Völker e_InfoPros. Ges_MiS

Völker healthcare and hospital beds with MiS® and MiS® Activ.
A stimulation system for pressure sore reduction and therapeutic support.
As you make your bed, so you must lie on it.
Pressure sore prevention considerations.
People who need care, the chronically ill,
those who are immobile or older are susceptible to an inherent problem which, wherever
it occurs is also a problem for nursing professionals: Pressure sores.
2
Experts call pressure sores a national tragedy.
The risk of developing pressure sores in hospitals is estimated at 30 % and in nursing
homes at at least 50 %, the incidence rate
fluctuates between 4 % and 27 %. This is no
wonder if you consider that the critical time
span is only 2 hours. This is the maximum
period skin cells and tissue can withstand
pressure of more than 25 mmHg without
sustaining any damage. The healing process,
however, takes much, much longer: months,
years perhaps. And pressure sores mean
enormous expenditure, unnecessary costs,
unspeakable suffering by patients and, of
course, they also burden the nursing staff in
an emotional way.
According to experts, the prevalence of this
problem – despite the knowledge of experts,
the many nursing measures, positioning aids
of all kinds, and finally, high-tech mattress
systems – can be attributed to a lack of information, difficult handling and incorrect application. In addition, there is the core problem
of residents and patients insufficient mobility.
Only at Völker:
Healthcare and hospital beds with MiS®
and MiS® Activ.
Pressure sores cannot always be prevented
by so-called pressure relieving mattresses
that are lying on a rigid mattress frame. Real
benefits require a well engineered and complete system: The Völker MiS® Micro-stimulation-System.
In 2003 Völker introduced the Micro-stimulation-System as a new mattress support system. A nursing aid is now integrated directly
into Völker healthcare and hospital beds
which supports and completes basal stimulation in an appropriate fashion and thus contributes to pressure sore prevention. There
has been such a compelling positive response
that now 9 out of 10 beds are delivered with
Völker MiS®.
The Micro-stimulation-Systems’ principle is primarily based upon the theoretic foundations
of basal stimulation, the Bobath concept and
kinaesthetics. Micro-stimulation-Systems promote and maintain the patients’ own movements and their perception through feedback
between them and the system itself, which
characteristically consists of the butterfly
spring technology. This feedback supports
the perception of one’s own body and thus
stimulates a patient’s own movements. This,
in turn promotes physiological blood circulation in the skin, which prevents the development of pressure sores or provides the right
conditions for the healing of such wounds.
MiS® Activ was developed as an upgrade to
support pressure sore therapy among immobile residents/patients with pressure sores of
stages III and IV. The advantage is that the
individual parts of the lying surface can easily
be retrofitted. MiS® Activ raises and lowers
the areas of most risk through slight automatic movements of the suspension elements
and is thus more efficient and inexpensive
than conventional systems.
Contents
As you make your bed, so you must lie on it.
Pressure sore prevention considerations .............2
Only at Völker: healthcare and hospital beds with
Völker MiS® and MiS® Activ. .................................2
George T. Rodeheaver, President of the NPUAP,
on pressure sore. .................................................4
Professor Christel Bienstein, Head of the ‘Institut
für Pflegewissenschaft’ Uni Witten-Herdecke,
on pressure sore. .................................................4
How do pressure sores develop?..........................4
Where do pressure sores develop?.......................5
The experts’ standard preamble...........................6
The experts’ standard ‘bedsore prophylaxis
in nursing’ ...........................................................6
Professor Andreas Fröhlich drew up the
basal stimulation concept. ...................................8
Professor Christel Bienstein implements
basal stimulation in nursing.................................8
Gunnar Thomas develops Thevo® in conjunction
with Thomashilfen. ..............................................8
®
Heinrich Völker implements MiS in institutional
healthcare. ..........................................................9
MiS® Micro-stimulation-System.
Völker’s new mattress support surface.
By Stephanie Cieslak. .........................................10
Different interface curves.
A comparison of mattress/support systems........12
The pros and cons of alternating pressure.
The right pressure sore therapy.
By Natascha Woltemade .....................................13
Positioning the lying surface.
Infinitely adjustable to the individual. ................14
The right bed environment.
With the right mattress. ......................................14
Two-part assist rails.
Protection and an assist. ...................................15
Völker MiS® and MiS® Activ.
Why they are so important for nursing.
By Heiko Heine ...................................................16
Test passed!
The results of the long-term study ‘Thevo-Activ’.
By Professor Jürgen Osterbrink
and Gerhard Schröder.........................................19
Thevo-Activ and Völker MiS® Activ.
Same operating mode, different drives.
An interview with Heinrich Völker ......................22
How does Micro-Stimulation work?
Völker MiS® and Völker MiS® Activ.
By Günther Dorenbeck .......................................24
Völker MiS® and MiS® Activ.
No undesired side effects...................................26
3
George T. Rodeheaver
President of the
National Pressure
Ulcer Advisory Panel
(NPUAP), USA
4
In the US, the pressure sore (pressure ulcer)
prevalence is between 2 and 20 per cent in all
surveyed areas.
In the opinion of George T. Rodeheaver, President of the NPUAP (National Pressure Ulcer
Advisory Panel, USA) pressure sores are a
national tragedy. They make people suffer
and are a burden on the healthcare system,
while, on the other hand, being completely
avoidable.
A variety of so called state-of-the-art pressure
reducing products are available for both prevention and therapy. Nonetheless, the pressure sore rates in the US have not been reduced yet to any sufficient extent.
Rodeheaver sees the reason as the more or
less incorrect use of these therapeutic systems.
However, he also sees the original problem:
“There is insufficient movement by the resident/patient. Even high-tech beds do not
tackle this problem.”
Quotation:
Pflegen Ambulant, Issue 5, 2002, p. 11
Prof. Christel Bienstein
Head of the ‘Institut
für Pflegewissenschaften an der Universität
Witten/Herdecke’
(a healthcare science
faculty), chairwoman of ‘Stiftung Pflege’
(a healthcare foundation)
More quality, says Professor Christel Bienstein, can lead to drastic savings in the
healthcare system. A consistent implementation of expert standards alone could have
such an effect. One example is the cost for the
treatment of pressure sores. Patients are
incorrectly “laid” on the operating table or in
the healthcare or hospital bed, even though
there are pressure reduction products and
there is sufficient knowledge. The causes are
inadequate treatment and insufficient information for the doctors, the nursing staff and
the patients.
From a healthcare science point of view the
following deficiencies are responsible for this
state of affairs:
– The risk of developing pressure sores is
identified by (an) international standard
assessment scale(s) more or less unknown
in Germany.
– A patient who might develop pressure
sores has to be relieved in accordance
with an individual positioning plan. In
Germany this is not done to any sufficient
extent.
– After a positive risk diagnosis pressurereducing aids have to be made available
within 12 hours at max.
Quotation:
Pflegen Ambulant, Issue 5, 2002, p. 11
How do pressure sores develop?
The real reason is immobility.
Pressure sores arrive by stealth. The human
body’s weight exerts pressure on the lying
surface, which in turn exerts counter-pressure
on the affected area of the skin. A pressure
sore will develop if a person does not have
sufficient movement and the resulting continuous pressure thus reduces blood circulation
in the tissue for too long. A compression of
the venous capillaries is enough to bring
about reduced blood circulation and an eventual lack of oxygen. The body responds by a
warning pressure pain, which in mobile persons will trigger a change of position and thus
a relief of the compressed areas of skin. Small
movements are all that is needed. But if
someone is no longer able to perceive the
pressure pain (e.g. because of unconsciousness, anaesthesia or serious dementia) or to
move on their own in response to that pain,
the skin will remain compressed and waste
products will build up in the tissue, which will
then lead to acidosis. This, in turn, causes an
outflow of water from the capillaries into the
tissue. The edema created will increase the
longer the pressure is being exerted. Any continuing of reduced blood circulation causes
the skin cells to die and a pressure sore develops.
Where do pressure sores develop?
Risk areas while lying.
The highest risk factor is a vertical impact by
both the body’s pressure and the lying surface’s
counter-pressure on areas of the skin above
convex bone structures not really cushioned
by elastic muscles fibers or subcutaneous fat.
These are the classically predisposed spots
like the sacrum, heels, knees, the trochanter
major and the sides of the ankles. About 95
per cent of all pressure sores develop in such
areas.
Characteristic symptoms - over the various
stages - are a skin reddening of intact skin
which just cannot be pressed away. This mere
reddening might nonetheless indicate damage in depth and thus every reddening of the
skin has to be taken seriously. There is also a
Pressure sore stages.
