Abstract:
The present invention relates to a system and method for support and off-loading. The system includes an inner bladder filled with a flowable composition. An outer bladder filled with a flowable composition is positioned adjacent to the inner bladder. The composition of the inner bladder has greater flow characteristics than the composition of the outer bladder. The inner bladder micro-contours to the received body part and the outer bladder macro-contours to the inner bladder after the inner bladder is micro-contoured to the received body part. Alternatively, the system provides a pair of ultra low pressure plenums and a positioner. The patient body size and size and corresponding surface area of the positioner control the amount of gas which is displaced evenly against the walls of the ultra low pressure plenums.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    The present invention relates to a patient support which can be used in a bed or flat surface and in particular to a system and method for support of the body, in particular in the prone position, which can also be used for turning and repositioning of a patient in a bed or on a flat surface. 
         [0003]    2. Description of Related Art 
         [0004]    Hospital bed and other patient static air and dynamic air supports are known. Typically, such patient supports are used to provide a support surface for patients or other individuals for treatment, recuperation, or rest and prevention of skin breakdown. 
         [0005]    U.S. Pat. No. 3,762,404 describes a positioning aid for restraining and immobilizing a part of the body of a medical patient including an air-tight flexible bag and deformable spherulic beads of expanded polystyrene are confined in the bag. A valve communicates with the interior of the bag for evacuating air therefrom. The bag becomes rigid upon evacuation of air from the bag. 
         [0006]    It is desirable to provide an improved support off-loading the patient in the prone position including bony prominences. 
       SUMMARY OF THE INVENTION 
       [0007]    The present invention relates to a system and method for body support and off-loading. It is optimal to barely elevate the body in a prone position from the surface of the bed. In the prone position, the body is laying face forward towards the support surface. The system provides a support including a first ultra low pressure plenum, a second ultra low pressure plenum and a positioner. Each of the ultra low pressure plenums can include one or more air chambers. Each air chamber is filled at a predetermined low pressure for distributing pressure along the length of the ultra low pressure plenum, but not providing significant elevation of a received body part by itself. 
         [0008]    A cover can be received over the ultra low plenums. The cover can include a retaining member for receiving the positioner. The cover can include a temperature regulating material for keeping the received body part in an optimal range of skin temperature to keep comfortable longer. In one embodiment, a phase change material can be used for adjusting the temperature of the system to adapt to temperature changes of the body. 
         [0009]    The positioner includes a bladder preferably filled with a fluidized particulate material with sufficient size and shape to displace an amount of air in the support to offload pressure being from a received body part, such as, but not limited to, bony prominences of which contact a surface when the body is positioned in a prone position and when the body is turned to other positions. The surface area of the positioner provides greater positive air displacement in the ultra low pressure plenums than would occur from the body part of the patient by itself. In one embodiment, the positioner can have a greater width than the patient. The positioner provides three dimensional movement. Preferably, the positioner has little or no flow characteristics unless an outside force is applied other than gravity. The positioner can displace and contour three dimensionally as though it was fluid while not having flow characteristics that would result in migration of the medium under the force of gravity. The positioner can provide three dimensional contouring. The positioner can be shaped as a pad. 
         [0010]    In one embodiment, the first ultra low pressure plenum includes a lower bladder section having a smaller width dimension than an upper bladder section. The air chambers of the lower bladder section and the upper bladder section being in air communication with one another. Air is communicated within the upper bladder section and lower bladder section through air displacement. The patient body size and size and corresponding surface area of the positioner control the amount of air which is displaced evenly against the walls of the first ultra low pressure plenum. A second ultra low pressure plenum is placed under the first ultra low pressure plenum. Alternatively, the second ultra low pressure plenum can be placed on top of the first ultra low pressure plenum. The second ultra low pressure plenum can have a size and shape identical or substantially similar to the upper bladder section of the first ultra low pressure plenum. The positioner is placed beneath or on top of both the first ultra low pressure plenum and the second ultra low pressure plenum or at other positions of the first ultra low pressure plenum and the second low pressure plenum or in combination one or more additional positioners. In one embodiment, the positioner displaces air in both the first ultra low pressure plenum and the second ultra low pressure plenum to off-load the body and allow the lungs to expand in a prone position of the body. In one embodiment, the positioner can be positioned at one of outer walls of the first ultra low pressure plenum to push air away from the outer wall, thereby aiding in turning of a patient. 
         [0011]    For example, the support can be used to allow a patient to be supported in the prone position for off-loading the body from the collar bone to the knees to aid in treating advanced respiratory distress. 
         [0012]    The combination of the first and second ultra low pressure plenums and positioner, including a fluidized medium, creates sufficient support of the received body part while responding to normal patient movement. The first and second ultra low pressure plenums can be low profile. In one embodiment, the system including the first and second ultra low pressure plenums can be positioned underneath the sheets of a bed, such as a hospital bed. Alternatively, the system including the first and second ultra low pressure plenums can be placed above the sheets for aiding in patient turning and repositioning. 
         [0013]    Gripping handles can be provided on either edge of the first ultra low pressure plenum to aid in movement of the first ultra low pressure plenum when a patient supported by the first ultra low pressure plenum. In this embodiment, the gripping handles can be placed over the sheet and unweighted to allow the patient to be moved for turning and repositioning of the patient. In one embodiment, the gripping handles are holes in the cover. In an alternative embodiment, the gripping handles are placed under the sheet and have a high coefficient of friction to prevent movement of the ultra low pressure plenum. 
         [0014]    The inner positioner includes a bladder preferably filled with a fluidized particulate material with sufficient size and shape to micro-contour to a received body part, such as, but not limited to, bony prominences of which contact a surface when the body is positioned in a prone position and when the body is turned to other positions. The surface area of the inner positioner provides greater positive air displacement in the outer support plenum than would occur from the body part of the patient by itself. In one embodiment, the inner positioner can have a greater width than the patient. The inner positioner provides three dimensional movement. The positioner can displace and contour three dimensionally as though it was fluid while not having flow characteristics that would result in migration of the medium under the force of gravity. The positioner can provide three dimensional contouring. The positioner can be shaped as a pad. 
         [0015]    In an alternate embodiment, the system provides a support including an outer support plenum providing a gross contouring and an inner positioner providing micro contouring. The outer support plenum can include a fluidized medium such as for example expanded foam beads contained therein. A lubricant can be used on the outside of the beads or in the interstitial spaces between the beads. Alternatively, kinetic sand can be retained in the outer support plenum. The outer support plenum can retain its shape after molding to a received body part. In one embodiment, a valve coupled to the outer support plenum can be used to pump air into the outer support plenum or draw down vacuum within the outer support plenum. The outer support plenum provides support for proper body alignment and keeping a received body part in position. 
         [0016]    In one embodiment, the inner positioner is first molded around a received body part to provide micro-contouring. After molding of the inner positioner, the outer support plenum can be molded around the inner positioner to provide macro-contouring and retaining of the inner positioner in place. The fluidized medium in the inner positioner closest to the skin can be the more flowable than the fluidized in the outer support plenum to prevent friction, shear and interface pressure on capillaries of received body parts and prevent nerve entrapment. 
         [0017]    The invention will be more fully described by reference to the following drawings. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0018]      FIGS. 1A-1C  are a schematic diagrams of a first bladder used in a system for body support in accordance with the teachings of the present invention. 
           [0019]      FIG. 2  is a schematic diagram of a positioner used in the system. 
           [0020]      FIG. 3  is a schematic diagram of a second bladder used in the system. 
           [0021]      FIG. 4  is a schematic diagram of the system including the first and second bladders and the positioner. 
           [0022]      FIG. 5  is a schematic diagram of the system including the positioner positioned at an outer wall of the support. 
           [0023]      FIG. 6  is a schematic diagram of an alternate embodiment of a system for support of a body part in accordance with the teachings of the present invention which provides low pressure loss. 
           [0024]      FIG. 7  is a front view of a cover placed over the support shown in  FIG. 6 . 
           [0025]      FIG. 8  is a rear view of a cover placed over the support shown in  FIG. 6 . 
           [0026]      FIG. 9  is a rear view of a cover placed over the support shown in  FIG. 6  including an extension of the support placed in a folded condition. 
           [0027]      FIG. 10  is a schematic diagram of the system in accordance with the teachings of the present invention when placed on a bed. 
           [0028]      FIG. 11  is a schematic diagram of the system in accordance with the teachings of the present invention when placed on a bed and having one side folded to expose handles attached to a rear side of the support. 
           [0029]      FIG. 12  is a schematic diagram of the system in accordance with the teachings of the present invention when placed on a bed and including a positioner placed in a retainer of the cover. 
           [0030]      FIG. 13  is a schematic diagram of the system in accordance with the teachings of the present invention when placed on a bed and in use by a user. 
           [0031]      FIG. 14  is a schematic diagram of the system in accordance with the teachings of the present invention when placed on a bed and in use by a user during folding of an edge towards the user. 
           [0032]      FIG. 15  is a schematic diagram of the system in accordance with the teachings of the present invention when placed on a bed and in use by a user during folding of an extension of the cover and support. 
           [0033]      FIG. 16  is a schematic diagram of the system in accordance with the teachings of the present invention when placed on a bed and in use by a user during turning of the user. 
           [0034]      FIG. 17  is a schematic diagram of the system in accordance with the teachings of the present invention when placed on a bed and in use including use of a positioner to aid in turning. 
           [0035]      FIG. 18  is a schematic diagram of an alternate embodiment of a positioner used in the system. 
