‘Smart bandage’ detects bedsores before they are visible to doctors

BERKELEY — Engineers at UC Berkeley are developing a new type of bandage that does far more than stanch the bleeding from a paper cut or scraped knee.

Thanks to advances in flexible electronics, the researchers, in collaboration with colleagues at UC San Francisco, have created a new “smart bandage” that uses electrical currents to detect early tissue damage from pressure ulcers, or bedsores, before they can be seen by human eyes – and while recovery is still possible.

Associate professor Michel Maharbiz explains how the smart bandage works to detect bedsores. (UC Berkeley video by Roxanne Makasdjian and Phil Ebiner)

“We set out to create a type of bandage that could detect bedsores as they are forming, before the damage reaches the surface of the skin,” said Michel Maharbiz, a UC Berkeley associate professor of electrical engineering and computer sciences and head of the smart-bandage project. “We can imagine this being carried by a nurse for spot-checking target areas on a patient, or it could be incorporated into a wound dressing to regularly monitor how it’s healing.”

The researchers exploited the electrical changes that occur when a healthy cell starts dying. They tested the thin, non-invasive bandage on the skin of rats and found that the device was able to detect varying degrees of tissue damage consistently across multiple animals.

The smart bandage is fabricated by printing gold electrodes onto a thin piece of plastic. This flexible sensor uses impedance spectroscopy to detect bedsores that are invisible to the naked eye. (Image courtesy of UC Berkeley)
The smart bandage is fabricated by printing gold electrodes onto a thin piece of plastic. This flexible sensor uses impedance spectroscopy to detect bedsores that are invisible to the naked eye. (UC Berkeley image)

Tackling a growing health problem

The findings, published today (Tuesday, March 17) in the journal Nature Communications, could provide a major boost to efforts to stem a health problem that affects an estimated 2.5 million U.S. residents at an annual cost of $11 billion.

Pressure ulcers, or bedsores, are injuries that can result after prolonged pressure cuts off adequate blood supply to the skin. Areas that cover bony parts of the body, such as the heels, hips and tailbone, are common sites for bedsores. Patients who are bedridden or otherwise lack mobility are most at risk.

“By the time you see signs of a bedsore on the surface of the skin, it’s usually too late,” said Dr. Michael Harrison, a professor of surgery at UCSF and a co-investigator  of the study. “This bandage could provide an easy early-warning system that would allow intervention before the injury is permanent. If you can detect bedsores early on, the solution is easy. Just take the pressure off.”

Bedsores are associated with deadly septic infections, and recent research has shown that odds of a patient dying are 2.8 times higher when they have pressure ulcers. The growing prevalence of diabetes and obesity has increased the risk factors for bedsores.

“The genius of this device is that it’s looking at the electrical properties of the tissue to assess damage. We currently have no other way to do that in clinical practice,” said Harrison. “It’s tackling a big problem that many people have been trying to solve in the last 50 years. As a clinician and someone who has struggled with this clinical problem, this bandage is great.”

Cells as capacitors and resistors

The researchers printed an array of dozens of electrodes onto a thin, flexible film. They discharged a very small current between the electrodes to create a spatial map of the underlying tissue based upon the flow of electricity at different frequencies, a technique called impedance spectroscopy.

Researchers varied the amount of pressure applied to the skin, creating bedsores ranging in severity. The orange hexagon marks where the bandage was placed on the skin, and the dotted blue circle highlights where pressure was applied to the tissue. The "reversible damage" example highlights sensitivity of the "smart bandage" impedance sensor since the wound is not visible at the surface of the skin. (Schematic courtesy of UC Berkeley)
Researchers varied the amount of pressure applied to the skin, creating bedsores ranging in severity. The orange hexagon marks where the bandage was placed on the skin, and the dotted blue circle highlights where pressure was applied to the tissue. The “reversible damage” example highlights the sensitivity of the “smart bandage” impedance sensor since the wound is not visible at the surface of the skin. (Schematic courtesy of UC Berkeley)

The researchers pointed out that a cell’s membrane is relatively impermeable when functioning properly, thus acting like an insulator to the cell’s conductive contents and drawing the comparison to a capacitor. As a cell starts to die, the integrity of the cell wall starts to break down, allowing electrical signals to leak through, much like a resistor.

“Our device is a comprehensive demonstration that tissue health in a living organism can be locally mapped using impedance spectroscopy,” said study lead author Sarah Swisher, a Ph.D. candidate in electrical engineering and computer sciences at UC Berkeley.

To mimic a pressure wound, the researchers gently squeezed the bare skin of rats between two magnets. They left the magnets in place for one or three hours while the rats resumed normal activity. The resumption of blood flow after the magnets were removed caused inflammation and oxidative damage that accelerated cell death. The smart bandage was used to collect data once a day for at least three days to track the progress of the wounds.

The smart bandage was able to detect changes in electrical resistance consistent with increased membrane permeability, a mark of a dying cell. Not surprisingly, one hour of pressure produced mild, reversible tissue damage while three hours of pressure produced more serious, permanent injury.

