Journal of Healthcare Engineering

Journal of Healthcare Engineering / 2010 / Article

Research Article | Open Access

Volume 1 |Article ID 873050 | 22 pages |

Lying Posture Classification for Pressure Ulcer Prevention


Pressure ulcers are a common problem among patients with limited mobility, such as those bed-bound and wheelchair-bound. Constant and prolonged applied pressure is one of the extrinsic factors contributing to the development of pressure ulcers. Analyzing lying postures together with interface pressure measurements from a pressure sensitive bed helps revealing pressure hot spots that can potentially lead to pressure ulcer development. We propose an intelligent system that features lying posture classification with pressure hot spots identification based on interface pressure measurements to possibly identify potential pressure ulcer risk and to provide effective preventive measures. Experimental outcomes correctly classify different lying postures with an accuracy of up to 93%. The proposed system is expected to assist caregivers to detect risk evidence and to provide timely and appropriate interventions for effective pressure ulcer prevention.


  1. A. Mihailidis et al., “The COACH prompting system to assist older adults with dementia through handwashing: An efficacy study,” BMC Geriatrics, vol. 8, 28, 2008. View at: Google Scholar
  2. M. A. Lebedev and M. A. Nicolelis, “Brain–machine interfaces: past, present and future,” Trends in Neurosciences, vol. 29, no. 9, pp. 536–546, 2006. View at: Google Scholar
  3. Zeller et al., “Pressure Ulcers,” The Journal of the American Medical Association (JAMA), vol. 296, no. 8, 1020, 2006. View at: Google Scholar
  4. J. Kottner, “Pressure Ulcers: A Critical Review of Definitions and Classifications,” Ostomy Wound Management, vol. 55, no. 9, pp. 22–29, 2009. View at: Google Scholar
  5. European Pressure Ulcer Advisory Panel (EPUAP), Available at:
  6. D. R. Berlowitz and D. M. Brienza, “Are all pressure ulcers the result of deep tissue injury? A review of the literature,” Ostomy/Wound Management, vol. 53, no. 10, pp. 34–38, 2007. View at: Google Scholar
  7. E. Park-Lee et al., Pressure Ulcers Among Nursing Home Residents: United States, 2004, National Center for Health StatisticsNCHS Data Brief, 14, 1-8, 2009.
  8. E. Kaltenhaler, Whitfield, S. J. Walters, R. L. Akehurst, and S. Paisley, “UK, USA and Canada: how do their pressure ulcer prevalence and incidence data compare?” Journal of Wound Care, vol. 10, no. 1, pp. 530–535, 2001. View at: Google Scholar
  9. G. Bennett, C. Dealey, and J. Posnett, “The cost of pressure ulcers in the UK,” Age and Ageing, vol. 33, no. 3, pp. 230–235, 2004. View at: Google Scholar
  10. The Fifth Annual HealthGrades Patients Safety in American Hospitals Study Report, April 2008, Available at:, Accessed October 21, 2009.
  11. B. T. Fay et al., “What is Interface Pressure?” in Proc. of 22nd Conf. of IEEE Engineering in Medicine and Biology Society (EMBS), pp. 2254–2255, July 2000. View at: Google Scholar
  12. K. Sakai et al., “Continuous Monitoring of Interface Pressure Distribution in Intensive Care Patients for Pressure Ulcer Prevention,” Journal of Advanced Nursing, vol. 65, no. 4, pp. 809–817, 2009. View at: Google Scholar
  13. A. Gefen, “Pressure-Sensing Devices for Assessment of Soft Tissue Loading under Bony Prominences: Technological Concepts and Clinical Utilization,” Wounds, vol. 19, pp. 350–362, 2007. View at: Google Scholar
  14. M. D. Stinson, S. A. Crawford, and A. P. Porter-Armstrong, “Interface pressure measurements: Visual Interpretation of pressure maps with MS clients,” Disability and Rehabilitation, vol. 30, no. 8, pp. 618–624, 2008. View at: Google Scholar
  15. L. Philips, “Interface Pressure Measurement: Appropriate interpretation of this simple laboratory technique used in thedesign and assessment of pressure ulcer managment device,” Australian Wound Management, vol. 15, no. 3, pp. 106–113, 2007. View at: Google Scholar
  16. K. Bogie et al., “new technique for real-time interface pressure analysis: Getting more out of large image data sets,” Journal of Rehabilitation Research & Development, vol. 45, no. 4, pp. 523–536, 2008. View at: Google Scholar
  17. Reenalda et al., “Analysis of healthy sitting behavior: interface pressure distribution and subsutaneous tissue oxygenation,” Journal of Rehabilitation Research and Development, vol. 46, no. 5, pp. 577–586, 2009. View at: Google Scholar
