Development of An Enhanced Dynamic Surface Therapy Model for Pressure Ulcer Management AbstractUlcer:An ulcer (from Latin ulcus) is an open sore of the skin, eyes or lubricated membrane, by an initial scratch and generally maintained by an inflammation, an infection, and/or medical conditions which obstruct healing.Pressure ulcer:An ulcer due to local interference with blood circulation.Persons are at risk who areShrunken due to nutrition deficient,overweight,immobilized by adhesive friction, diabetic, or suffering from a circulatory disorder.at skin breakdownimmune deficiencyThere are no boundaries of Pressure ulcers as shown in Figure below and these ulcers may affect all irrespective of age no matter, home or hospital, giving anguish and eats industry’s resource.Inopportunely, pressure ulcers are still common [1] with a substantial number occurring under medical supervision [2].  This has run to a rising tendency to categorize pressure ulcers as ‘medical errors’, as compared to simply say as a predictable progression of an existing condition [3].  Since unrelieved pressure is the key factor of pressure ulcers, the most appropriate intrusions must be those designed to alleviate risk by reducing exposure to the degree and duration of pressure. Intrusions, such as assisted repositioning routines, have been successfully endangered and effective for patients for decades when used in grouping with pressure-redistributing support surfaces.Today’s challenge is to select appropriate support surface for Ulcer management to meet the potentials of following stockholders:Patient: (100 % increase in last decade): Efficiency, Ease, high-qualityCaregiver: Effectiveness, Safety, Ease of use.Health care provider ($3M /year): Cost effective, Efficiency, Easy access.Introduction.Key factors of Ulcer Pathology        Pressure, Shear force, Friction                   Microcirculation / blood flow Lymphatic systemMicroclimate:Temperature, moisture and the humidity at the tissue surface are also affecting factors of pressure ulcer development [19,20].       Literature review:Therapy Surfaces Design PrincipalsAs per National Pressure Ulcer Advisory Panel (NPUAP) [4, 10]. Pressure-redistributing surfaces are categorized into one of two groups:Reactive Surfaces: Constant low pressure and either powered or non-powered, single zone surface are simply designed to decrease pressure across the whole body by increasing the area of the body in contact with the surface.    Dynamic support surface: A powered support?surface?with?  the?  ability?to?change?  its load distribution properties,?with?or without?applied?load. Review of the literature [11], [12], [13] shows that about 80 per cent of sores occur in the four anatomical positions,sacrum,ischium,trochanter andheel.Pathology rules related to pressure   ulcer growth and exploration for the dynamics  between vulnerability and immobility is considered in this study.Design of Enhanced Dynamic SurfaceTheraphy ModelUnder this project, lot of  built-in features  in one Dynamic Surface  is expected to play a  very important role in the pressure distribution to manage and minimize the effect of  pressure ulcer or Ulcer management.Eleven to fifteen cells of special fabric have been used, connected with different series of hoses with pump for pressure redistribution. These cells inflate and deflate with required pulsation cycle and duration with low, medium and high pulsating options.Bio Sensors pad and matt  placed underneath the mattress to detect and prevents bottom out.Pressure redistribution  in all surface area  can be  monitored  and measured  through  an interface by sensors placed underneath the pad of surface for effective Ulcer management.Automatic Turning therapy reduces interference pressure with two air bladdlers on the both sides of surface which inflates and deflate with required timings.Air loss theraphy to control heat and humidity of skin touched with surfaceSmart Surface Technology infrared light emitters and receivers which continuously measure the patient’s depth of immersion to adjust the air pressure according the weight of patient.All these features will be controlled by specially designed pump attached with the mattress.Methodology: Performance measurement of Reactive surface vs Dynamic surface:Position of surface on bed: FlatUse of loose sheet / pad to mimic hospital conditionsUsing Bio Sensors, Peek pressure at heel and sacrum readings recorded from seven volunteers over the age of 65 on reactive surface and dynamic surface on same day.Hypothesis testing for peak pressure at Sacrum:Null: Peek Pressure at Sacrum are same on both surfacesAlternate: Peek Pressure at Sacrum are NOT same on Surfaces Data Analysis:t-test result and conclusion for peak pressure at Secrum on two surfaces.There is a significant mean difference for Peak Pressure at Secrum between Reactive and Dynamic surfaces. Therefore, we accept the Alternate hypotheses. Peek Pressure at Sacrum are NOT same on reactive and Dynamic surface.    With the P<.05, Dynamic Surface is recommended to use for pressure ulcer management at Sacrum. Hypothesis testing for peak pressure at Heel:Null: Peek Pressure at Heel are same on reactive and Dynamic surfacesAlternate: Peek Pressure at Heel are NOT same on reactive and Dynamic surfaces t-test result and conclusion for peak pressure at Heel on two surfaces.There is a significant mean difference for` Peak Pressure at Heel on Reactive and Dynamic surfaces. Therefore, we accept the Alternate hypotheses. Peek Pressure at Sacrum are NOT same on reactive and Dynamic surface.  With p<.0.05, Dynamic Surface is recommended to use for pressure ulcer management on HeelStudy shows that Dynamic pressure redistribution system which has a logical evolution of dynamic Therapy for injury avoidance and treatment is expected to meet the required standards due to its optimized design, specialized modelling characteristics.                  Key featuresSurface is intended to support patients up to 300 kg to provide the unsurpassed pressure redistribution prevent tissue damage.Surface is designed 8” inflated cell height with an anti-sink upper body section which supports patients in profiled positions to reduce the risk of bottoming out.Automated sensor pad is used underneath the entire surface with the combination of an automatic blower to readjust cell pressures.Single handed Cardio Pulmonary Resuscitation (CPR) is a quick release function placed on the surface which permits rapid air deflation for emergencies, short-term physiotherapy and patient transfers.Few heel cells allowing the caregiver to remove heel pressure from this high-risk area, and supplying no pressure for the most vulnerable patients such as existing wounds.Low air loss therapy minimizes tissue deformation and pressure-induced discomfort.Heat and humidity management of skin.Pulsation therapy to improve blood flowTurning therapy reduces interference pressureSmart Surface Technology employs infrared light emitters and receivers that continuously measure the patient’s depth of immersion to create a customized pressure profile for each patientEight-inch air suspension depth for enhanced patient immersion References:1. 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