To diagnose pressure sores correctly.
partial loss of skin; the epidermis and parts of
the corium are damaged; the pressure damage is superficial and may clinically manifest
itself as a blister, a graze or a flat ulcer. There
is a loss of all skin layers and damage to or a
necrosis of all subcutaneous tissue, which
may affect the underlying fascia. Clinically,
the pressure sore is a deep, open ulcer. In
addition and at a later stage: there is a loss of
all skin layers including extensive damage,
tissue necrosis or damage to muscles, bones
or supporting structures like sinews or joint
capsules (also see stages below).
At an international level, the development of
pressure ulcers (pressure sores) is broken
down into stages I–IV. They serve as internationally applicable aids to document the
ulcers and to assess them. A clear classification may be difficult if pressure sores are
covered by necroses or scab. It has to be
remembered that large pressure sores might
well be multistage.
Stage I
Stage II
5
Stage I is a skin reddening of intact skin which
cannot be pressed away.
Stage III
At stage II, there is a partial loss of skin; the
epidermis and parts of the corium are damaged;
the pressure damage is superficial and may
clinically manifest itself as a blister, a graze or a
flat ulcer.
Stage III includes the loss of all skin layers and
damage to or a necrosis of all subcutaneous
tissue, which may affect the underlying fascia.
Clinically, the pressure sore is a deep, open ulcer.
Stage IV means loss of all skin layers including
extensive damage, tissue necrosis or damage to
muscles, bones or supporting structures like
sinews or joint capsules.
Stage IV
Experts’ standard ‘pressure sore prophylaxis’
and the ongoing pressure sore problem.
6
The pressure sore issue has been one of the
most important ones in nursing journals,
nursing training, advanced vocational training, meetings and conferences for several
years now. As a rule, these articles focus on
pressure sore therapy and/or wound management of such a chronic wound. Pressure
sore prophylaxis as the preventive measure
against the development of pressure sores is
not often enough emphasized in international
nursing publications.
National and international healthcare research has also dealt with this problem for
quite some time. Its findings have led to the
first national experts’ standard for pressure
sore prophylaxis. This represents traditional
measures like a risk assessment on the basis
of standardised scales and appropriate skin
care but also includes some new concepts for
skilled nursing. Shear force-reducing positioning and transfer techniques which are not
damaging to the tissue, encouraging patients’
self-repositioning and instructions and training for the nursing staff are the main items in
these concepts for the medical care this
group of patients is given.
But it is the prevention of this painful condition, so very expensive to those bearing the
cost, which should be paid much more attention to in times of tighter budgets. The prevention of pressure ulcers has to be the objective of all efforts in nursing. After all, according to experts almost all pressure ulcers could
indeed be prevented.
Preamble
to the experts’ standard.
Nursing experts in out-patient and long-term
care facilities, in home care, those bearing the
cost and healthcare science institutes and
manufacturers of nursing aids and dressing
material do indeed try to tackle the pressure
sore problem and provide solutions. The strategies available have to be innovative and
sound in terms of healthcare science.
It is Thomashilfen and Völker’s objective to
meet these high standards and to improve
such patients’ medical care. With innovative
ideas, intensive research and interdisciplinary
development, these two companies are the
ones to contact when it comes to anti-pressure sore systems.
The experts’ standards make for changed
requirements for anti-pressure sore systems.
Pressure reduction and shearing-force minimization are still not to be done without,
while at the same time are not entirely sufficient. Effective anti-pressure sore systems
have to be able to maintain and promote a
patient’s own movements. And they should
have a positive impact on the “conception of
one’s own body” and its perception in order to
avoid any negative influence on nursing measures and the patient’s condition.
“Since people in danger of developing pressure ulcers are found in all facilities within the
healthcare system, the (present) experts’
standard addresses geriatric nurses, nurses
and paediatric nurses. (...) The experts’ standard is based upon a comprehensive analysis
of the available national and international
literature – primarily a research of randomized controlled studies – and the practice
expertise of the members of the expert working group.
The precept and result criterion define the
prevention of pressure sores as the central
objective, since such a development can, as a
rule, be counteracted. Nonetheless, this
objective cannot be attained for all groups of
people. There are limitations for those people
whose medical condition does not allow a
consistent application of preventative measures (e.g. in life-threatening situations),
requires other priorities (e.g. people in their
terminal stage) or precludes the preventative
measures’ efficacy (e.g. serious blood circulation dysfunctions, perhaps when centralizing
drugs have been administered).
The (present) standard’s design in terms of
contents and forms (a short and definite precept, measurable structure, process and
result criteria) is based upon the tried-andtested international structure also used in the
European network. The selected priorities
focus on central aspects in order to avoid the
standard being fraught with general statements (...).
The general objective is an individual care,
which also takes into account the patient’s/
relatives’ needs, if need be.
The foundations for such an approach in nursing are, above all,
– a theory-based application of the nursing
process method including an evaluation
of the nursing success;
– an orientation along the patient’s/the
affected person’s physical, social, emotional and spiritual needs;
– a meaningful documentation of the nursing process as an important data base
for quality measurement;
– cooperation with other healthcare professions.
The experts’ standard for pressure sore prophylaxis presented in the following is the final
version, drawn up by the expert working
group in coordination with the DNQP’s steering committee after the consensus conference. (...)”
The experts’ standard
‘pressure sore prophylaxis in nursing’.
Precept:
Every patient in danger
of developing a pressure
sore receives a prophylactic treatment which
will prevent the development of a pressure sore.
Reasons:
A pressure sore is one of
the serious health risks
run by patients/affected
people in need of care or
outside assistance. In
view of the available
knowledge on the extensive possibilities to prevent pressure sores, the
objective is a reduction
to the minimum. It is of
primary importance that
qualified nursing staff
ensures a systematic risk
assessment, training of
patients and affected
people, mobility promotion, pressure reduction
and a continual use of
prophylactic measures.
Structure
Process
The qualified nurse …
The qualified nurse …
S1 … has up-to-date knowledge of the development of
pressure sores and a risk assessment competence.
P1 … assesses the pressure sores risk of all patients/
affected people for which a risk cannot be excluded
right at the beginning of the nursing process and then
at intervals to be individually determined and also
forthwith should there be any changes in mobility,
activity and pressure and on the basis of a standardized assessment scale, e.g. by Braden, Waterlow or
Norton, among other things.
R1 There is an up-to-date and systematic assessment of
the pressure sores risk.
S2 … has a command of mobility, positioning and transfer techniques kind to the skin and tissue.
P2 … on the basis of an individual mobility plan
ensures immediate pressure relief through regular
micro-movement. A low friction and shearing-force
transfer promotes the patient’s self-mobility as far
as possible.
R2 There is an individual mobility plan.
S3a … has the competence to select appropriate pressurereducing products.
P3 … uses the appropriate pressure-reducing products if
the patient’s/the affected person’s condition does not
allow a sufficient mobility promotion and/or pressure
relief.
R3 The patient is put on a pressure-reducing surface
adapted to his requirements forthwith, pressurereducing products are used forthwith.
S4 … knows further appropriate intervention methods for
pressure sores prophylaxis deriving from the risk
assessment besides mobility and promotion and
pressure reduction.
P4 … on the basis of the risk assessment initiates further
intervention methods for all identifiable risk factors,
which may, for example, affect the maintenance and
promotion of tissue tolerance.
R4 The implemented risk factor interventions are
documented.
S5 … has the skill, information and training material to
instruct and advise the patients/affected people and
their relatives on the promotion of self-mobility.
P5 … explains the pressure sores risk and the necessity
of prophylactic measures and plans such with the
patient/the affected person and his relatives.
R5 The patient/the affected person and his relatives now
the reasons for the pressure sores risk and the planned measures and cooperate on their implementation
within the bounds of their possibilities.
S6 … is employed in a facility which ensures that all staff
participating in the nursing of patients/affected people know of the link between continual intervention
and a successful prophylaxis. Information on the
pressure sores risk is transferred to external parties
at all times.
P6 … informs those involved in the care of patients/affected persons in danger of developing pressure sores
about the necessity of the continuation of the interventions (e.g. staff in doctor’s practices, operating
theatre and X-ray departments or transport services).
R6 All those involved in the patient’s/the affected
person’s care know about the pressure sores risk and
the necessary measures.
S7 … has the competence to evaluate the efficacy of the
prophylactic measures.
P7 … assesses the patient’s/the affected person’s skin
condition at regular, individually determined intervals.
R7 The patient/the affected person does not suffer from
pressure sores.
