breast and ovarian cancer: a statewide initiative.

Background: The Georgia Breast Cancer Genomic Health Consortium is a partnership created with funding from the Centers for Disease Control and Prevention (CDC) to the Georgia Department of Public Health to reduce cancer disparities among high-risk minority women. The project addresses young women at increased risk for hereditary breast and ovarian cancer (HBOC) syndrome through outreach efforts.

Methods: The consortium provides education and collects surveillance data using the breast cancer genetics referral screening tool (B-RST) available at www.

Multidisciplinary Testing of Floor Pads on Stability, Energy Absorption, and Ease of Hospital Use for Enhanced Patient Safety.

Objectives: A major improvement in hospital safety could be realized if serious injury did not accompany falls. We studied several commercially available floor pads made of different materials to determine which (if any) would be practical in a hospital room and reduce injury without posing a threat to the balance of patients.

Methods: A multidisciplinary approach was undertaken to (1) measure upper and lower body motion in 17 young (<50 years) and 17 older (>55 years) adults during an instrumented sit to stand test from a hospital bed onto the different floor pads, (2) predict the energy dissipation available in floor pads by quantifying the relative mechanical properties, and (3) obtain professional feedback from hospital nurses via a questionnaire (8 questions) following a period of working on the different floor pads.

Effect of interpolation on parameters extracted from seating interface pressure arrays.

Interpolation is a common data processing step in the study of interface pressure data collected at the wheelchair seating interface. However, there has been no focused study on the effect of interpolation on features extracted from these pressure maps, nor on whether these parameters are sensitive to the manner in which the interpolation is implemented. Here, two different interpolation paradigms, bilinear versus bicubic spline, are tested for their influence on parameters extracted from pressure array data and compared against a conventional low-pass filtering operation.

Comparison of muscle and skin perfusion over the ischial tuberosities in response to wheelchair tilt-in-space and recline angles in people with spinal cord injury.

Objective: To compare the efficacy of wheelchair tilt-in-space and recline on enhancing muscle and skin perfusion over the ischial tuberosities in people with spinal cord injury (SCI).

Design: Repeated-measures and before-after trial design.

Setting: University research laboratory.

Wheelchair tilt-in-space and recline does not reduce sacral skin perfusion as changing from the upright to the tilted and reclined position in people with spinal cord injury.

Objective: To investigate the effect of various wheelchair tilt-in-space and recline angles on sacral skin perfusion in wheelchair users with spinal cord injury.

Design: Repeated-measures, intervention and outcomes measure design.

Setting: University research laboratory.

Development and testing of an innovative user-adjustable support surface for wheelchair seating discomfort.

Beginning in 2000, a study of discomfort experienced by wheelchair users and development of technology solutions were undertaken. This research culminated with the present study of a new technology targeting sitting discomfort. Support for development of the "Butt Scooter" prototype and its testing was provided through an NIH research grant.

Critical gaps in universal access to reproductive health: contraception and prevention of unsafe abortion.

Unsafe abortion accounts for a significant proportion of maternal deaths, yet it is often forgotten in discussions around reducing maternal mortality. Prevention of unsafe abortion starts with prevention of unwanted pregnancies, most effectively through contraception. When unwanted pregnancies occur, provision of safe, legal abortion services can further prevent unsafe abortions.

Intrarater and interrater reliability of 22 clinical measures associated with lower quarter malalignment.

Objective: The purpose of this study was to assess the intrarater and interrater reliability of a broad range of techniques commonly used to assess the lower quarter.

Methods: A test-retest single group design was used to investigate the intrarater and interrater reliability of 22 lower quarter evaluation measures. Two raters conducted each measure twice on a total of 18 unimpaired subjects with an average age of 23.

In patients with heart failure elevated soluble TNF-receptor 1 is associated with higher risk of depression.

Background: Pro-inflammatory cytokines may contribute to the development and progression of heart failure (HF) and are also implicated in depressive disorders. In this cross-sectional study, we investigated whether systemic inflammation, as assessed by circulating levels of inflammatory cytokines, was associated with comorbid depression in patients with heart failure.

Methods And Results: Baseline clinical variables, depression status, and inflammatory marker levels were measured in 129 ambulatory HF patients.

A dynamic seating intervention for wheelchair seating discomfort.

Objective: The objective of this study was to examine the effectiveness of a new user-adjustable wheelchair seating system designed to relieve discomfort for long-duration wheelchair users.

Design: This objective was carried out using the newly developed Tool for Assessing Wheelchair disComfort (TAWC) as the primary outcome measure. Two wheelchair users each tested two different designs and feedback from the wheelchair users regarding the first design was used to guide development of the second design.