WO2005082250A1 - Capteur et procédé pour détecter un mouvement de patient par l'intermédiaire d'une position et d'une occlusion - Google Patents

Capteur et procédé pour détecter un mouvement de patient par l'intermédiaire d'une position et d'une occlusion Download PDF

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Publication number
WO2005082250A1
WO2005082250A1 PCT/US2004/022348 US2004022348W WO2005082250A1 WO 2005082250 A1 WO2005082250 A1 WO 2005082250A1 US 2004022348 W US2004022348 W US 2004022348W WO 2005082250 A1 WO2005082250 A1 WO 2005082250A1
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WO
WIPO (PCT)
Prior art keywords
patient
sensor
resistive
circuit
electrical
Prior art date
Application number
PCT/US2004/022348
Other languages
English (en)
Inventor
Toby E. Smith
Craig L. Cooper
Original Assignee
Bed-Check Corporation
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from US10/776,959 external-priority patent/US6987232B2/en
Application filed by Bed-Check Corporation filed Critical Bed-Check Corporation
Priority to CA2532600A priority Critical patent/CA2532600C/fr
Publication of WO2005082250A1 publication Critical patent/WO2005082250A1/fr

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Classifications

    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01H—ELECTRIC SWITCHES; RELAYS; SELECTORS; EMERGENCY PROTECTIVE DEVICES
    • H01H3/00—Mechanisms for operating contacts
    • H01H3/02—Operating parts, i.e. for operating driving mechanism by a mechanical force external to the switch
    • H01H3/14—Operating parts, i.e. for operating driving mechanism by a mechanical force external to the switch adapted for operation by a part of the human body other than the hand, e.g. by foot
    • H01H3/141—Cushion or mat switches
    • H01H3/142—Cushion or mat switches of the elongated strip type
    • H—ELECTRICITY
    • H01—ELECTRIC ELEMENTS
    • H01H—ELECTRIC SWITCHES; RELAYS; SELECTORS; EMERGENCY PROTECTIVE DEVICES
    • H01H2239/00—Miscellaneous
    • H01H2239/078—Variable resistance by variable contact area or point

