The present invention relates to inflatable supports and inparticular, but not exclusively, to inflatable supports such as mattresses andcushions for the prevention of, and/or relief from, decubitus ulcers on bed-riddenor relatively immobile patients.
Decubitus ulcers occur when blood flow through the skincapillaries is occluded by virtue of the fact that tissue is compressed for aprolonged period by the weight of the person and a support surface. Aperson who is healthy responds to nervous signals from the area of tissue inquestion when the tissue has been compressed for some time, and theperson will thus automatically shift position to relieve the compressed area,thereby enabling blood flow to recommence. This procedure repeats itselfindefinitely.
However, people without the ability to move themselves, e.g.comatose, obtunded or severely disabled people, cannot relieve the pressurein this way, and thus if they are allowed to remain in the same position, partsof the tissue die and become ulcerated, producing what are commonlytermed "pressure sores". The problem also arises with elderly people whohave restricted movement. The problem is exacerbated by diet, immobility,possible low blood pressure/volume and poor skin perfusion.
The traditional way of preventing or relieving bed pressure sores has been to turn the patient frequently, thus causing a different areaof the patient to be compressed from time to time. However, this is notalways practical or possible.
An alternative way is to place the patient on an overlay, with aview to contacting more areas of the body in order to spread the patient'sweight.
However, although such an overlay is comfortable, it frequentlydoes not prevent or relieve pressure sores, since the pressure relief obtainedin the areas most at risk (e.g. bony prominences) is very often insufficient toenable re-establishment of the blood flow.
The use of inflatable cushions and mattresses for the purposesof avoiding pressure sores and the like is also well known. An example ofthe prior art is EP0528666A which discloses a mattress having a plurality ofelongate inflatable cells arranged transversely to the longitudinal direction ofthe mattress and in which each cell is periodically inflated at higher and lowerpressures to vary the areas of support and thereby greatly reduce the risk ofpressure sores.
Whilst the aforementioned prior art operates extremelyeffectively, a need has been expressed for a self-contained or portablesupport which could be used, inter alia, as a seat cushion. One problem inimplementing this need is the requirement to ensure that should the supplyof inflating air fail, deflation of the support should not result in the patient being supported on a hard surface beneath the mattress or cushion, whichcould increase the likelihood of the formation of pressure sores.
In accordance with a first aspect of the present invention aninflatable support comprises an inflatable cell containing a deformable solidmaterial.
Such a patient support device can be made into a mattress orcushion and would normally be used with an air supply whereby the supportcan be periodically inflated and deflated as in the prior art to shift the regionsof support on the patient. However, should the inflating air supply fail thepatient will still be supported by the deformable material, which will minimisethe risk of formation of pressure sores until the air supply is restored.Preferably, the support comprises a plurality of inflatable cells and preferablythe solid material is resiliently deformable.
In one embodiment, the solid within the cells comprises a blockof solid material, such as foamed material. For example, the foamed materialmay be a foamed plastics such as polyurethane foam. The block of materialmay be laminated.
The solid material may be secured (e.g. glued) to one or more of thecell walls, e.g. one or both side walls and/or a base wall. As the cellexpands, the foam is thereby stretched. When the inflating pressure isremoved, the resilience of the foam helps to expel the air more quickly fromthe cell.
The solid may be in particulate form, e.g. a plurality of beads.Preferably the particles are resiliently deformable. A suitable material wouldbe a foamed plastic such as foamed polyurethane.
The solid may be substantially non-resiliently deformable. Forexample the solid may comprise fibres, such as polyester fibres, or feathers.
The support may comprise first and second cells containing adeformable solid material, one being located above the other. The solidmaterial in the first and second cells may be different from one another.
The first and second cells may have a common wall and may or maynot communicate with one another.
The inflatable support may additionally comprise one or more cellswhich contain no solid material. Alternatively, or in addition, the inflatablesupport may comprise one or more non-inflatable cells which may or may notcontain solid material.
Preferably, the support comprises means (e.g. a pump such as anelectric or hand-operated pump) for inflating the or each inflatable cell.
Where there is a plurality of inflatable cells, the cells are preferablyelongate and preferably arranged parallel to each other.
