Reducing the Risk of Pressure Sores with Watch Prompts and Alarm Avoidance

Background:

Beep ‘N Lift is a technique that prompts wheelchair users to push up from their wheel chairs every half an hour.

Purpose and anticipated benefits: This technique had the goal of reducing pressure sore

Who: Glen White tested the device on two 11-year-old youths

When: 1988

Method

At the start of this investigation, White, of the Research and Training Center on Independent Living, asked two children with spina bifida judged to be at risk for developing pressure ulcers whether they knew what pressure sores were and whether they understood the importance of doing regular weight shifts or wheelchair push-ups to prevent them. The children were told to do a wheelchair push-up for at least 3-seconds or more each time their watch beeped at 30-minute intervals and to remember the phrase “beep and lift.”

The Beep ‘N Lift intervention consisted of two main parts. First, a watch was programmed to beep at 30-minute intervals, signaling participants to perform a 3-second or longer wheelchair push-up, lifting their buttocks completely off of the wheelchair cushion. The second component was a small wheelchair-mounted pulsating alarm (about the volume level of a microwave alarm) that was connected to a weight sensor pad placed under each participant’s wheelchair cushion.

There was a 2-minute latency between when the watch beep went off and when the alarm sounded. This allowed participants to briefly complete tasks they were doing before performing their wheelchair push-up. Once the lift was accomplished, the alarm cycle would reset for the next 30 minutes. A small computer, also attached to the alarm sensor, recorded the frequency and duration of all wheelchair push-ups.

Results

The combination of instructions, prompts, and avoidance procedures proved effective when used together. No pressure sores were observed in either participant during the study. Typically, participants were up in their wheelchair for 30-minute intervals about 14 to 18 times each day. During the baseline condition, before participants had received any of the intervention components, they performed 3-second or longer wheelchair push-ups in a mean of only 22% of the intervals. When the Beep ‘N Lift intervention package was implemented, the mean rose to almost 90%. Other variations were attempted, such as using only a watch beeper or an alarm, but both components were needed to maintain the high number of intervals where the push-up criterion was met. Thus, the full intervention was more than four times more effective than baseline conditions. The participants approved of the technique, but found the alarm went off if they didn’t push up as moderately unacceptable.

Conclusion

While there is no agreement on the length and frequency of push-ups needed to prevent pressure sores, the use of three-second lifts every 30 minutes in this study and lack of subsequent sores suggest that this technique was useful. From a scientific perspective, the intervention had a significant effect. However, in subsequent months, interviews with other wheelchair users about the Beep ‘N Lift intervention revealed that most wheelchair users would dislike having an alarm attached to their wheelchairs to remind them to perform the push-up.

Products

White, G. W., Mathews, R. M., & Fawcett, S. B. (1989). Reducing the risk of pressure sores: Effects of watch prompts and alarm avoidance on wheelchair push-ups. Journal of Applied Behavior Analysis 22(3), 287-295.

White, G. W. (1990). Beep 'N Lift system. Colloquium of the prevention of secondary disabilities in people with spinal injury, The Centers for Disease Control, Atlanta, GA.

White, G. W., Fawcett, S. B., & Mathews, R. M. (1988). Beep N' Lift: A pressure sore prevention program. National Conference on Independent Living, Washington, DC.