Today, there are approximately 1.5 million people in the United States who use a manual wheelchair (MWC) for mobility. For MWC users younger than 65, the most common diagnosis is spinal cord injury (SCI) and this population is growing by over 17,000 persons each year. For these individuals pressure injuries are one of the most frequent secondary complications. These injuries limit independence and reduce quality of life, while complications arising from them are the second leading cause of death in individuals with SCI. Regular performance of pressure relief activities (i.e., leans and liftoffs) is a key component of preventing pressure injury development: these activities offload the skin and allow blood perfusion. However, patient adherence to pressure relief recommendations is low and new approaches to help individuals with SCI develop positive pressure relief activity behaviors are needed. One promising avenue is through the use of the latest smart technologies. Collectively referred to as the Internet of Things (IoT) these technologies have a wide range of advanced sensing, artificial intelligence, and feedback capabilities. Recently, IoT developers and researchers have focused adapting these technologies to improving health care outcomes, ushering in the era of the Internet of Me (IoT for the human body). The primary goal of our project is to test and refine a novel prototype smart system built from our existing IoMe technology platform aimed at changing pressure relief activity behavior in MWC users with SCI. Specifically, we will refine the prototype system in collaboration with potential end users (e.g., MWC with SCI, clinicians) to ensure that the user factors limiting mass adoption and utilization are addressed. We will then establish the efficacy of the fully realized system to produce behavioral change through active real-time feedback and coaching under real-world conditions encountered at home and in the community. A secondary aim
is to evaluate the feasibility of integrating state-of-the-art temperatures and humidity sensors (additional contributors to pressure injury development) into this system. If our project goals are achieved, we will provide advances in four key areas related to pressure injury prevention: (1) We will identify obstacles to adoption of existing technologies and specifically characterize the needs of individuals with SCI for future technology development; (2) We will generate new datasets and knowledge as to how individuals with SCI might utilize a consumer-based system over a multi-year time-period, including identifying obstacles to long-term technology adoption, retention and engagement; (3) We will evaluate the feasibility and effectiveness of temperature and humidity sensors as complementary technologies added into a pressure sensing system; (4) We will generate a new fully-realized real-time sensor and feedback system that will be ready for large-scale adoption. The results of the project will be disseminated at local, regional, and national levels through conference presentations, hosted workshops, and electronic media. In addition, a technology transfer plan will be developed aimed at making the novel system readily accessible to MWC with SCI and other potential end-users.