The support may be in the form of a mattress or a seat cushion.
By way of example only, specific embodiments of the presentinvention will now be described, with reference to the accompanyingdrawings, in which:-
Referring firstly to Figs. 1 to 3, an inflatablerectangularmattress 10 comprises a plurality of elongateinflatable cells 12 which arearranged parallel to one another transversely to the longitudinal direction ofthe mattress. Themattress 10 is provided with aremovable cover 14 ofmicroporous vapour permeable material. Each end of theupper wall 16 ofeach inflatable cell is provided with a projectingflap 18 having anaperture20 therein which is adapted to receive the head of a respective one of aplurality of securingstuds 22 attached to a portion of themattress cover 14in order to secure the cells in position. It will also be noted that the mattresscover can be held firmly in position over the assembly of cells by means ofstrips 24 of a hook and loop faster (e.g. VELCRO - Registered Trade Mark).
In the embodiment described,alternate cells 12 are connectedtogether by means of a first pressurisedair supply pipe 26 and a plurality ofT-shaped connectors 28. Similarly, the other group of alternate cells areconnected together by means of a second pressurisedair supply pipe 30 anda plurality of T-shaped connectors 32. Thepipes 26, 30 are fed withpressurised air from an electrically operated pump P (e.g. powered from themains electricity supply and/or by means of batteries) via an electrical heater H.
Thecells 12 are formed from flexible polyurethane sheetingwhich is radio-frequency welded into an elongate cell of generally rectangularcross-section. As best seen in Figs. 2 and 3, an internal dividingwall 34extends between the central regions of each of the upstandinglongitudinalside walls 36 of each cell, dividing the cell into an upper sub-cell and a lowersub-cell. This internal wall is provided primarily to assist in retaining therectangular cross-section of the cells when they are inflated, which in turnminimises bulging of the mattress in use. As shown in Fig. 2, the dividingwall 34 does not extend for the whole length of the cell and thus the upperand lower sub-cells communicate freely with each other.
As illustrated in Figs. 2 and 3, each of the upper and lower sub-cellsis partly filled with anelongate block 38, 40 of polyurethane foam. Inthis particular embodiment, the upper block offoam 38 is selected to besofter than the lower block offoam 40. As a typical example, the upper blockof foam may have a hardness of 110N and a density of 40kg/m3 and thelower block of foam may have a hardness of 150N and a density of 40kg/m3.The properties of the foams can be selected as required and may, forexample, be skinned foam, closed cell foam or any other type of foam. Thehardness and density of the foams may also be varied. Typically, theblocks38, 40 of foam are approximately the same width as the respective sub-cellin which it is located and the height of eachfoam block 38, 40 is typically about 75% of the height of the sub-cell in which it is located.
In use, theair supply pipes 26, 30 are connected to the pumpP supply (similar to that disclosed in EP 0528666A) which alternately appliesa higher pressure to one of the sets of connected cells and a lower pressureto the other set of connected cells. The supply of pressurised air is arrangedto change the set of cells to which the higher and lower air pressures areapplied on the basis of a predetermined programme.
As illustrated schematically in Fig. 2, the uppermost wall of eachinflatable cell is provided with a series of very small holes H formed bymeans of a laser. The use of a laser allows very accurately dimensionedholes to be formed and results in a mattress in which a small controlledamount of air A is deliberately allowed to leak from the surface in contact witha patient. The use of laser -drilled holes in the surface of inflatablemattresses is known and helps to remove moisture and assists in the healingof wounds.
In contrast to the prior art arrangements, when a cell is suppliedwith air at a lower pressure it is possible in some circumstances for thepatient to be at least partially supported by means of the foam within the cell.In practice, if a patient comes into contact with the foam filling then it is likelyto be in contact with thesofter foam 38 in the upper sub-cell of the cell as awhole.
One of the benefits of the present invention is that when the air supply changes the supply of air from a high pressure to a low pressure orvice versa, the change of pressure within a cell occurs much more rapidlythan with the prior art since a lower volume of air is involved as a result of thepresence of the resilient foam within the cells. This overcomes a problemsometimes encountered with the prior art devices in which the gradualchangeover in pressure can result in displacement of a patient along themattress.