Definitions

  • This invention relates generally to monitoring systems and more particularly concerns devices and systems used to monitor seated or lying patients in homes or in medical environments such as hospitals, institutions, and other care-giving environments so as to reduce the risk that such patients will develop decubitus ulcers.
  • BACKGROUND OF THE INVENTION It is well known that patients who are confined to a bed or chair for extended periods of time are at risk of developing decubitus ulcers, i.e., pressure sores, or bed sores as they are more commonly known. These ulcers are often seen to develop within soft tissue that is compressed between a bed or chair surface and a patient's weight-bearing bony prominences, the compressed tissue being at least partially of deprived of oxygenated blood flow.
  • Pressure sores do not develop immediately, but rather form over time, with the development speed depending on a number of factors including the firmness and friction of the supporting surface against the patient's skin, the patient/ambient temperature, the amount of moisture in contact with the skin, and the health and susceptibility of the skin due to age, illness, and/or nutrition.
  • One venerable and generally accepted means of reducing the risk of decubitus ulcer development in bedfast patients is to turn them regularly, usually at approximately two hour intervals.
  • a patient in a back rest position might be periodically rolled to one side or the other, such motion helping to maintain blood flow to soft tissue that is under compression.
  • Similar strategies are employed for patients that are confined to a chair for long periods of time.
  • an assisted- movement strategy relies largely on the vigilance of the (often harried) attending staff to insure that the patient is properly relocated.
  • this sort of strategy can be counterproductive for use with the patient that has some capacity for self- movement when, for example, the patient may have turned himself just before the caregiver arrived to manually turn him, in which case the caregiver will likely place the patient back in the position from which he recently moved, thus inadvertently exacerbating the problem.
  • the patient after being rolled to a new position the patient might return to the original "comfortable" position after the caregiver leaves which would obviously negate the effects of the reposition.
  • the process of moving a patient to another position is admittedly disruptive to the patient and this is especially true at night, since the patient — if he or she were sleeping — will be awakened for the purpose of relocation.
  • the typical two-hour movement interval must be observed around the clock if the method is to be effective, so it is necessary to disturb the patient — who might be sleeping soundly at the time — to make the required adjustment in position. Further, this adjustment might not have even been necessary, or even counter indicated, if the patient had recently moved of his or her own volition. Thus, in many situations it would be advantageous for the caregiver to know if and when the patient last moved his or herself. Then, if the last movement were within a prescribed period of time, it might be possible to spare the patient an unnecessary interruption in his or her healing sleep. The caregiver would then relocate the sleeping patient, only if that relocation were actually required.
  • the mechanical approach typically utilizes a specialized mattress, pad, or other arrangement, which is designed to lessen the weight-pressure that is brought to bear on the patient's bony prominences.
  • These devices might be either static (e.g., foam, air, or water mattresses) or dynamic (e.g., compartmentally inflatable mattresses that dynamically shift the locus of support pressure under the patient over time.
  • static e.g., foam, air, or water mattresses
  • dynamic e.g., compartmentally inflatable mattresses that dynamically shift the locus of support pressure under the patient over time.
  • Examples of inventions in the prior art that are generally concerned with this subject matter include U.S. Letters Patent 4,425,676, 5,926,884, and 5,072,468, the disclosures of which are incorporated herein by reference.
  • a mechanical approach is to be preferred because it seeks to spare the patient the discomfort and risk associated with bed sores and reduces the costs associated with treating such, which costs can potentially accrue to the facility under some circumstances.
  • One enhanced variant of the mechanical approach utilizes a proactive strategy that seeks to avoid tissue death by using a combination of automatic monitoring of the patient' s movement together with notification of a caregiver if the patient' s movement pattern does not meet or exceed some predetermined level. Upon receipt of such notice, the caregiver will then manually turn the patient, as has been the custom heretofore.
  • This approach if properly implemented, has the potential to dramatically reduce the risk of pressure sores while keeping the cost of such preventative measures within the reach of small institutions and individual patients.
  • Patent No. 5,945,914 wetness sensors (e.g., U.S. Patent No. 6,292,102), decubitus ulcer sensors (e.g., U.S. Patent 6,646,556), etc., all of which are incorporated herein by reference.
  • wetness sensors e.g., U.S. Patent No. 6,292,102
  • decubitus ulcer sensors e.g., U.S. Patent 6,646,556
  • mat or "patient sensor” should be interpreted in its broadest sense to apply to any sort of patient monitoring switch or device, whether the sensor is pressure sensitive or not.
  • pending U.S. Patent Application Serial No. 10 / 397,126 also incorporated herein by reference, discusses how white noise can be used in the context of decubitus ulcer prevention.
  • a patient sensor and electronic monitor combination that continuously monitors a bedfast or chair bound patient to determine whether or not that patient's amount of movement is sufficient to, for example, eliminate the next scheduled turning by the caregiver.
  • a sensor for use in connection with an electronic patient monitor wherein the sensor uses a resistive ladder with spaced-apart resistors as a means of determining at least approximately a location of the patient on the sensor as well as an approximate length of the sensor which is contacted by the patient.
  • the resistors will be linearly spaced apart within the patient sensor.
  • a plurality of resistive ladders arranged in a parallel configuration, one above the other will be used to determine the position and contact region of a patient with these multiple sensors and, additionally, will be used to calculate some relative value of the shear which is being experienced by the patient as his or her body slides down in the bed.
  • the resistive elements will be linearly spaced apart.
  • Figure 1 illustrates the general environment of the instant invention, wherein an electronic patient monitor is connected to a bed mat.
  • Figure 2 illustrates the general environment of the instant invention, wherein an electronic patient monitor is connected to a chair mat.
  • Figure 3 contains an illustration of the main features of a preferred embodiment of the instant pressure sensitive mat.
  • Figure 4 is an electronic schematic of the preferred pressure sensitive mat of
  • Figure 3 contains an illustration of a preferred monitor for use with the instant invention.
  • Figure 6 is a schematic diagram of a preferred microprocessor-based electronic monitor for use with the instant inventive pressure sensitive mat.
  • Figure 7 illustrates another preferred embodiment of the instant invention, wherein the resistive ladder is configured so as to provide both a lateral and longitudinal patient position.
  • Figure 8 contains a schematic illustration of another preferred embodiment of the instant invention, wherein the multiple resistive ladders are provided so as to provide both a lateral and longitudinal patient position.
  • Figure 9 contains a schematic illustration of another preferred embodiment of the instant invention, wherein each resistive element is separately readable.
  • Figure 10 illustrates another preferred embodiment, wherein the number of interconnect electrical conduits has been reduced by one.