S3b … has access to pressure-reducing products (e.g. soft
cushions and mattresses), special beds (e.g. aircushion beds) within 12 hours.
Result
7
All people whose perception, mobility and
communication are impaired need physical
contact and stimulation in order to perceive
other people.
They need the nurse, someone who will bring
their environment a bit closer to them, who
enables them to move and change their position, who will take care of them in a reliable
fashion.
In order to support both – the nurse and the
patient – and to prevent such results of immobility as pressure sores Micro-stimulation
Systems have been developed. Many of them
– like alternating pressure systems – have
been listed in the nursing aids register and
because of their special operating modes
they all can be used very specifically.
8
It is a long way to the realization of such a
system with all its advantages. And it needs
many an expert’s work in the development in
order to translate an idea into a vision and
see it come true.
Prof. Andreas Fröhlich
drew up the basal
stimulation concept.
Originally, basal stimulation was a concept
developed by Professor Andreas Fröhlich in
1975 for the personality promotion and development of physically and mentally handicapped children.
The term ‘basal’ means “that we want to use
the most simple and elementary possibilities
to reach out to people, to get in touch with
them. It also means that we revert to the
basis, i.e. the foundation of all human
action.” Stimulation means: “A severely handicapped person is offered something positive,
something that encourages him to get in
touch with other people and his environment.”
Within the framework of the concept of basal
stimulation, which is also based upon developmental physiology and psychology, Fröhlich offered the children perception experiences for which they didn’t need to fulfil any
requirements and which go back to very early,
mostly prenatal experiences:
Feeling one’s own body, experiencing to be in
motion, spatial position changes or discovering one’s inside through vibrations (somatic,
vestibular, vibratory experiences); listening
closely, watching closely, oral and olfactory
experiences, grasping one’s environment
(acoustic, visual, oral and olfactory plus tactile experiences).
Andreas Fröhlich and his staff have successfully discovered that children responded within the bounds of their possibilities and have
thus been able to develop a form of elementary communication which accompanies the
children during their experiences and promotes their skills.
Prof. Christel Bienstein
implements basal
stimulation in nursing.
Professor Christel Bienstein and Andreas
Fröhlich have jointly transferred the aforementioned basic ideas of their concept to the
nursing of adults and discovered that basal
stimulation can just as well be applied to
seriously ill adults.
They found, for example, that non-responsive
and comatose patients feel the same basic
need for perception, movement and communication, while only having impaired faculties
of experiencing them and running a risk of further damages if not stimulated in a targeted
fashion.
Basal stimulation in nursing tries to provide
such people with the known, elementary
experiences of perception in order to accompany them during such experiences and to
promote their capabilities. The target group
are all people with impaired capabilities of
perception, movement and communication
like unconscious, artificially respired, disorientated, somnolent, skull-brain traumatised
people; dying people; patients with hypoxic
brain damage, Morbus Alzheimer, hemiplegic,
non-responsive or comatose syndrome; patients with a very limited mobility; the disabled and premature babies as well.
All these people have in common that they
need to be physically close to people in order
to perceive them.
Gunnar Thomas
develops Thevo®
in conjunction with
Thomashilfen.
At the end of the 1990s, Thomashilfen used
the concepts developed by Fröhlich and Bienstein for a new technological system, a Microstimulation System, and called it Thevo.
The Micro-stimulation Systems’ principle is
primarily based upon the theoretic foundations of basal stimulation, the Bobath concept and kinaesthetics. Micro-stimulation
Systems promote and maintain the patients’
own movements and their perception through
feedback between them and the system itself.
If a human being has only a limited capability
to move or perceive, they are no longer able
to adequately respond to environmental stimuli. This lack of an individual’s own movement
is the reason for the development of pressure
ulcers. A targeted therapeutic stimulation will
promote the individual’s perception and they
are then able to move by themselves, e.g. by
shifting their weight.
Here, Thevo-Activ supports the therapeutically important somatic (physical) and vestibular
stimulation. Micro-Stimulation’s various
modes of movement promote the physiological blood circulation in the affected areas or
areas of risk. This microcirculation thus ensured supports the healing of the wound(s).
Heinrich Völker
implements MiS® in
institutional healthcare.
Völker is a licensee of Thevo. While retaining
the operating mode of Thevo, Völker, in a first
step, developed the technical prerequisites
for the use of a Micro-stimulation System in
institutional healthcare. The result is Völker
MiS®.
Since 2003, Völker healthcare and hospital
beds have been equipped with this mattress
support system, first optionally then as a
standard feature, which in the mean time has
been ordered by virtually all of Völker’s customers.
After the positive findings in a long-term
study of the active system Thevo-Activ, Heinrich Völker decided to develop a “state of the
art” active Micro-stimulations-System for
institutional healthcare too.
After one-and-a half-years, this work has now
been concluded. This time was necessary to
convert Thevo-Activ’s product to ensure an
easy integration and a long service life when
continuously operated according to pertinent
standards and guidelines and an inexpensive
large-scale production.
All experts have meanwhile recognized that
while the high incidence of pressure ulcers
has to be attributed to a lack of mobility
among patients, this mobility cannot really be
achieved, not only for a lack of knowledge but
primarily for a lack of available pressure soreprophylactic and therapeutic means. Since
costs play an important role here, this can
now be changed by using Völker MiS® for
pressure sore prophylaxis and by simply
exchanging it for Völker MiS® Activ for pressure sore therapy.
9
MiS® Micro-Stimulations-System.
Völker’s new mattress support system.
Stephanie Cieslak,
Head of Total Quality Management, Völker AG
10
A visually striking element of the Völker MiS®
Micro-stimulation System
are the butterfly springs,
which because of their
design have an ideal
torsional behavior.
The Micro-stimulation Systems’ principle is
primarily based upon the theoretic foundations of basal stimulation, the Bobath concept and kinaesthetics. Micro-stimulation
Systems promote and maintain the patients’
own movements and their perception through
feedback between them and the system itself,
which characteristically consists of the butterfly spring technology. This feedback supports
the perception of one’s own body and thus
stimulates a person’s own movements. This, in
turn, guarantees physiological blood circulation in the skin, which prevents the development of pressure ulcers or provides the right
conditions for the healing of such wounds. At
the same time, the Völker MiS® Micro-stimulation System also meets mobility, promotion of
perception and pain reduction requirements.
MiS® has thus become firmly established as a
nursing aid which supports and completes
basal stimulation in an appropriate manner.
As with all micro-stimulation systems, the
basic idea was that movement is only likely to
occur when there is prior sensory perception.
These stimuli are processed by the central
nervous system (CNS) and turned into movement in response to the stimuli. This physical
activity makes for permanent pressure alterations also among those regions of the body in
danger of developing pressure sores or affected by them. It is exactly these basic ideas
which were realised in the development of the
lying system Völker MiS®.
Völker MiS® Micro-stimulation System consists of three suspension elements which in
combination with an individual positioning of
the lying surface and the right mattress for
the lying surface make for an effective pressure sore-prophylactic springing curve that
continues dynamically.
1. The first element is the butterfly springs
which form the lying surface’s contact point.
The many evenly spaced butterfly springs create a pleasant and comfortable feeling. They
are made of recyclable plastic which is flexible
and will not break. Their flexibility and torsional qualities in combination with their ability to
return to neutral make them highly accommodating, independent of the shape of the body,
the patient’s lying position or posture.
The butterfly springs are removable and are
installed on the second element of the MiS®System.
2. The flexible support profiles.
These are made of glass-fiber reinforced plastic (GRP) and have a much better torsional
behavior than conventional cross members.
Their high stability and flexural strength can
be attributed to both their material and their
construction. Their optimized geometry and
the balanced combination of materials provide an excellent load-bearing capacity with
an evenly regulated flexibility and support.
The support profiles are held in place by the
third element.
3. The flexible suspension units.
One pair of suspension units bearing only one
support profile guarantees an optimal torsional angle. The suspension units are also
the link between the support profiles and the
aluminium sections of the frame. Inside they
also have a TPE module which, first, fixes the
suspension units on the aluminium section
and, second, gently cushion any high-load
sinking.
Völker MiS® is a lying support system supporting
various elements of the patient’s own movements:
1) Butterfly springs
2) Support profile
3) Suspension units
4) Lying surface’s frame
4
The upper side of the lying surface is dominated
by butterfly springs. A number of support points
distributes pressure evenly, the individual is automatically positioned correctly and their sleeping
behaviour is positively influenced as well.
3
2
1
11
Different interface curves.
A comparison of common laying systems.
Flexible elements on rigid surfaces’
operating mode doesn’t correspond with Micro-Stimulation’s. The necessary kinetic energy is “swallowed”
by the inflexible surface.