In view of the smaller volume of air within the cells, it is alsopossible to use a pressure pump of a lower rating for supplying thepressurised air, which not only results in a significant cost reduction but alsopermits portable or self-contained supports to be constructed and operatedmore easily. In the past, portable units have suffered from the disadvantagethat they have been relatively bulky as a result of the relatively large pumprequired to inflate the cells and have always required a supply of mainselectricity to operate the pump.
Moreover, in view of the fact that the foam contributes to the supportof a patient, pumps of a lower pressure rating can be used.
Moreover, should the supply of pressurised air fail for any reason,resulting in eventual deflation of the cells, the patient on the mattress will stillbe supported by the softerupper foam block 38 and the harderlower foamblock 40. Support of the patient by means of the foam will minimise thelikelihood of the formation of, or the deterioration of, pressure sores until the supply of pressurised air can be restored. This is in contrast to the prior art,in which failure of the air supply and consequent deflation of the cells resultsin the patient being supported by the hard supporting surface on which themattress is placed, which can result in the formation or deterioration ofpressure sores.
An alternative cell filling is illustrated in Fig. 4. In thisembodiment, theinternal dividing wall 34 is omitted and in addition only asingle block of resilientlydeformable foam 42 is used within the cell. As forthe filling of Fig. 3 the height of thefoam block 42 is approximately 75% ofthe height of the cell. The cell is otherwise identical to that of Figs. 1 to 3.
In the variation shown in Fig. 5, the dividingwall 34 is againomitted but instead of having a block of foam the filling is formed fromparticulate material and comprises resiliently deformable expandedpolystyrene beads 44. As for the filling of Fig. 3, the upper level of the beadscorresponds approximately to 75% of the height of the cell. The cell isotherwise identical to that of Figs. 1 to 3.
In both the Fig. 4 and 5 embodiments, the operation andconstruction is otherwise identical to that of the first embodiment, in that apatient may be partially supported by the filling when the lower pressure isapplied to the cell but will provide resilient support to the patient in the eventof air supply failure.
In the variation shown in Fig. 6, the construction is identical to that shown in Fig. 3, except that one or both of the elongate side faces S, S' ofthe foam blocks 38, 40 is/are bonded by means of a layer of adhesive to theinner face of theadjacent side wall 36 of thecell 12 in which it is located.Optionally, the lowermost face F, F' of eachfoam block 38,40 is also bondedto the inner face of the adjacent base wall portion of thecell 12 in which it islocated.
Since thefoam 38, 40 is resiliently deformable and is attached to atleast theside walls 36 of the cell, when a cell is inflated thefoam 38, 40within the cell will stretch. When the applied pressure is removed, theresilience of the foam blocks will tend to pull the opposed side walls backtogether, thus helping to expel air from within the cell and thereby assistingin reducing the pressure within the cell more rapidly.
Similarly, in the variation shown in Fig. 7, the construction is identicalto that shown in Fig. 4, except that one or both of the elongate side faces S"of the foam block 42 (and, optionally the lowermost face F" of the foam block42) is/are bonded to the adjacent inner face of the walls of thecell 12 bymeans of a layer of adhesive. This variation has the same advantages asdescribed for the variation of Fig. 6 in helping to deflate the cell when theapplied pressure is removed, except that the deflating effect is even morepronounced since there is no dividing wall joining opposing side walls of thecell 12 (corresponding to thewall 34 of Figs. 3 and 6) and thus thefoamblock 42 tends to be stretched further when pressurised air is applied to the cell.
In the variation shown in Fig. 8, the dividingwall 34 is again omittedbut instead of containing a block of foam or expanded polystyrene beads thecell 12 contains a fibrous filling 60, typically of polyester fibres. Such a fillingis deformable but is not particularly resiliently deformable. Nevertheless, thefibrous filling is effective to provide support when the cell is deflated. Theconstruction and operation are otherwise identical to the embodiment of Figs.1 to 3.