  • Figure 11 contains a preferred electronic monitor embodiment, wherein no microprocessor is utilized.
  • Figure 12 contains an optical switch embodiment suitable for use with the instant invention, wherein a foam block or similar material is used as an optical attenuator.
  • Figure 13 contains another preferred optical switch embodiment wherein misalignment of two optical fibers is used as an optical attenuator.
  • Figure 14 contains still another preferred optical switch embodiment which utilizes a movable plate or similar structure to block passing between two sections of optical fiber, thereby attenuating the amount of light passing therebetween.
  • Figure 15 illustrates a preferred sensor embodiment, wherein optical switches and attenuators are used instead of electrical resistors.
  • an electronic patient monitor for use with a patient sensor, wherein the attached sensor is at least suitable for determining the location of the patient in the bed or chair through the use of a resistive ladder.
  • electronic patient monitors of the sort discussed herein work by first sensing an initial status of a patient, and then generating a signal when that status changes (e.g., the patient changes position in the bed, the patient fails to change position in the bed, the patient leaves the bed, the sensor changes from dry to wet, the temperature of the sensor changes, etc.) or , in some cases, if the initial condition persists for too long a period of time (e.g., if the patient has not moved during a predetermined time interval).
  • that status changes e.g., the patient changes position in the bed, the patient fails to change position in the bed, the patient leaves the bed, the sensor changes from dry to wet, the temperature of the sensor changes, etc.
  • the initial condition persists for too long a period of time (e.g., if the patient has not moved during a predetermined time interval).
  • FIG. 1 wherein the general environment of one specific embodiment of the instant invention is illustrated, in a typical arrangement a pressure sensitive mat 100 sensor is placed on a bed 20 where it will lie beneath a weight-bearing portion of the reclining patient's body, usually the buttocks and / or shoulders.
  • the mat 100 / electronic monitor 50 combination works as follows. When a patient is placed atop the mat 100, the patient's weight compresses it, thereby closing an internal electrical circuit. This circuit closure is sensed by the attached electronic patient monitor 50 and, depending on its design, this closure may signal the monitor 50 to begin monitoring the patient via the mat 100. Additionally, in some embodiments, the monitoring phase is initiated by a manually engaged switch.
  • the patient's status changes e.g., if weight is removed from the sensing mat 100, thereby breaking the electrical circuit, or if the patient changes position on the mat 100
  • this change is sensed by the attached electronic patient monitor 50 which responds to the changing condition according to its internal design and/or programming.
  • the changed circumstance of the patient will result in a signal or alarm being sent to notify a caregiver of the event. For example, if the patient has risen to his or her feet and left the bed, an electronic signal will be sent to a remote nurses / caregivers station via electronic communications line 60.
  • an alarm will be sounded if, for example, the patient's skin temperature rises, which can in some instances be a precursor to the formation of a decubitus ulcer.
  • additional electronic connections not pictured in this figure might include a monitor power cord to provide a source of AC power although, as generally pictured in this figure, the monitor 50 can certainly be configured to be either battery or AC powered.
  • a change in position would not necessarily result in an alarm being generated, but rather such a change might be recorded by the monitor 50 for later review and analysis by the staff or for purposes of monitoring the patient's movement history as is discussed at greater length hereinafter.
  • the patient has not moved for some predetermined period of time, that circumstance could also generate an alarm.
  • a pressure sensitive chair sensor 200 might be placed in the seat of a wheel chair or the like for purposes of monitoring a patient seated therein.
  • a typical configuration utilizes a pressure sensitive mat 200 that is connected to an electronic chair monitor 250 that is suspended from the chair 30. Because it is anticipated that the patient so monitored might choose to be at least somewhat mobile, the monitor 250 will usually be battery powered and will signal a patient change event (or, patient non-change event) via an internal speaker, rather than a hardwired nurse- call. Of course, those of ordinary skill in the art will understand that in some instances the monitor 250 can be configured to communicate wirelessly with the nurses' station through RF, IR, ultrasonic or other communications technology.
  • a patient sensor 300 which is designed to determine at least an approximate longitudinal position of the patient on the sensor and, additionally, to determine an occluded length of the sensor.
  • a mat-type sensor with a resistive (or similar component) ladder which is comprised of a plurality of resistive elements arrayed in a spaced apart configuration is used to determinate at least a longitudinal position of the patient on the sensor.
  • the preferred mat 300 is comprised of three layers: upper 350 and lower 360 non-conductive layers, and inner spacer 355 which is positioned between and separates the upper 350 and lower 360 layers.
  • the pressure sensitive mat of the instant invention is generally rectangular in shape and provides external electrical connectivity by way of electrical line 305 and connector 308.
  • the connector 308 will take the form of an RJ-11 or similar connector.
  • the preferred sensor 300 is comprised of a "sandwich" of three layers: two outer nonconductive layers 350 and 360, and, preferably, an inner nonconductive central spacer 355.
  • each of these layers is made of a flexible material such as polyester.
  • polyethylene layers might be bonded to each of these of the components 350, 355, and 360 to make it possible to fuse them together as a single unit by, for example, heat sealing, or, alternatively, by pressure sensitive adhesive.
  • the inner surface of upper member 350 will contain a screened or printed pattern of electrically conductive material such as silver-based ink or, alternatively, carbon ink black, etc., which renders portions of that surface electrically conductive.
  • the screened material is laid onto the inner surface of upper member 350 in such a way that at least two different electrically isolated circuits are created.
  • a first circuit 335 is created which is preferably accessible via either connector 320 or 325.
  • contact circuit 335 will contain a plurality of cross members 338 which are interleaved with the corresponding cross members 333 from circuit 323.
  • one preferred optional feature of this circuit is that it by measuring the resistance from connector 320 to connector 325 it is possible to determine the actual value of the single resistive element 331 (i.e., to determine the actual resistance of the "calibration resistor").
  • the calibration resistive element 331 will be sized to have the same value as the sensing elements 330, although those of ordinary skill in the art will recognize that this is not essential.
  • a principal reason for including such a separate resistive element circuit is that it permits the instant invention to accommodate manufacturing variations that might occur in printing the conductive portions of the mat 300. That is, in the preferred arrangement the resistive elements 330 and 331 will formed of conductive ink and will be printed onto the nonconductive layer 350.
  • a more efficient alternative is to separately measure the resistive value of calibration element 331, and provided that any manufacturing variation that might be present in resistive elements 330 is comparably present in calibration element 331, modify the calculations that are described hereinafter according to methods well known to those of ordinary skill in the art to account for less than perfect manufacturing. For example, if the resistance of the calibration element 331 is expected to be 100 ohms, and the actual measurement gives 90 ohms, then it is straightforward to adjust the calculations that produce the patient's location to reflect this variation (e.g., by simply scaling all measured resistances by the factor 100/90).
