131 JRRD JRRD Volume 52, Number 2, 2015 Pages 131–146 Assistive technologies for self-managed pressure ulcer prevention in spinal cord injury: A scoping review James Y. Tung, PhD; 1* Brent Stead, PhD, MBA; 2 William Mann, MBA; 2 Ba’ Pham, PhD; 3 Milos R. Popovic, PhD 4 1 Department of Mechanical and Mechatronics Engineering, University of Waterloo, Waterloo, Canada; 2 SensiMAT Systems Inc, Toronto, Canada; 3 Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Canada; 4 Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Can- ada; and Toronto Rehabilitation Institute, University Health Network, Toronto, Canada Abstract—Pressure ulcers (PUs) in individuals with spinal cord injury (SCI) present a persistent and costly problem. Con- tinuing effort in developing new technologies that support self- managed care is an important prevention strategy. Specifically, the aims of this scoping review are to review the key concepts and factors related to self-managed prevention of PUs in indi- viduals with SCI and appraise the technologies available to assist patients in self-management of PU prevention practices. There is broad consensus that sustaining long-term adherence to prevention regimens is a major concern. Recent literature highlights the interactions between behavioral and physiologi- cal risk factors. We identify four technology categories that support self-management: computer-based educational tech- nologies demonstrated improved short-term gains in knowl- edge (2 studies), interface pressure mapping technologies demonstrated improved adherence to pressure-relief schedules up to 3 mo (5 studies), electrical stimulation confirmed improvements in tissue tolerance after 8 wk of training (3 stud- ies), and telemedicine programs demonstrated improvements in independence and reduced hospital visits over 6 mo (2 stud- ies). Overall, self-management technologies demonstrated low-to-moderate effectiveness in addressing a subset of risk factors. However, the effectiveness of technologies in prevent- ing PUs is limited due to a lack of incidence reporting. In light of the key findings, we recommend developing integrated tech- nologies that address multiple risk factors. Key words: assistive technology, integrated technologies, pres- sure ulcer, pressure ulcer incidence, pressure ulcer prevention, risk factors, SCI, self-managed care, spinal cord injury, wheelchairs. INTRODUCTION Individuals who experience a spinal cord injury (SCI) face numerous obstacles that require daily attention to mitigate complications that may arise throughout their lives [1]. One particularly devastating complication is pressure ulcers (PUs), typically resulting from partial or complete lack of control and sensation in the contact areas during sitting. This lack of sensation and mobility leads to extended periods of nonmovement that may result in excessive tissue pressures and ultimately necro- sis. The unfortunate reality is that up to 95 percent of individuals with SCI may develop an advanced stage 3 or 4 PU that penetrates to adipose tissue and bone, respec- tively, in their lifetime [2–4]. The physical implications of PUs include infections, permanent disfigurement, and risk of death [5]. In addition to the physical symptoms, social and work activities are disrupted by prolonged Abbreviations: CCM = chronic care model, CPG = clinical practice guideline, ES = electrical stimulation, IPM = interface pressure mapping, PU = pressure ulcer, RCT = randomized control trial, SCI = spinal cord injury. * Address all correspondence to James Y. Tung, PhD; Department of Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada; 519-888-4567, ext 33445. Email: james.tung@uwaterloo.ca http://dx.doi.org/10.1682/JRRD.2014.02.0064