In the variations shown in Figs. 9 and 10, the constructions areidentical to the constructions of Figs. 6 and 7 respectively, except that thefoam blocks 38, 40, 42 are laminated foam blocks, in that they comprise aplurality ofdifferent layers 38a, 38b, 40a, 40b, 42a, 42b, 42c bondedtogether. The different layers may be of any desired hardness or density inorder to produce a laminated block having the desired characteristic. Forexample, theblock 38 may comprise alower layer 38b of a greater hardnessand density than anupper layer 38a to which it is bonded.
In the variations of Figs. 9 and 10 the foam blocks 38, 40, 42 areshown as being bonded to the adjacent inner face of the cell wall by a layerof adhesive but the blocks may instead be bonded on only some faces or onno faces (corresponding to Figs. 3 and 4). The number of layers in thelaminated blocks may also be varied from the constructions shown, and thecharacteristics of each layer may be selected as desired.
It should be observed that the construction and filling of the cellsdescribed in Figs. 1 to 10 are examples only and other cells may be used.Moreover, a combination of cells with different cell fillings (for example, butnot exclusively, selected from those of Figs. 1 to 10) may be used to producea mattress with different support characteristics in different areas.
The embodiment shown in Fig. 11 is very similar to that shown in Figs.1 and 2 and can incorporate any or all of the variations thereof. The onlysignificant difference is that the dividing wall 34' of the embodiment of Figs.1 and 2 is extended such that it extends along the whole length of each ofthe inner elongate side walls of thecell 12 and additionally extends along thetwo end walls of the cell, whereby the dividingwall 34 in the construction ofFig. 11 divides thecell 12 into two sub-cells 12a, 12b which are inflatableindependently of each other. Each of the sub-cells 12a, 12b is connected toa respectiveair supply pipe 26, 30 by means of a T-connector 28.
Depending on the source of pressurised air, the upper and lower sub-cells12a, 12b may be arranged to be inflated and deflated simultaneouslybut at different pressures. Alternatively, the upper and lower sub-cells 12a,12b may be arranged to be inflated and/or deflated at different times andmay be arranged to be inflated at the same or different pressures.
The variation of Fig. 12 is shown as being a variation of theconstruction of Figs. 1 and 2 but it may equally well be a variation of theconstruction of Fig. 11. In the variation of Fig. 12, not all of the cells are arranged to be inflatable and deflatable. In Fig. 12, the end cell 12' is shownas being completely sealed, having no connections to an external source ofpressurised air and no holes H for the controlled escape of air. The end cell12' is shown as being sealed since this is one of the cells which will provideleast support to a patient. However, any cell or a plurality of cells may besealed. The sealed cell may (but need not) contain a solid filling. Theconstruction and operation of this embodiment are otherwise identical to thatof Figs. 1 to 3, with the possible modifications to the solid within the cells asdescribed previously.
The embodiment of Fig. 13 comprises a mattress having aplurality of elongate, parallel transversely extendingcells 60 as in theprevious embodiments. The cells are normally covered with a microporousvapourpermeable material 14 as in the first embodiment, but this has beenomitted from the drawings for clarity. However, the construction of thecells60 is different. The cells are formed from upper andlower sheets 70,72 offlexible polyurethane sheeting which are radio-frequency welded together ata plurality of parallel transversely-extendingwelds 74 to form a plurality oftransversely extending parallel elongateinflatable cells 60. Lateral,longitudinally extending edge seams 75 also define thecells 60. Eachcell60 is also provided with an elongatesolid core 76 of polyurethane foamextending along the whole length of the cell. The cells are connected to oneof two pressurisedair supply lines 26, 30 by means of a respective T-piece connector 28, 32, (not shown in Fig. 13) as in the embodiment of Figs. 1 and2. The operation of this embodiment is identical to that of Figs. 1 and 2.Only one corner of the mattress has been illustrated, but the whole mattresshas substantially the same length and width as in the embodiment of Figs.1 to 3.