  • Circuit 333 is preferably accessible by both connector 310 and connector 315. As was mentioned previously, this circuit preferably has a plurality of cross members 333 which are interleaved with, but electrically isolated from, cross members 338 of contact circuit 335.
  • circuit 333 contains a plurality of identical resistive elements 330 which are connected in series. By measuring the resistance across connectors 310 and 315 it is possible to measure the total resistance in the circuit 333.
  • Central spacer 355 is preferably made of a flexible and resilient material such as polyester and contains a plurality of apertures 340 therethrough. The location of each aperture 340 should at least approximately coincide with the interleaved cross members 333 and 338 when the surfaces 350, 355, and 360 are assembled into the single sensor 300.
  • Upper member 360 preferably contains a plurality of conductive elements 380, which at least partially span the apertures 340.
  • conductive elements 380 are configured such that when weight is placed on the mat 300, that pressure will force the conductive elements 380 through one or more apertures 340 and into contact with circuits 323 and 335. More particularly, conductive elements 380 are configured such that when they come into contact with cross members 333 and 338 they cause an electrical short between discrete circuits 323 and 335. Further, and is explained in more detail below, based on the measured resistances across connectors 310, 315, 320, and/or 325 it is possible to reconstruct the location of the patient on the mat, as well as the proportion of the mat 300 which is compressed (or, more generally, occluded) by the patient, the latter measure being indicative of the orientation of the patient on the mat 300.
  • non- conductive support elements 390 are preferably superimposed upon the conductive elements 380 to help prevent inadvertent contact between the conductive elements 380 and the cross members 333 and 338 through the apertures 340 when there is no patient on the mat 300.
  • circuits 323 and 335 are laid onto their respective non-conductive surfaces 350 and 360 by printing with a flexible conductive ink such as silver-based ink.
  • resistive elements 330 be formed of the same ink or other conductive material as is used to create the circuits 323 and 335. As those of ordinary skill in the art will understand, resistive elements 330 can readily be formed to match a desired resistive value by simply adding length to the path traveled by electricity in completing the circuit.
  • the resistive elements 330 are formed by printing additional lengths of the same conductive material used elsewhere in circuits 323 and 335.
  • One obvious advantage of this approach is that it is more cost effective to print all of the elements of the mat in a single pass. Additionally, if a discrete resistor were to be used that element could very well introduce a hard bump or bulge in the mat surface, which might prove to be uncomfortable for the patient resting thereon. That being said, those of ordinary skill in the art will recognize that there are many ways that resistive or other elements suitable for use with the instant invention could be introduced into the circuits 323 and 335.
  • FIG 4 contains a schematic illustration of a preferred embodiment of the circuits of Figure 3.
  • the closure of switches 410, 420, 430, 440, 450, 460 and/or 470 engage different numbers of resistive elements 330.
  • This arrangement allows the attached electronic monitor to determine at least approximately the position of the patient on the sensor 300 and the number of switches (410 to 460) that have been closed by the patient's weight, this latter count being representative of the patient's position on the mat.
  • Figure 4 it is possible to determine the position and orientation of the patient on the mat according to the following preferred scheme.
  • the resistance between connectors 325 and 320 be measured and, assuming that any significant variation in ink quality or quantity has affected every resistive element 330 in the same general fashion, this measurement can be used to determine the approximate resistance of a single resistive element in the circuit which then provides a correction factor that can be applied in subsequent calculations.
  • this measurement can be used to determine the approximate resistance of a single resistive element in the circuit which then provides a correction factor that can be applied in subsequent calculations.
  • circuit "CI" hereinafter.
  • the measured resistance will be indicative of the nearest switch (410 through 460) to the connector-end that is engaged.
  • each resistive element 330 is the same value
  • contacts 440 and 450 are both engaged, the measured resistance between 315 and 320 will be approximately three times the resistance of individual resistor 330.
  • the calculated resistive value across these contacts will vary depending on the precise combination of contacts that are engaged and the values of the resistances. Further, it is readily possible to build a table or develop an equation that relates the measured resistance to every possible position of the patient on the mat 300.
  • Table 1 which follows, contains a listing of voltages normalized to 1 volt that would be measured across the leads indicated as a function of the number and location of switches engaged.
  • the resistive elements 330 are resistors and the preferred normalized resistance of each is about 100 ohms, with the values in column CI below being normalized to 1 volt.
  • Table 1 Fractional Voltage Arising from Different Combinations of Closed Switches 410 to 470
  • the column labeled "CI” contains resistances measured across contacts 315 and 320 with voltage applied to 310 and with 315 being grounded with switches 410 through 470 closed as indicated.
  • the values stored in the column labeled "C2" are the resistances measured across contacts 315 and 320 with voltage applied to 325 and with 315 being grounded with switches 410 through 470 closed as indicated.
  • each cell that contains a bullet therein indicates that the corresponding switch 410 through 470 is closed. Note that in some instances it is necessary to measure both circuits to uniquely determine the location and number of switches compressed. For example, the normalized voltage that would be observed when only switch 420 is closed (0.75, Row 2) is the same as would be observed if switches 410 through 450 were closed (0.75, Row 23).
  • the location information which is obtained from the mat 300 be combined with logic (whether implemented by discrete logic, one or more gate arrays, analog circuitry, or via a CPU / software combination, etc.) to help determine whether or not the patient has moved significantly, where a significant move is one that persists at least long enough for there to be sufficient reoxygenation of the previously compressed tissues.
  • logic whether implemented by discrete logic, one or more gate arrays, analog circuitry, or via a CPU / software combination, etc.
  • the number of switch closures is determined by preferably applying a constant current to connector 320 while grounding either 310 or 315 and measuring the resulting voltage. Table 2 which follows illustrates how various switch closures will be reflected in the measured voltages.
  • the values in the column headed by "C3 Volts” are the voltages read between 320 and 315 with a constant current, for example 4.167 mA, being applied to 320. Switches 410 through 470 are closed if a bullet is present in the corresponding column.
  • the values stored in the column labeled "C4 Volts” are the voltages read between 320 and 310 with a constant voltage applied to 320, and with switches 410 through 470 being closed as indicated. If, for instance, each resistor 330 has been chosen to be 100 ohms, the voltage drop across each is 0.4167 volts.
