This skin breakdown usually occurs over bony places such as the hips, sacrum (upper buttocks), heels and ankles, and is much more likely to occur when a patient lies in one position for a long time. When this happens, pressure on those bony areas cuts off the blood flow to those areas and can cause a sore to develop.

Therapeutic support surfaces help distribute body weight more evenly in bed than a regular mattress can. This helps relieve the pressure in those trouble spots and allows for healing blood flow. A therapeutic support surface can help sores heal and aids in the prevention of new injury. It also aids in patient comfort, eliminating the need for constant turning by the caregiver.

In February 2007, the National Pressure Ulcer Advisory Panel (NPUAP) redefined the definition of a pressure ulcer and the stages of pressure ulcers, including the original 4 stages and adding 2 stages on deep tissue injury and unstageable pressure ulcers. Pressure wounds are staged (I-IV, deep tissue, and unstageable) relative to the depth and extent of damage. This staging system may be viewed at http://www.npuap.org/pr2.htm.

A variety of medical issues influence the kind of therapeutic support surface (TSS) a patient might require. According to the NPUAP Support Surface Initiative, a support surface is defined as "a specialized device for pressure redistribution designed for management of tissue loads, micro-climate, and/or other therapeutic functions (i.e., any mattresses, integrated bed system, mattress replacement, mattress overlay or seat cushion, or seat cushion overlay).” A variety of wheelchair cushions come under the TSS guidelines.

Issues related to patient compliance can impact the healing of a pressure wound, and thus the effectiveness of a mattress. Bariatric needs are perhaps the most complex. To begin with, bariatric patients often require treatment of other co-morbidities. A bed that articulates to help treat those other conditions, such as raising the legs in the case of edema or changing the position to aid a respiratory condition, might be required.

Some bedridden patients might need an alternative support surface to ensure they don’t incur pressure sores, or for those who might have a single stage 2 or less. These patients might simply need a gel overlay or similar product. While prevention is a huge consideration from a medical standpoint, most insurance companies and Medicare are not prevention providers. However, if the patient has another related condition, then the provider might be able to put them on a prevention product due to the co-diagnosis.

Mattresses have an equal number of variations that must be tailored to the patient’s needs, especially since most of them are geared for treating or preventing pressure sores. (See “Pressure Ulcer Stages: http://www.npuap.org/pr2.htm). There are two main types of mattresses available: standard low air loss mattresses and alternative pressure mattresses. There is also a third type of mattress that uses three-cell technology.

Two-cell alternating pressure mattresses have A and B cells that alternate in pressure. When the A cells inflate, the B cells deflate. A third-cell mattress adds a C cell to the mix so that when the A and B cells are inflated, the C cells are deflated, which allows the patient to “bridge” across the cells to relieve more pressure. The more severe the pressure wound, the more complex the mattress that will be required. A patient with a single stage 2 sore or less might simply need a gel overlay, while a patient with multiple stage 3 or 4 wounds might need a three-cell mattress.

RCH&P offers a variety of therapeutic support surfaces for use in the home, from an assortment of mattress overlays to complete mattress replacement systems, examples of which are noted below:

• Mattress Replacement Systems
• Mattress Overlays
• Group One Products
• Group Two Products

NPUAP's Components of Support Surfaces

Cells/Bladder - a means of encapsulating a support medium

Foam:

• Viscoelastic — A type of porous polymer material that conforms in proportion to the applied load and to the rate of loading
• Elastic — A type of porous polymer material that conforms in proportion to the applied load
• Closed Cell — A non-permeable structure in which there is a barrier between cells, and gases or liquids from passing through the foam
• Open Cell – A permeable structure in which there is no barrier between cells, and gases or liquids can pass through the foam
• Gel – A semisolid system consisting of a network of solid aggregates, colloidal dispersions or polymers which may exhibit elastic properties
• Pad - A cushion-like mass of soft material used for comfort, protection or positioning
• Viscous Fluid - A fluid with a relatively high internal resistance to flow
• Elastomer - Any material that can be repeatedly stretched to at least twice its original length;
  upon release of the stretch it will return to approximately its original length.

Features of Support Surfaces

Air Fluidized - A feature of a support surface that provides pressure redistribution via a fluid-like medium created by forcing air through beads as characterized by immersion and envelopment.

Alternating Pressure - A feature of a support surface that provides pressure redistribution via cyclic changes in loading and unloading as characterized by frequency, duration, amplitude, and rate of change parameters over the active area of the surface.

Lateral Rotation - A feature of a support surface that provides rotation about a longitudinal axis as characterized by degree of patient turn, duration and frequency.

Low Air Loss - A feature of a support surface that provides a flow of air to assist in managing the heat and humidity (microclimate) of the skin.

Categories of Support Surfaces

Reactive Support Surface - A powered or non-powered support surface that changes mechanical load distribution only in response to external forces.

Active Support Surface - A powered support surface, with the capability to change its mechanical load distribution properties, independent of external forces.

Integrated Bed System - A bed frame and support surface that are combined into a single unit whereby the surface is unable to function separately.

Non-Powered - Any support surface not requiring or using external sources of energy for operation.

Powered - Any support surface requiring or using external sources of energy to operate.

Mattress Overlay - A support surface designed to be placed directly on top of an existing mattress.

Mattress Replacement - A support surface designed to be placed directly on the existing bed frame.

For more information on the terms and definitions of support surfaces, visit http://www.npuap