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wheelchair cushion design, deep tissue injury, biomechanical modeling, finite element simulations



  1. Shoham, Naama MSc
  2. Levy, Ayelet MSc
  3. Kopplin, Kara BSc
  4. Gefen, Amit PhD


OBJECTIVE: To determine changes in internal soft-tissue loads in the buttocks of individuals with a spinal cord injury (SCI), who undergo pathoanatomical changes during the first months and years following the occurrence of the SCI, while sitting on a contoured foam cushion (CFC) that has been fitted close to the time of the injury but has not been replaced in subsequent years.


DESIGN: Internal tissue loads in variant buttocks anatomies on a CFC were analyzed by means of finite element computer simulations. The pathoanatomical changes that are characteristic to SCI and were simulated here are: increase in fat tissue mass, intramuscular fat infiltration, muscle atrophy, and combinations of these conditions.


SETTING: Computational biomechanical modeling.


MAIN RESULTS: Simulating the aforementioned pathoanatomical changes consistently resulted in greater mechanical strain and stress magnitudes and more inhomogeneity in the loading state of muscle and fat tissues, with a more profound effect in fat. The simulations further indicated a clear trend of exacerbation in tissue exposure to loads as the pathoanatomical changes progress chronologically and the CFC is not replaced.


CONCLUSIONS: A CFC that has been fitted at a time close to the SCI, but has not been replaced in subsequent years, substantially loses its efficacy in protecting patients from developing pressure ulcers and deep tissue injury in particular.