  • the number of resistors in the circuit may be calculated (assuming a given number of switch closures) and the results of such a calculation may be found in the columns in the Table 2 labeled C3 and C4. Note that each cell in the previous table that contains a bullet therein indicates that the corresponding switch 410 through 470 is taken to be closed.
  • the values in the column headed by "C3" are the number of resistors read between 320 and 315 while a constant current is applied to 320 with switches 410 through 470 being closed as indicated.
  • the values stored in the column labeled "C4" are the number of resistors read between 320 and 310 with a constant voltage being applied to 320 and with switches 410 through 470 being closed as indicated.
  • the instant invention would be used as follows.
  • the sensor 300 would be placed into electronic communication with an electronic patient monitor 500.
  • an electronic patient monitor 500 will contain an interface port 520 which preferably takes the form of a standard connector (e.g., an RJ-11-type connector) into which the sensor cord 305 is plugged.
  • a microprocessor 620 which might additionally utilize a separate timer / clock chip 640 to assist it in measuring the various time intervals that are useful and necessary in the monitoring of an at-risk patient.
  • a separate (or external) clock chip 640 is not strictly necessary and, instead, software timing loops could readily be used instead.
  • RAM/ROM 610 it is customary to include some amount of computer RAM/ROM 610 in which to store program instructions and variable values. That being said, those of ordinary skill in the art will recognize that such RAM/ROM 610 need not be external to the microprocessor 602 but might, instead, be incorporated into the microprocessor 602 according to methods well known to those of ordinary skill in the art.
  • sensor port 1110 could be monitored by detector 1120 which might be comprised of, by way of example only, a position detection circuit, a window comparator, a sample-and-hold circuit, and a differential amplifier circuit.
  • the detector circuit 1120 would preferably work in combination with one or more timers 1130, which timers would preferably include a timer for monitoring the doctor-prescribed turn interval (e.g., a two-hour timer) and a separate timer to determine whether the patient has maintained a changed position for a period of time sufficient to allow reoxygenation of the previously-compressed tissues (e.g., a ten-minute timer). Finally, if the alarm conditions are satisfied, an alarm circuit 1140 would be triggered which preferably would sound an audible alarm via speaker 1150 which might be directly incorporated into the patient monitor 1100 or situated remotely thereto, e.g., at a nurses station.
  • timers 1130 which timers would preferably include a timer for monitoring the doctor-prescribed turn interval (e.g., a two-hour timer) and a separate timer to determine whether the patient has maintained a changed position for a period of time sufficient to allow reoxygenation of the previously-compressed tissues (e
  • the orientation will preferably be established by reference to the percentage of the mat 300 that is occluded. That is, if only a few (e.g., one or two) of the switches 410 through 470 are closed, the patient is likely lying on his or her side. However, if a larger number are closed (e.g., 3 or 4 or more), the patient is likely lying on his or her back or stomach.
  • the monitor 500 will continue to monitor the patient's location and orientation to determine whether or not the patient has moved.
  • determining whether or not the patient has "moved" is not enough: the patient who is lying, say, on his right side and who moves sideways in the bed is still in risk of decubitus ulcers.
  • the patient will be possible to tell at least approximately whether the patient has truly moved to so that manual turning will not be necessary. For example, if the patient's weight has caused only two of the switches 410-460 to be engaged, that patient is likely lying on his or her side. However, if the weight distribution of the patient later changes to engage four of the switches 410-460, it is likely that the patient has rolled onto his or her back or stomach. Thus, the patient is unlikely to need to be manually turned. In a typical arrangement, the patient will be monitored continuously by an attached electronic patient monitor during the time that he or she is bed-fast or chair- fast.
  • the attending physician will prescribe a turn interval for the patient, the turn interval being the frequency with which the staff must manually turn the patient so that the compressed tissues can reoxygenate.
  • a two-hour turn interval is commonly used.
  • a preferred embodiment of the instant invention operates by determining an initial orientation of the patient on the sensor and then thereafter repeatedly redetermining the patient's position over time to ascertain whether or not he or she has moved.
  • sampling frequency or period of time between measurements of the patient's position that need be used, but that the sampling interval must necessarily be shorter than the turn interval and, preferably, will be on the order of once a minute or so.
  • a sensor substantially as described above, but wherein a plurality of spaced-apart longitudinally aligned resistive ladders are utilized so as to give a horizontal and vertical profile of the patient's orientation in the bed, i.e., to provide both a longitudinal and vertical measurement of the patient's location.
  • the resistive ladder of Figures 3 and 4 is spatially configured so as to give an approximate "X” and "Y” location of the patient on the sensor 700, where "X” is preferably measured with respect to the width of the bed and the "Y” with respect to its length.
  • "X" is preferably measured with respect to the width of the bed and the "Y” with respect to its length.
  • Figure 7 by spatially varying the location of the resistive elements 330 and the switches 410 - 470, it is possible estimate, not only the lateral location of the patient on the mat, but also his or her vertical position relative to the head (or foot) of the bed. In more particular, consider the case where switches 440, and 460 are closed (“Case 1") in comparison with the case where, say, switches 450, and 470 are closed (“Case 2").
  • the combination of switches in Case 1 would be interpreted as a patient who is higher (i.e., closer to the head) of the bed than the combination of Case 2.
  • the preferred arrangement which utilizes a series of staggered switches — can be used to obtain general information about the vertical location of the patient in the bed.
  • the instant sensor 700 can provide dynamic / real-time information about the patient's condition by monitoring the changing closure patterns of its switches over time. For example, in the previous scenario where the closure pattern of Case 1 is followed directly by the pattern of Case 2, the patient is likely sliding toward the foot of the bed.
  • this information will be utilized to estimate the amount of shear experienced by the patient's tissue during this time period.
  • a sensor and attached electronic patient monitor substantially as described above, but wherein the patient monitor utilizes information from the time- varying switch closures to help identify those patient's that are at risk of decubitus ulcers by virtue of shear stress placed on their tissues, a sheer stress being a force that is tangent to the skin's surface.
  • the amount of shear experienced by a patient is increasingly recognized as another factor in predicting the occurrence of decubitus ulcers.
  • a patient's sliding down in the bed is an obvious source of such stress, and may, indeed, cut off oxygenated blood to the patient's tissues by capillary deformation, thereby increasing the risk of injury. If an at-risk patient can be automatically identified and the staff notified, additional manual intervention, or a change to another bed or chair, might circumvent the occurrence of ulcer formation entirely. Needless to say, it is much better to prevent decubitus ulcers than to treat them. Additionally, shear that is caused by sliding can indicate a general restlessness in the patient, which might be correlated with an increase in his or her pain or anxiety level. Those of ordinary skill in the art will recognize the utility of being able to automatically identify such a change in patient condition and to notify the staff so that intervention is possible if it is necessary.