Lying surfaces with rigid elements
do not convey any movement stimuli. There is permanent pressure, which may well lead to damages in
areas of risk in particular.
Alternating pressure systems
reduce pressure and shearing forces but do not provide any incentives to move. Owing to their nonphysiological lying position with lifting movements and temporary pressure cones they lead to negative
changes and emotional concerns, increase pain and impede the quality of the patients’ sleep through
noises and vibrations.
Anti-pressure sore mattresses
on rigid lying surfaces do also not convey any movement stimuli. The load is slightly reduced and more
or less spread out.
Micro-stimulation Systems
through the interplay of their individual elements – see figure 11 – produce an interface curve that
dynamically continues into movement stimuli processed by the patient’s CNS and then translated into
movement in response to such stimuli.
Mattresses made of visco-elastic, thermo-active material
reproduce the shape of the body. There are no pressure cones, the need to change the position is
reduced, there are no incentives to move.
Active Micro-stimulation
in the areas of risk also works via so-called activators and thus makes for a consistent and effective
nursing concept to support pressure sore prophylaxis and therapy by completing standard Micro-Stimulation most preferably among immobile patients.
12
The pros and cons of alternating pressure.
The right pressure sore therapy.
Natascha Woltemade
Graduate in healthcare science, Head of IGAP.
Pressure sore prophylaxis and therapy is one
issue the ‘Institut für Innovationen im Gesundheitswesen und angewandte Pflegeforschung’ (institute for healthcare innovations
and applied healthcare research) in Bremervörde focuses on.
In daily practice it is often hard to find an
effective anti-pressure sore system which also meets the patient’s requirements. Remember: There is no operating mode which would
lead to the best possible therapeutic results
for all patients. Alternating pressure systems
have long since been established in anti-pressure sore nursing. However, on the basis of
more recent findings and observations in nursing and medicine their uniform use should
now be questioned. Inspired by the process of
professionalisation in German nursing, nursing concepts developed, incl. ‘Aktivitas’,
kinaesthetics or old and scientifically proven
concepts like basal stimulation, which were
then applied to nursing. The resulting skills
made for a holistic view and care of patients.
Pressure sores are now also being viewed differently. While a few years ago, pressure
ulcers were deemed the mere consequence of
pressure and shearing forces, we know now
that psychosocial factors also have an impact.
As a result, earlier anti-pressure sore product
developments focused on a reduction of pressure and shearing forces to the exclusion of
other factors. Today we know that the selection of positioning systems also has to take
account of the underlying illness. This is especially so among patients with an impaired perception, e.g. stroke or Alzheimer patients,
that alternating pressure systems may have
serious negative side effects.
The following changes in patients lying on
alternating pressure systems have been
observed: degenerative habituation because
of repetitive, uniform stimuli; a body conception and perception dysfunction; coordination
disorders; a potential misinterpretation of
environmental stimuli, spatial and temporal
disorientation; communication disorders;
behavioural disorders; emotional disorders;
pain symptoms aggravated by lifting movements and temporary pressure cones; low
quality of sleep due to noises, vibrations and
a physiologically detrimental lying position;
negative changes in the skin and bed environment; restricted mobility, resulting in contractions; spasm of the muscles possible; negative impact on the patient’s well-being
through the system’s deficient adjustability.
In the past, air lying systems - here on a 1998 Völker hospital bed – were deemed the very best in bedsore
therapy. New findings have changed this perception.
Nursing staff may also find it difficult to use
alternating pressure systems:
– positioning and moving the patient is
made difficult;
– there are problems in the transfer of patients;
– many systems are liable to malfunction;
– they can’t be repaired (by the nursing
staff ); the result may be a total system
breakdown.
It is therefore clear that a suitable anti-pressure sore system has to be selected by responsible nursing staff and doctors on the
basis of the patient’s individual needs.
Natascha Woltemade, IGAP
13
Positioning of the lying surface.
Infinitely adjustable to the individual.
Positioning a resident/patient in bed is always done in accordance with a certain nursing standard adapted to the prophylactic or
therapeutic indication and/or an individual
nursing plan.
Positioning serves a therapy’s objectives (e.g.
respiratory support, after orthopaedic operations etc.), a patient’s well-being and prevention (e.g. of pressure sores, to restore mobility etc.).
Since a pressure sore develops when a person lies on one spot for a long period of time,
when using conventional beds turning the
patient is an effective form of prevention. The
patient is turned by nurses when they are no
longer able to do it themselves.
14
Völker beds support pressure sore prophylaxis with MiS®/MiS® Activ so effectively that a
risk can almost entirely be excluded. Another
aid in preventing pressure sores is the individual themselves – since the
bed is infinitely adjustable
and the occupant can move
to varying positions by
means of a hand control unit.
Bed positioning is done with
two to three separate motors
operating at a safe load of up
to 210 kg (463 lbs).
All Völker beds’ back sections
can be inclined up to 70°, the
thigh sections up to 45° with
an angle control between
back and thigh maintaining
less than 90° to prevent midsection compression. The
manual adjustment of the
lower leg can be achieved in
combination with the electric
The right bed environment.
With the right Völker mattress.
raising of the upper leg. The lower leg in a
stretched position can be individually elevated to 16°. The lying surface is divided into 4
sections – back (90 cm/35.4 in.), seat, thigh,
lower leg - that are ergonomically developed
according to the recommendation of DBfK.
Shearing and friction forces, found at the pelvis in particular, are compensated by an integrated mattress compensation (12 cm/4.7 in.)
with an additional head section ramp (5°, see
figure below). This helps to prevent the occupant from slipping down. At the same time, it
also prevents compression that would otherwise develop at the body’s mid-section (by
creating a kinaesthetic space).
The bed environment also has to be taken
account of when discussing preventative
measures.
Studies conducted by IGAP have led to the following findings:
– Patients often lie in beds soaked in sweat.
Such moisture is not only very unpleasant; it may also foster colds and tension.
Above all, however, it lets the epidermis
swell up and may therefore also lead to
pressure sores.
– Often unnecessary incontinence articles
like rubber sheets etc. are used in beds.
This makes for stored heat and moisture.
– Such incontinence articles may be inexpensive and of low quality. They don’t
always keep the skin dry enough.
– Non-breathable nightclothes and linen
often leads to an increased perspiration.
Natural fibres, however, make for a good
bed environment and therefore are good
for the skin.
- The quality of the mattress has a huge
influence on the bed environment. Good
mattresses have to absorb moisture. The
degree of their air permeability is determined by ventilation ducts.
Two-part assist rails.
Protection and an assist.
Völker’s mattress program meets all the requirements of patients and nursing staff and
form the desired comfort to effectively reduced pressure. The quality of the materials
is very important. All foams are hygienic,
clean, dimensionally stable and durable.
Their open-cell structure makes for a continued elasticity and good ventilation.
As a very suitable mattress for its Microstimulation System Völker recommends its
Rubex® Finess, which offers utmost laying
comfort. The core structure with a firm-elastic
central zone and a soft-elastic lying surface
make for an ideal sinking/supporting behaveiour, the long-term effect of which is reinforced by the dimensionally stable and durable Rubex® special foam.
Its extreme open-cellular structure guarantees an exemplary breathability and an
almost unhindered exchange of moisture,
which is even more enhanced by the diagonal
3-layer wave structure.
Assist rails are an important feature of healthcare or hospital beds and fulfill a number of
tasks. They must provide an assist to the
occupant in getting into and out of the bed,
while at the same time they must provide protection from rolling out of bed by indicating
the outer edge of the bed. Völker assist rails
achieve both of these goals and therefore
provide security to the individual using the
bed.
In order for the assist rails to achieve both of
the above objectives, they must meet certain
requirements. They must be extremely strong
and must be designed so they will not cause
injuries. They should be flexible in design, so
they can be used incrementally as needed. In
short they should be a complete solution to
all requirements no matter how demanding,
while at the same time they should disappear
when not in use.
Völker, as the innovator of integrated assist
rails, has been a leader in assist rail design.
Integrated assist rails actually disappear into
the side of the bed. This allows them to be
out of the way of nursing personnel when not
in use. In addition they never extend below
the side of the bed when in use. Nursing staff
can therefore find secure footing while
attending to the resident/patient without fear
of injury to the lower leg. Another advantage
is that devices that may pass under the bed
will not be obstructed. And finally, integrated
assist rails simply look better, providing a
more homelike design and greater dignity for
the occupant.
