Study: Ultrasound a Viable Risk Assessment Tool for Deep Tissue Injuries

A new research study suggests clinicians could have a valuable new tool in the fight against the debilitating deep tissue injuries sustained by many wheelchair users.

In July, Medical Engineering & Physics published the study, called “Feasibility of Freehand Ultrasound to Measure Anatomical Features Associated with Deep Tissue Injury Risk.” The principle investigator was David Brienza, Ph.D., a professor in the University of Pittsburgh’s Department of Rehabilitation Science and Technology.

Also contributing to the study was Amit Gefen, Ph.D., of Tel Aviv University. Kara Kopplin, senior director of efficacy & research for ROHO Inc., was a co-author and industry collaborator. ROHO provided a grant to fund the study.

In an Oct. 5 news announcement, ROHO said the study “concluded ultrasound is a good, viable measurement method to assess anatomical structures and identify one of the key risk factors of deep tissue injury. The study authors believe ultrasound examinations hold the potential to develop a patient-specific, bedside biomechanical risk factor assessment tool to screen and classify risk level.”

Deep tissue injuries can be difficult to detect in earlier stages because they develop internally and therefore out of sight. Traditional skin check procedures, which emphasize looking for changes in skin color and texture, often aren’t successful at detecting deep tissue injuries.

Magnetic resonance imaging (MRI) technology — particularly machines capable of taking images while the patient is seated — has been a useful tool in detecting deep tissue injuries in the past.

“An image is taken to capture the shape and thickness of the soft tissues and the pelvic bone structure, and the distortion of the tissues can be seen and measured during sitting,” the ROHO announcement noted. “Additionally, biomechanical computer models can quantify the internal tissue stresses which contribute to deep tissue injury.”

While MRI technology works well in that setting, it’s too costly for typical seating clinics, and MRI machines are very large and therefore not portable.

Compare that to ultrasound technology, which is more readily available, less costly and more easily transported to a seating clinic or even bedside to a patient in need of an exam.

“The study shows that ultrasound can be used to easily see and measure a key patient-specific risk for deep tissue injury using ultrasound instead of seated MRIs, which are prevalent in the scientific literature,” the ROHO announcement said.

“No previous studies have assessed the ultrasound as a risk-assessment tool in comparison to the data from seated MRIs, which are currently the research standard.” In fact, “While the MRI images display the entire pelvic bone, the ultrasound shows only the portion of the bone that actually must be measured as one indication of deep tissue injury risk, describing the ‘sharpness’ of the bone surface,” ROHO said. “As a result, the ultrasound can ‘see’ more clearly the physiological status of the patient in this important region of the body, underneath the ischial tuberosities, or ‘sit bones.’”

Kopplin said about the study, “ROHO Inc. was pleased to partner with both the University of Pittsburgh and Tel Aviv University to conduct this study, which can provide an important bridge from academic research to a possible clinical risk assessment to ultimately help clinicians provide better, individualized solutions to wheelchair users and patients who chronically sit, thereby delivering better outcomes for value-based health care.”

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at

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