  • a mat substantially as described above, but wherein there are two or more resistive ladders configured in a roughly parallel arrangement.
  • two or more electrically isolated resistive ladders are utilized, each such ladder being independently accessible via connectors 810 through 825 and 830 through 845, respectively.
  • switches 850 through 862 are separately readable to determine which are closed.
  • switches 864 through 876 provide a horizontal, as well as a vertical, image of the patient's position. Given this sort of arrangement, it is possible to determine vertical and horizontal changes in the patient's position and, if desired, to estimate whether or not the patient's body is experiencing shear.
  • each switch 910 through 924 is separately readable by virtue of the individual electrical lines coming to it. That is, rather than using a four-element electrical line 305, a nine- element line is preferably used instead, wherein each of the conductive elements leading to switches 910 through 924 is kept electrically isolated from the others.
  • a patient monitor in electrical communication with the embodiment of Figure 9 can directly determine which of the switches is closed, e.g., by bringing each connecting line into a separate port in the microprocessor (or other programmable device) of the monitor.
  • the resistive elements 330 might take any resistive value that is greater than or equal to zero.
  • switches in Figure 9 and elsewhere in this disclosure are normally opened, those of ordinary skill in the art will recognize that normally closed switches could be used instead and that the procedure for determining patient location discussed previously would not need to modified materially in order to determine the patient's position.
  • switches that are based on optical, rather than electrical, properties wherein the resistive element takes the form of an optical attenuator. That is, if the electrical conductor 930 were instead replaced by some sort of optical fiber, if resistive elements 330 included sections of optical fiber, and, if, for example, the amplitude or frequency of light passing through the switch were changed
  • FIG. 12 illustrates a first preferred optical switch that would be suitable for use with an optical embodiment of the instant invention.
  • a block of open cell foam or similar material acts as the optical attenuator.
  • a light source 1210 is provided at one end of an optical conduit 1220 (e.g., a section of fiber optic cable). Light is transmitted through the optically conductive material 1220 until it reaches optical attenuator 1230, which in one preferred embodiment is a low density open cell foam.
  • a portion of the light that falls on the attenuator 1230 will be transmitted therethrough to optical conduit 1240 (e.g., a section of fiber optic cable) where it will be further conducted to photo-sensor 1250.
  • optical conduit 1240 e.g., a section of fiber optic cable
  • photo-sensor 1250 As is well know to those of ordinary skill in the art, when open cell foam is compressed (e.g., via the weight of the patient on the sensor) its density increases and it becomes less transparent to light. Thus, by measuring the intensity of light that is received at photo-sensor 1250 it will be possible to determine whether or not the foam block is compressed and, hence, which of the switches within the sensor are "closed". In a preferred arrangement, an initially calibrated amount of light that is transmitted through the attenuator 1230 when the foam is not compressed will be continuously compared with the actual amount of light received from light source 1210.
  • an optical attenuator which utilizes misalignment of two optical conduits as a means of attenuating the optical signal when the patient is present on the sensor.
  • the ends of optical conduits 1320 and 1340 will be in near direct alignment and much of the light that emanates from the source conduit 1320 will be received by receiver conduit 1340, depending, of course, on the distance between the two conduits.
  • the patient's weight on the sensor which is typically made to be at least somewhat flexible for purposes of the increasing the patient's comfort, would tend to misalign the two optical conduits ( Figure 13B) and reduce the amount of light transmitted between them.
  • a photo-sensor 1250 in optical communication with the receiving conduit 1340 would thus be readily able to determine whether or not the switch was engaged depending on the level of light received.
  • a reference level of light transmissivity will be established while the mat is empty so that deviations therefrom can be identified.
  • the optical attenuation in this case is brought about by the degree of physical misalignment between the sections of optical conduit.
  • a calibration value will be provided against which the currently measured optical intensity will be measured which will then provide an indication of when the termini of the two conduits 1320 and 1340 are in alignment.
  • Figure 15 a preferred arrangement wherein a plurality of optical attenuators 1530 (e.g., any of the attenuators of Figures 12 to 14, but the embodiment of Figure 14 would likely be best suited) are placed in series with light collectors 1540 - 1570 interspersed in between.
  • the light originating from all of the light collectors 1540 - 1570 will be additively combined through junction 1595 into a single optical conduit where it can be read by photo-sensor 1250.
  • the attenuators will be assumed to be the shutters 1430 of Figure 14.
  • light sources 1510 and 1520 will be positioned at opposite ends of the light conduit 1590 and alternately activated. That is, light source 1510 will be activated while source 1520 is dark, and then light source 1510 will be darkened while source 1520 is activated. The reason for this arrangement is that it allows a patient's location and occlusion to be readily determined using a single photo-sensor 1250.
  • optical attenuators 1532 - 1535 are engaged (i.e., the shutters of these optical attenuators are in the "down" or blocking position) light from source 1510 will be received only at collector 1540, with the remaining collectors 1545 - 1570 being dark. However, when optical source 1520 is activated, light will be received at collectors 1560 through 1570, with the remaining collectors being dark
  • a microprocessor is utilized as a component of the monitor 500, the only requirement that such a component must satisfy is that it must minimally be an active device, i.e., one that is programmable in some sense, that it is capable of recognizing signals from a bed mat or similar patient sensing device, and that it is capable of initiating the sounding of one or more alarm sounds in response thereto.
  • PLD programmable logic devices
  • gate arrays FPGA's (i.e., field programmable gate arrays), CPLD's (i.e., complex PLD's), EPLD's (i.e., erasable PLD's), SPLD's (i.e., simple PLD's), PAL's (programmable array logic), FPLA's (i.e., field programmable logic array), FPLS (i.e., fuse programmable logic sequencers), GAL (i.e., generic array logic), PLA (i.e., programmable logic array), FPAA (i.e., field programmable analog array), PsoC (i.e., programmable system-on-chip), SoC (i.e., system-on-chip), CsoC (i.e., configurable system-on-chip), ASIC (i.e., application specific integrated chip), etc
  • processors integral thereto.
  • CPU central processing unit
  • processors any PLD or other programmable device of the general sort described above.
  • clock or timer or similar timing circuitry those of ordinary skill in the art will understand that such functionality might be provided through the use of a separate dedicate clock circuit or implemented in software within the microprocessor. It might further be obtained with discrete, linear, timers and logic circuitry: a microprocessor is not strictly required, but is merely convenient.
  • the instant invention could also be configured to operate by calculating the various travel times of an electronic pulse that is sent through the instant circuitry (e.g., as measured by a Ditmico tester).