In addition to the practicality of Völker’s assist
rails, they are also strong enough to protect
against side pressure and pressures exerted
while using them as a support for getting into
and out of the bed. They are patented and
have been designed to meet or exceed the
dimensional requirements and recommendations of the harmonized standards as well as
the guidelines of the Hospital Bed Safety
Workgroup.
Functionally, Völker’s two-part assist rails are
a complete solution. They can be used incrementally to achieve almost any solution. The
head section can be raised to a low height as
a bed edge indicator and low assist. It can
then be raised higher for more protection and
a high assist. Used in conjunction with the
foot section assist rail in low or high position,
the occupant can easily exit or enter the bed
with a secure assist on both sides. For special
requirements, a spacer can be inserted between the assist rails to create a full length
side rail. Very important is the fact that all sections will work together while raising and
lowering the head and foot sections of the
bed and can be fully padded as required. As
an important alternate solution, the assist
rails can be left completely under the lying
surface so that no one even knows they are
there. This meets the needs of facilities looking for a non-restraint solution, while reserveing the option to have some assist rail capability in case of a special requirement.
15
Völker MiS® and MiS® Activ.
Why they are so important for nursing.
Heiko Heine
Editor-in-chief of the customer magazine
Völker Wörld, in whose 20/2005 issue this report
was also published.
16
The experts’ standard ‘pressure sore prophylaxis in nursing’ (see also pages 6, 7) was
published by the DNQP in August 2000. One
would expect a lot to have happened since
then. After all, a huge range of anti-pressure
sore mattresses and various prophylactic
systems are available. And any lying surface
of hospital or healthcare beds featuring a
small and flexible part is advertised as an
effective preventive measure. This statement
on pressure sore prophylaxis by a major
manufacturer’s expert at an exhibition stand
is thus no real surprise: “We refer our customers asking about this problem to our antipressure sore mattresses. After all, you don’t
feel plastic suspension elements anyway!”
And, let’s face it, he is not totally wrong. In
fact, the risk of irritation developments in
nursing is certainly on the increase. And the
incidence of pressure sores has not gone
down. It is all still about nipping it in the bud.
Thus, the precept of the experts’ standard
reads: “Every patient in danger of developing
a bedsore receives a prophylactic treatment
which will prevent the development of a pressure sore”. Nursing staff are able to do that
because they are up-to-date on the development of pressure sores and able to assess the
risk (see experts’ standard S1).
And according to the experts’ standard, nursing staff have also mastered mobility, positioning and transfer techniques gentle to the
skin and tissue (see experts’ standard S2)
and have the competence to select suitable
pressure-reducing aids available within 12
hours, e.g. air cushion beds (see experts’
standard S3 a, b). And here is the rub. In reality, it is not all about knowledge and competence but about the availability of such means
and considerable expenditure, too.
“The measures required by the experts’
standard often fail for a lack of suitable
solutions.”
Prophylactic treatment has to be provided in
accordance with an individual exercise plan.
This includes immediate pressure relief
through regular mobility of the patient, e.g.
30° incline, micro movement, low-friction and
gravity transfer and, as far as possible, the
resident/patient’s independent mobility. If
the individual’s condition does not allow sufficient mobility or pressure relief, suitable
pressure-reducing aids have to be used. The
result according to the experts’ standard:
“The patient is put on a pressure-reducing
surface adapted to his requirements
forthwith, pressure-reducing aids are used
forthwith.”
“A 100 percent prevention of pressure sores
would require appropriate aids for 450,000
healthcare beds.”
“People in danger of developing bedsores
need an immediate prophylactic treatment,
mobilisation above all, once the danger has
been recognised.”
Insiders estimate the risk of developing pressure sores in hospitals at 30 per cent, in geriatric nursing homes at 50 per cent or more.
There are about 500.000 beds in hospitals,
and about 600.000 in nursing homes. In plain
language, this means the initiation of appropriate measures and an availability of appropriate aids for 150.000 plus 300,000 beds, if
100 percent of pressure sores are supposed
to be prevented. And with regard to hospitals
we only speak of their number of beds, not of
the annual number of about 4.5 m patients,
out of the total of 15 m, in danger of develop-
ing pressure sores. People responsible for
pressure sores management point out that
rendering medical care and funding medical
care are two sides of the same coin. While
experience teaches us that money does not
equal quality, we can also see that there is no
such thing as a “free quality lunch” (Heike
Lubatsch, Dekubitusmanagement, Schlütersche, Hannover 2004).
“Pressure sore therapy costs about
Euro 3.2 bn p.a.”
And the costs are huge. But the exact figures
are as hard to come by as exact data on the
pressure sores risk and incidence and reliable
estimates. ‘Stiftung Pflege’ (a healthcare
foundation) estimates the costs for the German healthcare system to come in at at least
Euro 3.2 bn. Pressure sore management in
hospitals is thus often a continuous struggle
with the financial department. These examples indicate insufficient medical care:
demands for lower rents for pressure sore
mattresses, orders being placed without any
consideration of nursing criteria, the procurement of 20 foam pads and 25 foam mattresses for pressure sore prophylaxis and 10 for
pressure sore therapy, an additional 200 positioning cushions, and all this for a 550-bed
facility.
“Pressure sores develop unexpectedly. They
are already there when you see them.”
Pressure sores arrive by stealth. The human
body’s weight exerts pressure on the lying
surface, which in turn exerts counter-pressure
on the affected area of the skin. A pressure
sore will develop if a person does not have
sufficient movement and the resulting continuous pressure thus reduces blood circulation
in the tissue for too long. A compression of
the venous capillaries is enough to bring
about reduced blood circulation and an eventual lack of oxygen. The body responds by a
warning pressure pain, which in mobile persons will trigger a change of position and thus
a relief of the compressed areas of skin. Small
movements are all that is needed. But if
someone is no longer able to perceive the
pressure pain (e.g. because of unconsciousness, anaesthesia or serious dementia) or to
move on their own in response to that pain,
the skin will remain compressed and waste
products will build up in the tissue, which will
then lead to acidosis. This, in turn, causes an
outflow of water from the capillaries into the
tissue. The edema created will increase the
longer the pressure is being exerted. Any continuing of reduced blood circulation causes
the skin cells to die and a pressure sore develops.
“Why there is such a pressure sore incidence.”
“Pressure sores are an avoidable ailment
because there is sufficient support and knowledge available. The causes are a lack of treatment or an inadequate treatment and insufficient information for the patients,” says Professor Christel Bienstein.
The NPUAP (National Pressure Ulcer Advisory
Panel) even calls pressure sores a “national
tragedy” because they make the affected patients suffer while at the same time being
avoidable.
And all this despite the fact that both in Ger-
many and the USA various prophylactic and
therapeutic means, some even state-of-theart, are available. According to experts, the
fact that the incidence of pressure sores is not
reduced despite the broad range of therapeutic systems available is due to their complicated, but also their frequently incorrect handling. On the other hand, the original problem,
“insufficient movement of the patient”, is not,
or only to a small extent, addressed even
when it comes to high-tech beds.
“Nip it in the bud.
With the Völker Micro-stimulation System.”
Inspired by the process of professionalism in
German nursing, some nursing concepts
developed which allowed a holistic view and
care of patients. Basal stimulation developed
by Professor Andreas Fröhlich in 1975 was
one of them. During the 1980s, this principle
was applied to nursing by Professor Christel
Bienstein. At the end of the 1990s, Thomashilfen developed – under consideration of basal
stimulation, by Bobath and including kinaesthetic principles – a mattress undersuspension which was called Micro-stimulation
System (see also page 8).
In 2002, Heinrich Völker developed this
undersuspension into a lying system for pressure sore prophylaxis in institutional care
(see also page 9). As with all microstimulation
systems, the basic idea was that movement is
only likely to occur when there is prior sensory perception. These stimuli are processed
by the central nervous system and turned into
movement in response to the stimuli. This
physical activity makes for permanent pressure alterations also among those regions of the
body in danger of developing pressure sore or
affected by them. It is exactly these basic
17
ideas which were realized in the development
of the lying system Völker MiS®.
ment. In this case, Völker MiS® Activ is a really cost effective alternative.
Heiko Heine
“Völker MiS® is now standard
in Völker beds.”
18
The (passive) Micro-stimulation System has
been a standard feature of all Völker beds
since 2003. This means there is prophylactic
treatment from the very first day of hospitalization, and there are no additional costs, no
additional labor. It has been proven that Völker MiS® prevents the development of 34 per
cent of all pressure sores, as was found in the
long-term study by Meander Medisch Centrum, Amersfort/NL 2003/2004. These results
of the passive MiS® encouraged Heinrich Völker to complement the passive system with
an active one. Again, for this system Thomashilfen developed prototypes, under the name
‘Thevo-Activ’, which were then tested in a
long-term study (see also page 19). This study
leaves no doubt whatsoever that the system
is suitable for patients with pressure ulcers
(pressure sores) at predisposed regions of
the body.
