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Paper text:
pressure ulcers , also known as decubitus ulcers or bedsores , are defined as localized 
 tissue breakdown in the skin and adjacent tissue caused by prolonged high pressure and 
 mechanical forces over the bony prominences1,2,3,4 .
the most common sites of pressure ulcers 
 are over the sacrum , coccyx , heels , and hips .
other sites such as the elbows , knees , ankles , 
 or the back of the cranium can also be affected .
external pressure or mechanical forces may 
 reduce or interrupt blood flow to the skin and affect the transport of nutrients into the 
 cells , resulting in decreased tissue oxygenation and ischemia that may eventually lead to 
 tissue necrosis5,6,7 .
pressure ulcers are 
 hazardous , particularly for individuals with additional risk factors related to poor 
 health8 .
even small injuries may have 
 significant implications on the quality of life of disabled people .
these 
 cushions are made of viscoelastic materials such as foam , gels , air , or a combination of 
 these and in south korea , foam , gel , and air cushions are widely used .
the seating areas of 
 these inflatable cushions are not divided , and the inflated air pressure in the compartments 
 does not adjust automatically . the participation science laboratory , through collaboration 
 with small- and medium - sized enterprises ( smes ) , developed a prototype special support 
 system ( sss ) .
sss is a novel inflatable cushion with four separate support surfaces made to 
 left buttock , right buttock , left thigh , and right thigh , and the inflated air pressure in 
 each support surface can be adjust automatically .
before the sss can be utilized in a 
 clinical setting , its reliability must be demonstrated , and this was the purpose of this 
 study .
ethical approval for this study was obtained from the institutional review board on human 
 subjects research and ethics committees , soonchunhyang university , cheonan , korea .
this was 
 a pilot study testing the reliability of the special support system ( sss ) and it may 
 influence the future direction of research in the field of normal adult pressure mapping . 

exclusion criteria included any type of 
 sitting problem , hearing , vision , or cognitive impairments that would have interfered with 
 accurate assessments .
ages of the male and female subjects were 21.1  1.6  years and 20.1  0.3  years 
 respectively .
the procedure was fully explained to all of the participants , and written 
 consent was obtained prior to commencing measurements .
the participant characteristics are 
 shown in table 1table 1.general characteristics of the participantsage ( years)height ( cm)weight ( kg)male ( n=18)21.1  1.6171.7  5.064.9  5.6female ( n=14)20.1  0.3162.7  3.857.6  9.6 .
all the study procedures were performed at the participation science laboratory of 
 soonchunhyang university .
the sss has 30 air columns that are divided into four parts : right thigh , left thigh , right 
 buttock , left buttock .
one column in each of the four parts contains a thin tube to 
 introduce and remove air from that particular section .
each of the four part s inflated air 
 pressure can be controlled automatically or manually . in the automatic mode ,
air is 
 introduced and removed via the thin tube every 5 minutes over a 20 minute period , based on 
 the measured interface pressure distribution .
the air pressure in the automatic mode can 
 also be increased up to 15 kpa .
the standard air pressure for each part was set to the 50% 
 of maximum air pressure of each column . in the manual mode
, the inflatable air pressure can 
 be adjusted from level 1 to level 10 , with each level representing a 10% change in pressure . 

after inflation , the inflated air pressure of each part was digitally displayed on a lcd 
 each display . in this study ,
the sss was set to automatic mode , and the inflated air 
 pressure of each part was recorded consecutively 15 times for each subject .
the reliability 
 of the air pressure after inflation was evaluated based on the reading given by the lcd 
 display .
the conformat system was used for pressure mapping , and v.7.2  research software was used 
 for data acquisition ( both conformat and v7.2  are manufactured by tecksan inc .
while being seated on the sss , 
 participants were asked to keep their chins tucked in , spines straight , pelvis neutrally 
 positioned , and to place their hands on their thighs .
they were also asked to flex their 
 hips , knees , and ankles to approximately 90 degrees and to put their feet flat on the floor . 
 the seating position and each joint angle
after all 
 measurements were obtained , the pressure map was divided into four quadrants ( left hip , left 
 thigh , right hip , and right thigh ) on the screen .
mergl s method was adapted for quadrant 
 division and analysis of the pressure on the cushion . in this study , the total contact area , 
 mean total pressure as well as each quadrant s mean and peak pressures were measured 
 consecutively 15 times and then analyzed .
the icc was more than 0.89 for the inflated air pressure of the four areas , with the right 
 thigh area having the highest icc ( table 
 2table 2.test-retest reliability of the inflated air pressureitemmean95% ciicclt .
the iccs for total contact area , total pressure mean , each quadrant s mean , 
 and the peak pressure of each quadrant were statistically significant ( table 3table 3.test-retest reliability of the pressure redistribution values of each quadrant of 
 the special support systemitemmean95% ciicctotal contact area804.2  96.10.880.960.96total pressure mean45.3  5.80.950.990.97lt . buttock pressure mean50.8  26.80.960.990.98rt . buttock pressure mean54.1  10.90.910.980.95lt . thigh pressure
mean43.1  17.70.960.990.98rt . thigh pressure mean41.6  9.70.850.960.92lt . butt pressure peak91.6  32.60.920.980.95rt .
pressure ulcers are common in the elderly and the immobile , and result in increased 
 healthcare costs and reduced quality of life .
pressure - relieving support surfaces ( e.g. 
 beds , mattresses , seat cushions etc . ) are used to help prevent ulcers9 .
the useof suitable support surfaces has been found to be 
 beneficial in the prevention and management of pressure ulcers . carrying out a holistic 
 assessment of the patient and recording the patient s at - risk score helps clinicians 
 determine the most suitable pressure - relieving surface for a patient10 .
the purpose of this study was to test the reliability of the prototype sss that measures 
 and redistributes the interface sitting pressure .
the special support system was developed 
 to provide four , interactive , dynamic , support surfaces that measure interface pressure 
 while a subject is seated on it .
as with other measures of reliability , there are no 
 standard values defining acceptable reliability when using the icc .
icc values range between 
 0.00 and 1.00 , with values closer to 1.00 representing greater reliability11 . as a general guideline , an icc of 0.75 
 and above is indicative of good reliability , while an icc below 0.75 indicates poor to 
 moderate reliability . in the present study ,
the lowest icc obtained was 0.89 for inflated 
 air pressure , while iccs for sitting pressure were even higher .
this study demonstrated that the special support system is a reliable tool for measuring 
 sitting interface pressure redistribution and continuously maintaining an appropriate level 
 of inflated air pressure .
future studies need to be conducted to compare the clinical 
 interface pressure redistribution effects of sss against those of gel , hybrid , air , and foam 
 cushions .
[ purpose ] this study investigated the reliability of the special support system . 
 [ subjects and methods ] eighteen female and 14 male volunteers participated in this study . 
 
 participants were asked to sit on the special support system with their chins tucked in , 
 spines straight , pelvis neutrally positioned , and their hands placed on their thighs . they 
 were also asked to flex their hips , knees , and ankles to approximately 90 degrees and to 
 put their feet flat on the floor . 
 the total contact area , mean total pressure , as well as 
 mean and peak pressures of each quadrant were each measured 15 times . 
 test - retest 
 reliability was analyzed for inflated air pressure , and pressure redistribution values by 
 using intraclass correlation coefficients . 
 [ results ] the intraclass correlation 
 coefficient was greater than 0.89 for inflated air pressure and greater than 0.92 for 
 total contact area , mean total pressure , and each quadrant s mean and peak pressure . 
 
 [ conclusion ] the findings suggest that the special support system is reliable and can be 
 used as an alternative method for redistributing sitting pressure .