  • the resistive elements 330 are preferably created by screening additional lengths of the electrically conductive material onto the mat surface, thereby creating increased resistance. This additional length would also result in an increased travel time as well, so a technique that measured the travel time of an electronic pulse from, say, 320 to 310 and from 315 to 320 would be able to determine the number of switches closed by the patient's weight.
  • resistive value when used to describe the measurement of some electrical property of the circuit, it should be understood that the quantity that is actually measured might be different from “resistance” and, instead, could be any other property that is representative of the number of switches that are closed in the attached mat including, without limitation, capacitance, voltage, transit time, etc.
  • electrical properties, electrical conductors, and electrical resistors that same language should be understood to also include optical properties, optical conductors, and optical attenuators.
  • the preferred arrangement includes an array of identical resistive elements, those of ordinary skill in the art will recognize that this arrangement is not required.
  • the single continuous resistive element will be used with a plurality discretely spaced activation (e.g., switches 410 through 460), the goal being to determine the nearest point of contact of the patient to one end of the mat and the occluded / contact area.
  • the instant invention may be utilized to detect when a patient is moving toward the edge of the sensor with the intent of exiting the bed. It should be clear that if none of the mat switches are engaged, the patient is no longer present on the mat and, presumably, will have left the bed or chair into which he or she had been placed.
  • the instant invention can function in connection with a conventional "exit monitor" and be used to signal the nursing staff when a patient has risen. This much should be clear.
  • the preferred mat embodiment has numerous switches distributed along its length, it is possible to utilize the instant invention determine when a patient is preparing to leave the bed and, if so desired, signal that intent to the nursing staff.
  • the preferred embodiment has switches distributed throughout the length of the mat, including switches that are proximate to each end.
  • switches typically, when a patient is intending to leave the bed, his or her weight is relocated laterally to the exit side as a prelude to exiting.
  • the speed with which the patient moves toward the edge of the bed may also be telling, with faster movements toward the bed edge usually being indicative of a patient that is preparing to exit the bed.
  • the instant invention it is possible to determine when the patient's weight so-shifts by looking for instances when only the switches proximate to one end of the mat are engaged. Additionally, the velocity at which the patient moves toward the edge may also be calculated. In the event that the patient approaches the edge of the bed and / or approaches the edge of the bed in excess of a predetermined velocity, a signal will preferably be sent to the nursing staff, thereby allowing the staff to intervene before the patient has had time to stand and fall. Additionally, although it is preferred that the instant sensor be placed under the patient's hips or back, that is not the only possible orientation. Of some additional concern is the condition of the patient's heels, elbows, and other bony prominences. Each of these sites can potentially be a site at which decubitus ulcers can develop.
  • the sensor of the instant invention could certainly be positioned under any of these areas and/or multiple sensors could be used (e.g., one under each area of concern), more practically speaking the those of ordinary skill in the art will recognize that monitoring the patient's movement at his or her hips allows at least some general inferences about the other locations of concern (e.g., if the patient has rolled on his or her side it is likely that the heels are in a position to reoxygenate, etc.) Further, it should be noted and remembered that, although a preferred embodiment of the instant invention employs a discrete central spacer, that is not absolutely required.
  • spacer and “central spacer” should be broadly interpreted to include any structure that serves to separate the upper 350 and lower 360 members of the instant invention when there is no weight on the mat 300.
  • a preferred electronic monitor of the instant invention utilizes a microprocessor with programming instructions stored therein for execution thereby, which programming instructions define the monitor's response to the patient.
  • ROM is the preferred apparatus for storing such instructions, static or dynamic RAM, flash RAM, EPROM, PROM, EEPROM, or any similar volatile or nonvolatile computer memory could be used.
  • the software it is not absolutely essential that the software be permanently resident within the monitor, although that is certainly preferred. It is possible that the operating software could be stored, by way of example, on a floppy disk, a magnetic disk, a magnetic tape, a magneto-optical disk, an optical disk, a CD-ROM, flash RAM card, a ROM card, a DVD disk, or loaded into the monitor over a network as needed. Additionally, those of ordinary skill in the art will recognize that the memory might be either internal to the microprocessor, or external to it, or some combination. Thus, "program memory" as that term is used herein should be interpreted in its broadest sense to include the variations listed above, as well as other variations that are well known to those of ordinary skill in the art.
  • the preferred embodiment of the instant invention utilizes a plurality of resistive elements 330 organized in a serial arrangement
  • alternative circuit configurations e.g., parallel, or some other arrangement
  • All that is required for purposes of the instant invention is that the mat circuit, what ever its configuration, be capable of determining at least an occluded / contact region and a location from one end of the mat.
  • a sensor which yielded a distance from each end of the mat would allow an immediate calculation of the occluded or contact region.
  • Those of ordinary skill in the art will be able to devise many alternative configurations of the instant invention beyond those suggested herein.
  • the preferred embodiment of the instant invention has the two circuits 323 and 335 and the resistive elements 330 and 331 all physically located on the same surface of mat 300, it should be clear that various permutations of this arrangement are possible. Indeed, the only requirement is that the resistive elements 330 be in electrical communication with the circuits 323 and 325 so that the sensor 300 functions as has been described previously. Thus, it would be within the spirit of the instant invention if the resistive elements 330 were to be located, say, on the central spacer 355 or on the inner face of mat surface 360.
  • the two circuits 323 and 335 need not be physically resident on the same mat element 350, but could instead be on opposite mat elements so long as they can be selectively closed to indicate at least a patient's approximate lateral location as a function of the number of switches closed. Additionally, those of ordinary skill in the art will recognize that it is certainly possible that the sensor 300 might be made a part of, or incorporated, into the bed itself or some other structure.
  • the term "nurse call” as that term has been used herein should be interpreted to mean, not only traditional wire-based nurse call units, but more also any system for notifying a remote caregiver of the state of a patient, whether that system is wire-based or wireless (e.g., R.F., ultrasonic, IR link, etc.). Additionally, it should be clear to those of ordinary skill in the art that it may or may not be a “nurse” that monitors a patient remotely and, as such, nurse should be broadly interpreted to include any sort of caregiver, including, for example, untrained family members and friends that might be signaled by such a system.