The embodiment of Fig. 14 is similar to that of Fig. 13 having aplurality of elongate, parallel, transversely extending cells 80 comprisingupper and lower sub-cells 80a, 80b, similar to the embodiments of Figs. 1 to3 and 11. The cells are normally covered with a microporous vapourpermeable material 14 as in the first embodiment, but this has been omittedfrom the drawings for clarity. The cells are formed from anupper sheet 82,anintermediate sheet 84 and alower sheet 86 of flexible polyurethane whichare radio-frequency welded together at a plurality of parallel transversely-extendingwelds 86 to form the cells 80. Lateral, longitudinally extendingedge seams 88 also define the cells. The presence of theintermediate sheet84 forms the upper and lower sub-cells 80a, 80b divided by theintermediatesheet 84. Each of the upper and lower sub-cells 80a, 80b contains anelongatesolid core 90 of polyurethane foam. The sub-cells 80a, 80b areconnected to one of two pressurisedair supply lines 26, 30 by means of arespective T-piece connector 28, 32, (not shown in Fig. 14) as in theembodiment of Fig. 11. The operation of this embodiment is identical to thatof Fig. 11. As for Fig. 13, only one corner of the mattress has been illustrated, but the whole mattress has substantially the same length andwidth as in the embodiment of Figs. 1 to 3.
The embodiment of Fig. 15 is virtually identical to the earlierembodiments, with the exception that instead of being in the form of amattress the support is of such a size that it forms aseat cushion 46, in thisparticular embodiment comprising eight inflatable cells 12 (inflated by meansof a pump P via a heater H as in the first embodiment, but omitted from Fig.15) in the form of two groups of four interconnected cells each with itsrespectiveair supply pipe 48, 50. The cushion of Fig. 6 can be constructedin any of the manners described previously and can contain any of the fillingsthat could be used for the mattresses as described previously. The cushionis otherwise operated identically, and works identically, to the mattress asdescribed previously.
The embodiment of Fig. 16 is a cushion of identical construction tothat of Fig. 15 except that theair supply pipes 48, 50 and air pump P of thatembodiment are replaced with a hand-operated bellows pump 94. Thebellows pump 94 can be used to inflate the cushion manually when desiredand although it does not provide any alternating pressure it doesnevertheless provide additional support if the patient should contact the solidfilling within the cells.
A further variation is illustrated in Fig. 17. The embodiment ofFig. 17 is very similar to that of Fig. 6 except that instead of a singleinternal dividing wall 34 two parallel spaced apart dividingwalls 34a, 34b areprovided, dividing the cell into three sub-cells, each containing a respectiveblock of foam 38', 39', 40'. In the embodiment illustrated, the side walls andthe base wall of each of the foam blocks are glued to the inner face of thererspective adjacent wall of the cell, but this need not be the case. Also, thesolid fillings of the sub-cells may be varied, as for the previouis embodiments.Moreover, more than two dividing walls, e.g. three or four walls, may beused. The dividing walls may allow the sub-cells to communicate, as in theFig. 3 embodiment, or may isolate the sub-cells from each other, as in theFig.11 embodiment.
A further variation is illustrated in Figs. 18a and 18b. In thisembodiment, thecell 12 itself is identical to that of Fig. 7. The cell containsa block ofcompressible foam 43 whose upper and lower faces F are eachglued to the respective inner face of the upper and lower walls of thecell 12.The side walls of theblock 43 are not glued to the inner faces of the sidewalls of the cell. Thus, when the cell is not inflated (as shown in Fig. 18a) theside walls of the cell are slack and the foam is in its relaxed state since theheight of the foam block when relaxed is chosen to be smaller than themaximum height of the side walls of the cell.
When the cell is inflated as in the previous embodiments (asshown in Fig. 18b), the vertical expansion of the cell causes the previousslackness of the cell side walls to be taken up and causes the foam block to be placed under tension. Thus, when the applied pressure is removed, thestretchedfoam block 43 will resume its relaxed state, thereby assisting inexpulsion of air from the cell.
The invention is not restricted to the details of the foregoingembodiments. For example, other types of fillings could be used. Or,mixtures of different types of filling materials could be used. Indeed, thematerial within the cells need not be the same for each cell. It would bepossible for one type of filling to be arranged in a first area on the mattressor cushion (where, for example, more pressure is commonly applied) and forother fillings to be used in other areas to suit the intended region of supporton the body. It would also be possible for the solid fillings to be included inonly some of the cells, perhaps in those areas which are most important forpressure relief.