Promising future

“One of the things that makes this work novel is that we took a comprehensive approach to understanding how the technique could be used to observe developing wounds in complex tissue,” said Swisher. “In the past, people have used impedance spectroscopy for cell cultures or relatively simple measurements in tissue. What makes this unique is extending that to detect and extract useful information from wounds developing in the body. That’s a big leap.”

Maharbiz said the outlook for this and other smart bandage research is bright.

“As technology gets more and more miniaturized, and as we learn more and more about the responses the body has to disease and injury, we’re able to build bandages that are very intelligent,” he said. “You can imagine a future where the bandage you or a physician puts on could actually report a lot of interesting information that could be used to improve patient care.”

Other lead researchers on the project include Vivek Subramanian and Ana Claudia Arias, both faculty members in UC Berkeley’s Department of Electrical Engineering and Computer Sciences; and Shuvo Roy, a UCSF professor of bioengineering. Additional co-authors include Amy Liao and Monica Lin, both UC Berkeley Ph.D. students in bioengineering; and Yasser Khan, a UC Berkeley Ph.D. student in electrical engineering and computer sciences, who fabricated the sensor array.

Study co-author Dr. David Young, UCSF professor of surgery, is now heading up a clinical trial of this bandage.

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To learn about other bedsore and pressure sore treatments click here.

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State Not Required to Treat Medicaid Applicant’s Multiple Transfers as One Transaction

A Kentucky appeals court rules that a Medicaid applicant’s penalty period is appropriate because the state is not required to treat multiple transfers as a single transaction when the transfers are not related. Marcum v. Commonwealth (Ky. Ct. App., No. 2014-CA-000487-MR, April 10, 2015).

In July 2011, Betty Marcum applied for Medicaid and the state imposed a penalty period based on a transfer of assets. During the penalty period, Ms. Marcum sold her home and transferred the proceeds into an irrevocable trust, with her family gifting a portion of the money back to her. She also made other transfers from her bank account. In June 2012, Ms. Marcum applied for Medicaid benefits again. The state imposed a second penalty period, running from the date of the second application.

Ms. Marcum appealed, contending that the state incorrectly calculated the penalty period. The state’s Medicaid operations manual requires that multiple related transfers be counted as a single transaction that occurred on the date of the first transfer and that once a penalty period has been established, it runs until expiration. Ms. Marcum argued that these provisions required the state to treat all of the disqualifying transfers together in a single penalty period. A state appeal board upheld the imposition of the second penalty period, and a trial court affirmed.

The Kentucky Court of Appeals affirms, holding that because Ms. Marcum’s second application involved transfers that were not related to the first penalty period, the state was not required to treat the transfers as a single transaction. The court rules that the state cannot “simply recalculate the first disqualification period to include transactions occurring after that period was imposed.” Similarly, the state cannot allow “the first disqualification period to be modified after it had expired.”

Remember, although federal funded, Medicaid rules do vary by state. For a free initial consultation or more information on how to protect and preserve your assets with Medicaid Planning, click here.

Free Tax Help & Filing for Low- and Middle-Income Taxpayers

The United States Internal Revenue Service (IRS) is sponsoring the largest free tax counseling and preparation program in the country, available through AARP.

As seen in: SeniorLiving.about.com
As seen in: SeniorLiving.about.com

Who Can Use this Free Tax Help and Free Filing Service?

Most people who work need to file a tax return. AARP Tax-Aide is a free tax help service for people who meet the following criteria:

  • Low- or middle-income taxpayers who want tax help and free filing of their U.S. federal income tax returns
  • You must have a simple tax return. People seeking tax help who have more complex returns will be advised to get professional tax assistance.
  • You do not need to be a member of AARP or a senior to receive tax help from Tax-Aide, however special attention is paid to people age 60 and over.

What Are the Details of This Free Tax Help and Filing Service?
Every year, from February 1st through April 15th, about 32,000 trained and certified Tax-Aide volunteers across the country are available to provide tax help for preparing and filing your federal tax return.

  • Many Tax-Aide locations are equipped to file your return electronically, allowing you to receive your tax refund much faster.
  • Some Tax-Aide locations offer bilingual assistance.
  • In most situations, you must visit an AARP Tax-Aide site in person to have your tax returns prepared by Tax-Aide volunteers. However, special arrangements can be made to assist shut-ins and homebound disabled persons by providing tax help at locations including hospitals, nursing homes, assisted living facilities, etc. To make a special tax help request, contact AARP at taxaide@aarp.org[/Email”>.
  • Volunteers are not available to provide tax help by phone, so visit the online tax counseling site for a list of frequently asked questions or to submit your own questions.
  • What Do I Need to Bring When I Receive Free Tax Help?
    • Photo identification
    • Social Security card
    • Wage and earning statements
    • Interest and dividend statements
    • A copy of last year’s federal and state returns if available
    • Your bank account and bank routing numbers so you can arrange for direct deposit of your tax refund
  • Where Can I Find the Closest Tax-Aide Site?

    What If There’s No Tax-Aide Site Near Me?
    If you cannot find a Tax-Aide location near you, the IRS offers other tax help options. For more information: