Abstract

Background: Alternating Pressure Air Mattresses (APAMs) are a method of relieving pressure without the need for frequent patient turning. Although considered best practice by NICE for the prevention of pressure sores, clinical observation suggests that APAMs can hinder tone management programmes for patients undergoing Neuro-rehabilitation. The continual mattress movement may promote insecurity; reducing a patient’s sense of stability, culminating in increased anxiety and muscle tone. The aim of this study is to compare the effects of APAMs to standard foam mattresses on elbow stiffness and restlessness in patients with Acquired Brain Injury (ABI). Method This pilot study seeks to recruit 15 ABI patients. Using a single case experimental ABA design, each subject will provide his or her own control data. Subjects will be exposed to a standard foam mattress (A), air mattress (B), finishing on foam mattress (A), for a randomised period of 7 or 14 nights over a total period of 28 nights. For each trial, heart rate (by pulse oximetry) is recorded for 5/7 nights and turning activity (ActivPal Duo, dual axis accelerometer) is recorded for 2 consecutive nights out of 7. Outcome measures assessing stiffness and damping around the elbow joint are recorded using a quantative pendulum test as described by Lin [1], each weekday morning before getting up. In addition to visual inspection of the data, we will use summary measures of overnight heart rate, number of turns and damping ratio to look for differences in effect.