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  • Measuring And Recording Apparatus For Diagnosis (AREA)
  • Invalid Beds And Related Equipment (AREA)

Abstract

Il est fourni ici un capteur destiné à une utilisation en relation avec un moniteur électronique pour patient, dans lequel le capteur utilise de préférence un réseau résistif en échelle configuré linéairement, comportant des résistances espacées les unes des autres, en tant que moyen de détermination d'au moins approximativement un emplacement du patient sur le capteur, de même que d'une longueur approximative du capteur qui est compressé par le patient. En déterminant en continu ces deux quantités dans le temps, il est possible de suivre le mouvement du patient et de déterminer dans quelle mesure le patient a besoin d'être retourné manuellement et/ou la mesure dans laquelle un retournement suivant programmé peut être omis.
PCT/US2004/022348 2004-02-11 2004-07-13 Capteur et procédé pour détecter un mouvement de patient par l'intermédiaire d'une position et d'une occlusion WO2005082250A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
CA2532600A CA2532600C (fr) 2004-02-11 2004-07-13 Capteur et procede pour detecter un mouvement de patient par l'intermediaire d'une position et d'une occlusion

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US10/776,959 2004-02-11
US10/776,959 US6987232B2 (en) 2003-07-14 2004-02-11 Sensor and method for detecting a patient's movement via position and occlusion

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WO2005082250A1 true WO2005082250A1 (fr) 2005-09-09

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100324753A1 (en) * 2009-06-17 2010-12-23 Toyota Jidosha Kabushiki Kaisha Vehicle, system including the same, vehicle motion producing method

Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5353012A (en) * 1992-05-14 1994-10-04 Bartronix, Inc. Bed position and activity sensing apparatus
US6646556B1 (en) * 2000-06-09 2003-11-11 Bed-Check Corporation Apparatus and method for reducing the risk of decubitus ulcers
US20030216670A1 (en) * 2002-05-17 2003-11-20 Beggs George R. Integral, flexible, electronic patient sensing and monitoring system

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5353012A (en) * 1992-05-14 1994-10-04 Bartronix, Inc. Bed position and activity sensing apparatus
US6646556B1 (en) * 2000-06-09 2003-11-11 Bed-Check Corporation Apparatus and method for reducing the risk of decubitus ulcers
US20030216670A1 (en) * 2002-05-17 2003-11-20 Beggs George R. Integral, flexible, electronic patient sensing and monitoring system

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100324753A1 (en) * 2009-06-17 2010-12-23 Toyota Jidosha Kabushiki Kaisha Vehicle, system including the same, vehicle motion producing method

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CA2532600A1 (fr) 2005-09-09

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