{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:06:16Z","timestamp":1790798776537,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,9,6]],"date-time":"2017-09-06T00:00:00Z","timestamp":1504656000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Permobil Group"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["International Wound Journal"],"published-print":{"date-parts":[[2017,12]]},"abstract":"Abstract<\/jats:title>For wheelchair users, a common injury is a sitting\u2010acquired pressure ulcer (PU<\/jats:styled-content>) which typically onsets near the interface between the ischial tuberosity (IT<\/jats:styled-content>) and the overlying soft tissues. The risk of developing PUs<\/jats:styled-content> can be reduced considerably if an adequate cushion is placed on the wheelchair in order to protect tissues from PUs<\/jats:styled-content> by minimising interface mechanical loads between the body and cushion and also, exposure to internal soft tissue loads. In this work, we studied the biomechanical performances of an off\u2010loading (OL<\/jats:styled-content>) cushion with limited adjustability, in comparison to a standard foam cushion and a fully adjustable air\u2010cell\u2010based (ACB<\/jats:styled-content>) cushion. These different cushion design approaches were methodologically and quantitatively analysed and compared here using a finite element (FE<\/jats:styled-content>) modelling framework. We determined the internal mechanical deformations, strains and stresses in soft tissues of the seated buttocks during symmetric sitting, in a specific anatomy of a person with a spinal cord injury that was acquired during sitting in an open, magnetic resonance imaging configuration. Our results have shown that strains and stresses in muscle, fat and skin tissues are orders of magnitude lower for the ACB<\/jats:styled-content> cushion with respect to the standard foam and OL<\/jats:styled-content> cushions. The OL<\/jats:styled-content> cushion design has taken the approach of protecting at\u2010risk sites of the buttocks by transferring local internal tissue loads away from the ITs<\/jats:styled-content> and towards the greater trochanters, at the price of increasing exposure to internal tissue loads at sites other than the ITs<\/jats:styled-content>. The ACB<\/jats:styled-content> cushion design, however, has taken a different approach, that is, immersion and envelopment of the entire buttocks structure, which is useful for minimising the exposure to internal tissue loads throughout the whole buttocks. Quantifying performances of wheelchair cushions using FE<\/jats:styled-content> modelling provides insights into deep tissue loads, which is essential for informed decision\u2010making in developing sitting solutions for individuals at risk, as well as for patient groups.<\/jats:p>","DOI":"10.1111\/iwj.12807","type":"journal-article","created":{"date-parts":[[2017,9,6]],"date-time":"2017-09-06T07:52:42Z","timestamp":1504684362000},"page":"1327-1334","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Deep tissue loads in the seated buttocks on an off\u2010loading wheelchair cushion versus air\u2010cell\u2010based and foam cushions: finite element studies"],"prefix":"10.1111","volume":"14","author":[{"given":"Lea","family":"Peko Cohen","sequence":"first","affiliation":[{"name":"Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0223-7218","authenticated-orcid":false,"given":"Amit","family":"Gefen","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Faculty of Engineering Tel Aviv University Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,6]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1742-481X.2007.00330.x"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1179\/2045772313Y.0000000093"},{"key":"e_1_2_6_4_1","volume-title":"Cost implications of the pressure ulcer treatment guideline","author":"Miller H","year":"1994"},{"key":"e_1_2_6_5_1","first-page":"30","article-title":"Pressure ulcers in the United States' inpatient population from 2008 to 2012: results of a retrospective nationwide study","volume":"62","author":"Bauer K","year":"2016","journal-title":"Ostomy Wound Manage"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1553-7250(07)33069-9"},{"key":"e_1_2_6_7_1","volume-title":"Patient safety and quality: an evidence based handbook for nurses","author":"Lyder CH","year":"2008"},{"key":"e_1_2_6_8_1","volume-title":"Injury fact book of the Center for Disease Control and Prevention (CDC)","author":"National Center for Injury Prevention and Control Centers for Disease Control and Prevention","year":"2001"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmbbm.2013.04.015"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtv.2013.12.005"},{"key":"e_1_2_6_11_1","unstructured":"The European and US National Pressure Ulcer Advisory Panels (EPUAP and NPUAP) and the Pan Pacific Pressure Injury Alliance (PPPIA). International Guidelines;2014. URLhttp:\/\/www.epuap.org\/guidelines\/[accessed on 8 August 2017]"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1109\/TNSRE.2007.906967"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.3005195"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2007.10.011"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1053\/apmr.2002.32677"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1191\/0269215503cr692oa"},{"key":"e_1_2_6_17_1","first-page":"111","article-title":"Three\u2010dimensional computer model of the human buttocks, in vivo","volume":"31","author":"Todd BA","year":"1994","journal-title":"J Rehabil Res Dev"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/10255840410001727832"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtv.2017.04.005"},{"key":"e_1_2_6_20_1","unstructured":"Simpleware Ltd. ScanIP +FE +NURBS and + CAD Reference Guide version 5.1;2012. URLhttp:\/\/www.simpleware.com\/software\/[accessed on 8 August 2017]"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2006.06.020"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbiomech.2008.09.036"},{"key":"e_1_2_6_23_1","unstructured":"The Musculoskeletal Research Laboratories at the University of Utah. FEBio: finite element for biomechanics theory manual version 2.5;2016. URLhttp:\/\/mrl.sci.utah.edu\/software\/febio[accessed on 8 August 2017]"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijengsci.2007.09.002"},{"key":"e_1_2_6_25_1","volume-title":"Poisson's ratio and mechanical nonlinearity under tensile deformation in crystalline polymers, rheology","author":"Nitta K","year":"2012"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.1115\/1.4005694"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-349-02492-6_38"},{"key":"e_1_2_6_28_1","first-page":"26","article-title":"How much time does it take to get a pressure ulcer? 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