  18. S. Sprigle, W. Dunlop, and L. Press, “Reliability of bench tests of interface pressure,” Assistive Technology, vol. 15, pp. 49–576, 2003. View at: Google Scholar
  19. J. Reenalda et al., “Clinical Use of Interface Pressure to Predict Pressure Ulcer Development: A Systematic Review,” Assistive Technology, vol. 21, no. 2, pp. 76–85, 2009. View at: Google Scholar
  20. A. Gefen, “How Much Time Does it Take to Get a Pressure Ulcer? Integrated Evidence from Human, Animal and In Vitro Studies,” Ostomy Wound Management, vol. 54, pp. 26–35, 2008. View at: Google Scholar
  21. A. Gefen, “A Reswick and Rogers pressure-time curve for pressure ulcer risk. Part 1,” Nursing Standard, vol. 23, no. 45, pp. 64–74, 2009. View at: Google Scholar
  22. A. Gefen, “A Reswick and Rogers pressure-time curve for pressure ulcer risk. Part 2,” Nursing Standard, vol. 23, no. 46, pp. 40–44, 2009. View at: Google Scholar
  23. M. Reddy et al., “Preventing Pressure Ulcers: A Systematic Review,” The JAMA, vol. 296, no. 8, pp. 974–984, 2006. View at: Google Scholar
  24. Suriadi et al., “Development of a new risk assessment scale for predicting pressure ulcers in an intensive care unit,” Nursing in Critical Care, vol. 13, no. 1, pp. 34–43, 2008. View at: Google Scholar
  25. W. B. Mortenson and W. C. Miller, “A review of scales for assessing the risk of developing a pressure ulcer in individuals with SCI,” Spinal Cord, vol. 46, no. 3, pp. 168–175, 2008. View at: Google Scholar
  26. T. Defloor and J. D. De Schuijmer, “Preventing Pressure Ulcers: An Evaluation of Four Operating-Table Mattresses,” vol. 13, no. 3, pp. 134–141, 2000. View at: Google Scholar
  27. E. McInnes, N. A. Cullum, S. E. M. Bell-Syer, and J. C. Dumville, “Support surfaces for pressure ulcer prevention,” Cochrane Database of Systematic Reviews, no. 3, Article ID CD001735, 2008. View at: Publisher Site | Google Scholar
  28. T. Defloor, D. De Bacguer, and M. H. Grypdonck, “The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers,” Int. Journal of Nursing Studies, vol. 42, no. 1, pp. 37–46, 2005. View at: Google Scholar
  29. M. Inhyuk et al., “Control of Air-cell Mattress for Preventing Pressure Ulcer Based on Approximate Anthropometric Model,” in Proc. of 9th IEEE Conf. on Rehabilitation Robotics, pp. 164–167, June-July 2005. View at: Google Scholar
  30. K. Vanderwee, M. Grypdonck, and T. Defloor, “Alternating pressure air mattresses as prevention for pressure ulcers: A literature review,” Int. Journal of Nursing Studies, vol. 45, no. 5, pp. 784–801, 2008. View at: Google Scholar
  31. A. Gefen and J. Levine, “The false premise in measuring body-support interface pressures for preventing serious pressure ulcers,” Journal of Medical Engineering and Technology, vol. 31, no. 5, pp. 375–380, 2007. View at: Google Scholar
  32. A. Stekelenburg, D. Gawlitta, D. L. Bader, and C. W. J. Oomens, “Deep tissue injury: how deep is our understanding?” Arhives of Physical Medicine and Rehabilitation, vol. 89, no. 7, pp. 1410–1413, 2008. View at: Google Scholar
  33. C. Gehin et al., “Which techniques to improve the early detection and prevention of pressure ulcers?” in Proc. of the 28th Conf. of EMBS, pp. 6057–6060, Aug-Sept 2006. View at: Google Scholar
  34. Q. Wang et al., “Portable Gage for Pressure Ulcer Detection,” in Proc. of the 28th Conf. of EMBS, pp. 5997–6000, Aug-Sept 2006. View at: Google Scholar
  35. David R. Thomas, “Prevention and Treatment of Pressure Ulcers: What works? What doesn't?” The Cleveland Clinic Journal of Medicine, vol. 68, no. 8, pp. 704–722, 2001. View at: Google Scholar
  36. H. Z. Tan et al., “A Sensing Chair using Pressure Distribution Sensors,” The IEEE/ASME Transactions on Mechatronics, vol. 6, no. 3, pp. 261–268, Sep 2001. View at: Google Scholar
  37. Kap-Ho Seo et al., “Bed-type Robotic System for the Bedridden,” in Proc. of the IEEE/ASME, pp. 1170–1175, July 2005. View at: Google Scholar
  38. David C. Lay, Linear Algebra and It's Applications, Addison-Wesley, New York, 3rd updated edition, 2005.
  39. J. S. Taylor et al., Supprot Vector Machines and other kernel-based learning methods, Cambridge University Press, 2000.
  40. M. Wozniak, “Classifier fusion based on Weighted Voting –Analytical and Experimental Results,” in Proc. of 8th ISDA, pp. 687–692, 2008. View at: Google Scholar
  41. Sleep position gives personality clue, Accessible at:, Accessed October 21, 2009.
  42. David L. Hall and James Llinas, Handbook of multisensory data fusion, CRC Press, 3rd edition, 2001.

Copyright © 2010 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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