This system was then further developed for
institutional care and is now in its production
stage. The advantages for an effective pressure sore management: it is cost effective and
can easily be exchanged for the passive ‘Standard MiS®’ in Völker beds. It conforms to the
standard dimensions of hospital beds, has a
long service-life when continuously operated,
is easily connected, can be set for extended
operation and patterns of movement can be
programmed in accordance with the resident/
patient’s requirements (see page 27).
The use of active systems is required when
immobile patients with pressure sores up to
stage IV have to receive therapeutic treat-
The Völker Lying surface
with MiS® Activ.
Test passed!
The results of the long-term study ‘Thevo-Activ’.
How does a pressure sore develop
and what can one do to fight it?
Prof. Dr. Jürgen Osterbrink
Project manager of the study Klinische Evaluation der
Wirksamkeit des MiS Micro-Stimulations-Sytems ThevoActiv (clinical evaluation of the efficacy of the MiS Microstimulation System Thevo-Activ)
Gerhard Schröder
Member of the expert working group
‘pressure sore prophylaxis’
Long-term study:
Klinische Evaluation der Wirksamkeit
des MiS Micro-Stimulations-Systems
Thevo-Activ (clinical evaluation of the
efficacy of the MiS Micro-stimulation
System Thevo-Activ)
(Project management:
Dr Herbert Mayer, Gerhard Schröder,
Professor Jürgen Osterbrink).
A pressure sore will develop if a person moves
only insufficiently and the pressure thus caused damages the blood circulation in the tissue for too long. A clamping of the venous
capillaries is enough to bring about this reduced blood circulation and lack of oxygen. The
body responds by a warning pressure pain,
which in mobile persons will trigger a change
of posture and thus a relief of the compressed
areas of skin. Small movements will suffice.
But if someone is no longer able to perceive
the pressure pain or to move on his own in
response to that pain, the skin will remain
compressed and waste products will build up
in the tissue, which will then lead to acidosis.
This, in turn, causes an outflow of water from
the capillaries into the tissue. The oedema
thus formed will grow the longer the pressure
is being exerted. When the oedema is so big
that it will clamp the capillaries, we talk of
pressure sore stage I. Stage I can be diagnosed by applying the finger test: press the finger
into the red spot and withdraw it quickly. If
the spot turns white, the blood could be pressed away. Should it stay red, there is the
afore-mentioned compression, i.e. pressure
sore stage I (see page 15).
Movement means prevention.
The duration of the exertion of pressure is the
decisive factor in the development of pressure sore, which means that movement is the
best preventive measure. Therefore, the national experts’ standard ‘pressure sore prophylaxis in nursing’ (www.dnqp.de) also calls
for mobility promotion by means of a mobility
plan as a prophylactic pillar. If, however, the
patient’s passive movement no longer suffices, as can be diagnosed by applying the finger test, or the affected person is no longer
able to move, the pressure has to be reduced.
Soft mattresses will not resolve the problem,
however. Clinical observations have shown
that the very low pressure on soft mattresses
can have side effects (Knobel 1996). The
lower the pressure – or the softer the mattress – the more immobile the patient gets.
This may well lead to an even higher risk of
developing pressure sores. But what might
even be worse: The lower pressure on the soft
mattress will make the patient lose his/her
“conception of his/her own body”. This results in even less movement and more difficult mobility. We know this problem from
hemiplegic patients. This mis- or non-conception of one’s own body (see figure above) can
also negatively influence disorientation so
that some patients on soft mattresses appear
even more confused. And finally, we know of
some side effects caused by alternating pressure mattresses: The higher pressure exerted
on a regular basis may let sensitive patients
feel additional pain (see page 13).
A solution is on the horizon.
This called for a new system avoiding the
afore-mentioned side effects.
Some years ago, experts started to develop
an entirely new lying system. Pressure reduction aside, the result is an additionally stimulating system, based upon the principles of
basal stimulation, a concept developed by
Professor Fröhlich for severely handicapped
children and patients with an impaired perception, which was then applied to nursing by
Professor Bienstein. Vibratory, acoustic,
visual stimuli make for means of communication. The newly developed system is called
Micro-stimulation System (MiS®) and has
been tested in an extensive, multi-centred
study.
Extensive clinical study confirms success.
The preparation of the first clinical study started in 2002. There had been no previous studies of this kind, so it was rather a new frontier.
We, the authors Gerhard Schröder and Professor Jürgen Osterbrink and Dr Herbert
Mayer, renowned experts in clinical healthcare research, were commissioned to conduct
the study.
The pressure sore-therapeutic efficacy aside,
the study was also about whether the system
would bring about a reduction of pain, an
improved orientation among normally disorientated patients, a promotion of self-mobility
and about whether the affected people find
the system comfortable and agreeable.
Hospitals, domestic care services and geriatric care facilities participated in this study.
After all, in the latter facilities the monitoring
period for individual patients is much longer
than in hospitals.
The study was conducted in accordance with
a randomised, comparative and explorative
study design. The factors favoring a development or healing of pressure sores could not
be the same for all patients. Therefore, it was
“drawn by lot” what patient would form part
of the test or control group.
19
systems, and in addition 4 patients were laid
on the new MiS. This, however, remained
switched off, so there was no stimulation.
60%
50%
40%
30%
20%
10%
20
0%
Very bad
Bad
Support system
Thevo Activ
Good
Very good Wound healed
Small-cell systems
Large-cell systems
The chart clearly shows the superiority of the
“Activ” system as a support system in the “wound
healed” category.
Patient recruitment involved those who had
one or more pressure ulcers of stage 2 to 4 on
which their lying position still had an influence. The monitoring period was four weeks,
during which comprehensive healthcarescientific tools were employed, .e.g. the Bradden scale to assess the pressure sore risk,
wound photography and a standardised
wound documentation sheet, the visual analogue scale to determine the degree of pain, a
mobility measurement we had developed our-
selves, the Glasgow-Coma-Scale and the Confusion-Rating Scale and a comfort scale surveying the patient’s subjective impressions
when lying in bed.
The results are definite and are going to change nursing practice. The 47 concluded measurements made for a monitoring period of
1,224 days. 27 patients were laid on the new
system, 16 patients, the control group, on
another pressure sore-therapeutic aid like
small and large-cell alternating pressure
Among 74 % of the patients laid onto the new
system, the healing of wounds was “good” or
“very good”. Among 33 % they even healed
completely. In terms of the “healing of pressure ulcers” the new system was superior to
small-cell alternating pressure systems and
equal to large-cell systems.
In some cases there was a marked improvement in orientation, in some others it was not
quite so marked. It was likewise with mobility,
but this factor was very hard to analyse since
some measuring equipment errors made for
only a small number of results to be analysed.
This shall serve as an example: One female
patient of 77 years suffers from Morbus Alzheimer and vascular encephalopathy and is
very confused. There are no longer any clear
phases, especially with regard to communication. Suffering from a number of diseases
(osteoporosis, hypertension, Parkinson, cardiac insufficiency), she is bed-ridden. Dependent upon her state of confusion, she moves
by herself and is partly very restless in motor
terms. Previously she had been laid on a normal mattress. Attempts on a large-cell system
failed because her motor restlessness only
increased on such a system. When spoken to,
the patient was able to open her eyes but
unable to move actively (e.g. to raise her arm)
in a targeted fashion or give details concerning time, place or her own person.
Within the framework of the study, she was
put onto the new system. After 7 days of stimulation , there was a huge improvement in
her state of confusion: The evaluation criteria
“inadequate behaviour” and “inadequate
communication” previously both rated “2”*
on the Confusion-Rating Scale, over the following 3 weeks improved to “0” (0 = no such
behaviour; 1 = slight manifestation of such
behaviour; 2 = marked manifestation of such
behaviour). After the 4-week monitoring period the patient was put back on a normal mattress. After 3 days she relapsed into her former state of confusion which then remained
unchanged.
The change was so massive that her relatives,
who were also her guardians, demanded she
was to be put back onto the new system,
which indeed she was for another 3 weeks.
Her confusion was gone again, i.e. after 3
days clear communication with this patient
was possible. Unfortunately, after this second
monitoring period the patient had to be hospitalised due to her general condition.
Among the mostly disorientated patients, the
rate of pain over the four weeks, which was to
be assessed by the patients themselves, was
also very hard to evaluate, but there were
positive results among some patients. Patients rated the lying comfort from “very
good” to “good”. It is especially gratifying
that the new system got a very positive rating
because of its lack of noise.
For what patients is the new MiS-System
suitable?
On the basis of the results of the study, the
new system is suitable for patients with pressure sores but also for pressure sore prevention. The advantages of the new stimulation
seem to have a positive impact on patients
with an impaired perception, a lack of mobility, pain and disorientation. We were, however,
unable to ascertain this impact throughout
and in all areas and in all patients. Further
11,1%
bad
wound healing
33,3%
complete
wound healing
sh i
l fe n
22,2%
good
wound healing
ho
ma
22,3%
very good
wound healing
,T
G. Schröder, Prof. Dr. J. Osterbrink
11,1%
very bad
wound healing
ie
development, consistent monitoring and
studies should be able to determine the exact
group of suitable patients. It must be said,
though, that the new system has led to no
deterioration or even complication whatsoever.
Q
le:
u el
Mi
t
SS
ud
Result of the MiS® ThevoActiv long-term study:
77% significant improvement, 33% thereof a
complete healing.
21
Thevo-Activ and Völker MiS® Activ.
Same operating mode, different activation.
Sabrina Simon interviews Heinrich Völker,
Völker AG.
Sabrina Simon
Member of the editorial staff of Völker Wörld,
interviewed Heinrich Völker for the issue 20/2005.
S. Simon: “Mr Völker, why have you, as a
licensee of Thevo Adapt and Thevo Activ,
decided to participate in the development of
microstimulation systems?”
H. Völker: “It may sound a bit immodest but
Völker healthcare and hospital beds have
many advantages which you do not find in
other beds and certainly not in this combination and variety. It starts with the telescopic
height adjustment and doesn’t stop at our
innovative split assist rail system. It also
includes finding solutions to the issues of traditional lying surfaces. We asked ourselves;
what are the kinaesthetic issues associated
with the movement of an aluminium or solid
(HPL or steel) four part lying surface with mattress compensation.
We knew that pressure sore problems could
not be resolved completely with an anti-pressure sore mattress or flexible elements on a
rigid surface. We also found out that subsequent use of positioning aids for therapy is
never an ideal solution. Therefore we were
looking for a really efficient, complete and
cost effective system that as manufacturers
we could integrate into each and every bed.
And which, in an ideal form, could also be
used for therapy. In looking for such a system,
our decision to work with Thomashilfen and
Thevo Adapt became perfectly clear.”
22
A spring behavior comparison.
Left: a conventional slatted frame, which
practically absorbs kinetic energy;
right: Winx bed systems return the kinetic
momentum.
S. Simon: “We know that Thomashilfen is
known for many pressure reduction solutions.
But why does this name also embody such a
system?”
H. Völker: “’Thomashilfen’ has been associat-
ed with Lattoflex for decades now.
With Lattoflex, there was a very good mattress support system, which was then enormously improved by the so-called Winx
systems. Conventional slatted frames practically absorb movement. Winx systems,
however, respond to natural movements in
sleep and gently return this momentum to the
body. I thought this was the first step in the
right direction.”
S. Simon: “Why this difference? And where is
the difference between Winx and Thevo?”
H. Völker: “First, in contrast to all other
systems where, if at all, disc elements rest on
rigid support profiles, the Winx system has
three different suspension levels. While with
a rigid undersuspension with a low point elasticity there will be pressure cones, Winx has
the effect of a balanced pressure distribution
without such cones. ”
the nursing staff, too. And in addition for service personnel and housekeeping. While the
operating mode is exactly the same, the system had to be adapted to meet these specialized requirements.”
S. Simon: “And now for Thevo.”
H. Völker: “Thevo, distributed by Thomashilfen via the specialised sanitary trade, is the
professional realization of Winx, which is distributed by Lattoflex via the specialised bed
trade.”
S. Simon: “Well, you call the system integrated into your beds Völker MiS®, that is Völker
Micro-stimulation System. Why didn’t you
stick with ‘Thevo’?”
H. Völker: “Because Völker MiS® is not the
same as Thevo. Our consumers in institutional healthcare, i.e. hospitals and nursing
homes, have higher standards. These have to
be met for the patients and residents and for
S. Simon: “The success of microstimulation
systems has been published. You yourself
point to results like Völker hospital beds with
MiS® having reduced the incidence rate of
pressure sores by 34 per cent and reduced the
necessity of air-surface systems by 57 per
cent. Can similar cost savings be expected in
other facilities?”
H. Völker: “Yes, that is right. We are now delivering 90 per cent of our beds with MiS®,
which we now call our “standard lying surface”.
That means, MiS® is included in a bed’s price
and there is no additional charge for this. The
simple fact that with no additional expenditure 30 per cent of all costs previously incurred
annually - experts even give an estimate of 50
per cent, which is up to Euro 2 bn – can now
be saved, fully justifies the following bold
statement: Given the ensuing cost savings, if
half of all hospital and healthcare beds were
to be replaced by Völker beds with MiS® all at
once, this expenditure would fully pay off
within only one year.”
S. Simon: “Why then do we also have Völker
MiS® Activ?”
H. Völker: “Even if we were to see a 100 per
cent prevention by using Völker MiS® beds at
a rate of 100 per cent, the pressure sore incidence could not be reduced down to zero. But
with an integrated MiS®, we are able to provide patients/residents with an effective
system for pressure sore prophylaxis which
minimises the risk from their very first day of
hospitalisation. For the pressure sore incidence rate remaining, we have no developed
Völker MiS® Activ.”
S. Simon: “Within the framework of a longterm study, Thevo Activ has been rated very
positively. Völker is a licensee and still develops its own system?”
H. Völker: “Not our own system. Again, the
operating mode is the same as Thevo Activ’s,
only the drive is different. In Thevo-Activ,
valve activators, as they are normally called,
trigger the desired pattern of movement.
These activators are controlled by air, more or
less of which, as is needed, is supplied by the
system’s hoses. This pneumatic drive, an
alternating pressure drive as it were, is in
some ways disadvantageous. Thevo Activ has
to be put on an existing lying surface. This
means, the system will exceed a minimum
height, also construction-related, and appli-
cable standards cannot be complied with.
And the huge number of cables and hoses
and connections makes handling somewhat
difficult, and we really wanted to avoid that.”
S. Simon: “So, its operating mode is identical
with Thevo-Activ’s, but it has a different
drive.”
H. Völker: “Yes, an electromotive drive. Where
Thevo uses valves, we use motors. This modification we thought was necessary because in
our experience in institutional healthcare on
the one hand and for Völker beds on the
other, certain requirements have to be met.
Our active system is designed to be interchangable with the passive system. This
means, the standard MiS® can be replaced by
the active MiS® system, if need be. The active
system therefore has to be an integrated component of the lying surface and work in this
concept. Furthermore, for Völker MiS® Activ
we had to develop a drive which is able to
endure under professional conditions. This
drive had to have a control by which various
patterns of movement for various indications
or any pattern can be programmed (see also
page 27). An electric drive should use low-voltage and DC to preclude alternating voltage
fields. And MiS® Activ has to see large-scale
production at a price which can be justified, in
terms of economic considerations, given that
a sufficient number of them may be desired at
any given health care facility.”
S. Simon: “Völker MiS® Activ meets all these
requirements?”
H. Völker: “Indeed it does! The technical
development has been concluded, as has the
patent application. The operating mode – as a
licensee we would take for granted at any rate
- is that of the study now conducted in cooperation with Thevo Activ. Regardless of this
study, we will commission our own study in
2006. We will present the first Völker beds
equipped MiS® Activ at the Medica 2005 in
Düsseldorf. We will start large-scale production at the beginning of 2007.”
S. Simon: “Mr Völker, we wish you every success with the launch of MiS® Activ, also for all
those affected by pressure sores, who may
then be no longer affected after all.”
Figure above: Pressure points, shown pressure
cones on a rigid mattress support surface.
Figure below: An even pressure distribution without pressure cones by Winx type surface.
Interview: Sabrina Simon
23
How does microstimulation work?
Völker MiS® and Völker MiS® Activ.
Günther Dorenbeck
Development Manager at
Völker AG, was interviewed by Heiko Heine, for our
customer magazine Völker Wörld 20/2005.
We asked Günther Dorenbeck, at Völker AG
responsible for development and construction since autumn 2002, for the mechanisms
which lead to microstimulation and active
microstimulation in the newly developed
system Völker MiS® Activ in particular.
among those regions of the body which are
either affected by pressure sore or in danger
of developing them.”
VöWö: “These three suspension levels are
realised by Völker MiS®?”
G. Dorenbeck: “The passive MiS® has an
extremely flexible arrangement of torsional
butterfly springs on elastic supprt profiles in
VöWö: “Mr Dorenbeck, you are co-responsible for the development of Völker MiS®
systems?”
G. Dorenbeck: “Yes, but Heinrich Völker is still
our development powerhouse. In addition,
we cooperate with a number of experts,
engineers, designers and nursing staff. And
we also cooperate with the most innovative
companies, e.g. for Micro-stimulation Systems with Thomashilfen. The Völker Development Department has the responsibility to
accompany these developments, prepare for
their production stage and implement the
project.
24
VöWö: “Mr Dorenbeck, how does MiS® work
and how do other anti-pressure sore systems
work?”
4
3
2
The passive Völker MiS®:
1) butterfly spring, 2) support profile,
3) suspension unit, 4) frame.
1
G. Dorenbeck: “All anti-pressure sore systems
I know have one deficiency. While they are
better than an overall rigid lying surface made
from HPL (high pressure laminiate) or other
materials, these designs can only have a limited effect, since the kinetic energy is not
transmitted but absorbed. Völker MiS® is
effective because here the system works via
three suspension levels, which trigger microstimulations to be processed by the central
nervous system as stimuli and which are then
translated into movement as responses to
such stimuli. It is this physical activity only
which causes permanent pressure alterations
A pressure sore will develop wherever pressure is exerted on the skin, especially however above convex
bone structures. Active microstimulation takes this into account.
adjustable positions. These profiles are put
on suspension units fixed to the frame rails of
the lying surface and allowing for an additional spring depth. This produces a continual
sequence of stimuli, which enable the patient
to move by himself, thereby in turn triggering
more stimuli. Ad infinitum, as it were. This, I
think, is the ideal kind of pressure sore prophylaxis.”
VöWö: “And in contrast to this passive
system, the active system is in addition used
for pressure sore therapy?”
G. Dorenbeck: “Using an active system is
always required when immobile patients who
have already developed stage-IV pressure
sores have to undergo therapy. The precondition is an indicator for active microstimulati-
on, having an effect on the critical regions in
particular. The highest risk factor is a vertical
impact by both the body’s pressure and the
lying surface’s counterpressure on areas of
the skin above convex bone structures not
really cushioned by elastic muscles fibres or
subcutaneous fat. These are the classically
predisposed spots like the sacrum, heels,
knees, the trochanter major and the sides of
the ankles. I think that 95 per cent of all pressure sores develop in such areas. Therefore
we now use activators to move the otherwise
passive support profiles in these areas of risk:
small electric motors, which move the support profiles by minimally raising and lowering them, thereby replacing passive suspension units. The other elements, i.e. support
profiles and butterfly springs, correspond to
our standard system.”
VöWö: “The passive and active system use
the same basic construction?”
G. Dorenbeck: “Both systems can be used in
all Völker beds’ lying surface frames of the
current model and can thus also be exchanged if need be. In contrast to the standard
system, in the Völker MiS® Activ system those
eight (out of the twelve) support profiles that
are found in the afore-mentioned areas of risk
are placed upon activators. Each of the 16
activators has its own drive, the low-voltage
motor of which is controlled by a processor.
This micro-processor signals the lift unit to its
correct position in order to perform the desired pattern of movement. This pattern is then
chosen from a control panel that is attached
to the bed.”
G. Dorenbeck: “That’s easy, really. The individual components of a lying surface equipped
with Völker MiS® Activ, i.e. back, posterior,
thigh and lower leg component, are closed
units connected by simple plug buses. This
makes maintenance and cleaning very easy.
The activators are driven by 12 V DC low-voltage motors with 0.5 A at max, thus precluding alternating voltage fields.”
1
3
2
VöWö: “This rather sounds like an easy-touse, no-fuss concept.”
Figure above: The new Völker MiS® Activ: 1) butterfly springs, 2) support profile, 3) activator, 4) frame.
Interview: Heiko Heine
25
VöWö: “An electromotive drive and individually removable components: How does that
work?”
4
system, that is cost effective and readily available. It is a system that makes sense and is
often a better alternative than conventional
systems. It can be a cost effective solution
with a comparable success rate to other
systems.”
G. Dorenbeck: “Well, this has been our objective: Prevention without any additional costs
and right from the beginning. And, if need be,
additional therapeutic measures can be
employed with an easily exchangeable active
1
2
3
4
5
6
26
7
Völker MiS® and MiS® Activ.
No undesired side effects.
It is of the utmost importance that the patient’s own movements and perception are promoted and maintained. This indispensable
therapeutic effect is generated by the close
feedback between patient and the system.
This feedback is triggered by the afore-mentioned micro movements by the butterfly
springs. The patient receives important information on his body. The unique operating
mode, based upon findings of healthcare
research, as yet has never led to any undesired side effects like muscle spasms or coordination disorders. Just like the Micro-stimulation System Thevo-Adapt, Völker MiS® can be
used for almost any underlying illness, but is
most suitable for the treatment of pain and
patients and patients suffering from dementia
or neurological disorders.
The classical Thevo-Adapt (no aggregate, up
to stage III according to Seidler) has been
very successfully used for pressure sore and
pain patients for the past three years, as has
the Völker Micro-stimulation System in institutional healthcare for the past two years.
After the results of a scientific long-term
study have now been made available, Völker
has decided to introduce active microstimulation in Völker healthcare and hospital beds as
well.
The long-term study (see page 19) has proven
the efficacy and the therapeutic benefit of
active Micro-stimulation Systems. The study
was conducted by the internationally renowned healthcare scientists Professor Jürgen
Osterbrink (Nuremberg), Gerhard Schröder
(Uslar) and Dr Herbert Mayer (Witten) and
had been coordinated with the ‘IKK-Bundesverband’ and checked and approved by an
ethics commission. Its study design follows
the demanding Evidence Level 1.
The Thevo-Activ systems selected for the
study are suitable for both pressure sore prophylaxis and therapy. Thevo-Activ is a member of the Micro-stimulation Systems family,
which means that it does not use the conventional operating modes of pressure distribution or alternating pressure. This system also
includes the theoretical approaches of basal
stimulation, the Bobath concept and kinaesthetics and thus has the same objectives of
promoting perception and mobility. On that
basis, Thevo-Activ was further developed for
Völker beds used in institutional healthcare.
ion. There will be continued counter-rotating
profile movement. After three rotations, their
direction is changed.
If “inclined plane” is activated, all activators
of one side are triggered simultaneously and
thus create an inclined plane. After a selection of three predetermined intervals, the axis
pitch is changed.
There is also the option of simply programming patterns of movement based upon a
patient’s individual needs.
Butterfly springs and flexible support profiles
are still part of the suspension elements. The
suspension units, in the passive system not
only bearing the support profiles but through
their construction also dampening any sinking, have here been replaced by a certain
number of activators driven by a small noiseless motor. These activators hold the support
profiles and also raise and lower them in a
predetermined pattern, electrically and thus
actively (see figure on page 25). The active
elements create a therapeutically gentle stimulation, which is programmed by a hand-held
control panel (see figure on he right).
There is a wide range of patterns of movement based upon basal stimulation in order
to include the patient’s/resident’s needs on
an individual and therapeutically efficient
basis.
A mere push on an icon will choose the desired pattern of movement to the control unit,
which will then activate the selected pattern
of movement (see figure below), e.g. “wave”:
the left and right activators are triggered
simultaneously. The stimulation pattern is
like a wave running through the bed and causing the patient to perceive his whole body.
If “rotation” is activated, the left and right
activators are triggered in a staggered fash-
27
Figure on the left: There
are various modes to be
chosen for the butterfly
springs’ patterns of movement.
In addition, other modes
can be programmed if
there are special requirements.
Völker Care Concept
Additional Information
Völker healthcare and hospital beds have so much to offer. If you want more
information on our many advantages please don’t hesitate to contact us.
Last name, first name
Healthcare facility, if applicable
Street
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Phone
E-mail
[ ] Please call me to make an appointment.
Völker Inc., Hertz Supply Co., Inc
4315 Independence Dr · Schnecksville PA 18078
Phone: 610-769-4900 · Toll free (USA): 800-321-4240 · Fax: 610-769-4908
[email protected] · www.hertzsupply.com
ProSell! USA/GES5849e 04.07-0.000
Völker AG
Wullener Feld 79 · 58454 Witten/Germany
Phone +49 2302 96096-0
Fax
+49 2302 96096-16
www.voelker.de · [email protected]