           [0036]      FIG. 19  is a schematic diagram of an alternate embodiment of a system for body support. 
           [0037]      FIG. 20  is a schematic diagram of an outer bladder used in  FIG. 18 . 
           [0038]      FIG. 21  is a schematic diagram of an outer bladder used in  FIG. 18 . 
           [0039]      FIG. 22  is a schematic diagram of an outer bladder used in  FIG. 18 . 
       
    
    
     DETAILED DESCRIPTION 
       [0040]    Reference will now be made in greater detail to a preferred embodiment of the invention, an example of which is illustrated in the accompanying drawings. Wherever possible, the same reference numerals will be used throughout the drawings and the description to refer to the same or like parts. 
         [0041]      FIGS. 1-4  illustrate system for support of a body part of a patient turning and repositioning of the patient with simultaneous offloading of the bony prominences  10  in accordance with the teachings of the present invention. First ultra low pressure plenum  12  is configured to a shape to fit underneath a patient and support the lower back and/or hips of a patient. For example, first ultra low pressure plenum  12  can have a width W 1  of approximately 52 inches, and a height H 1  of about 35 inches. Alternatively, width W 1  can be a width of a bed, such as a hospital bed. First ultra low pressure plenum  12  is formed of upper bladder  14  and lower bladder  16 . First upper bladder  14  can have a width W 2  and height H 2 . Lower bladder  16  has a smaller width dimension W 3  and height dimension H 3  than upper bladder  14 . Air pressure within upper bladder  14  and lower bladder  16  is reduced sufficiently for distributing pressure within first ultra low pressure plenum  12 , but is not providing support of the received body part by itself. Upper bladder section  14  extends between edges  13   a - 13   d . Lower bladder section  16  extends between edges  15   a - 15   d.    
         [0042]    Gripping handles  20  can be provided on either edge  22   a ,  22   b  to aid in movement of first ultra low pressure plenum  12  over surface  19 . Gripping handles  20  can be placed over a sheet of a bed and unweighted to allow the patient to be moved. In an alternative embodiment, gripping handles  20  are placed under the sheet and have a high coefficient of friction to prevent movement of first ultra low pressure plenum  12 . 
         [0043]    Positioner  23  can include bladder  24 , as shown in  FIG. 2 . Bladder  24  is filled with fluidized material  25  which can retain its shape after sculpting. The flowability or lubricity of fluidized material  25  can be increased by adding a lubricant or by the removal of air from the interstitial spaces or both. The preferred medium of fluidized material  25  is a particulate material that has been modified in such a way that it acts like a fluid. Fluidized material  25  refers to a compound or composition which can be sculpted and retain its shape and has no memory or substantially no memory. The no memory or substantially no memory feature enables bladder  24  to increase in height and maintain support of a body part. Fluidized material  25  is made of a viscosity that will allow it to contour but not collapse under the weight of the body part. 
         [0044]    At sea level, the normal interstitial air pressure would exceed about 760 millibars of mercury. This increases or decreases marginally as altitude varies. Depending on the nature of the particulate fluidized material  25 , the pressure can be lowered below about 500 millibars to about 5 millibars, preferably, 350 millibars to about 5 millibars, while still maintaining the necessary flow characteristics of the product. 
         [0045]    Fluidized material  25  can include compressible and non-compressible beads, such as polyethylene or polystyrene (PS) beads, expanded polyethylene (PE), crosslinked expanded polyethylene (PE), polypropylene (PP) pellets, closed cell foams, microspheres, encapsulated phase changing materials (PCM). The beads can be hard shelled or flexible. In one embodiment, the beads are flexible and air can be evacuated from the beads. In one embodiment, hard beads can be mixed with flexible beads in which air can be evacuated from the flexible beads. In an alternative embodiment, fluidized material  25  can a porous foam substance including pockets of interstitial air. In one embodiment, fluidized material  25  can be a polyurethane foam. The polyurethane foam can be open or closed cell and cut into small shapes such as spheres or blocks. For example, a sphere of polyurethane foam can have a size of 2 inches in diameter. For example, a block of polyurethane foam can be a 1×1×1 inch block. 
         [0046]    Suitable examples of fluidized material  25  can be formed of a mixture of microspheres and lubricant. The microspheres can include hollow or gas-filled structural bubbles (typically of glass or plastic) with an average diameter of less than 200 microns. The composition flows and stresses in response to a deforming pressure exerted on it and the composition ceases to flow and stress when the deforming pressure is terminated. For example, fluidized material  25  can be formed of a product referred to as Floam™. A flowable compound comprising lubricated microspheres, including the compound itself, formulations for making the compound, methods for making the compound, products made from the compound and methods for making products from the compound as defined by U.S. Pat. Nos. 5,421,874, 5,549,743, 5,626,657, 6,020,055, 6,197,099 and 8,175,585, each of which is hereby incorporated by reference into this application. 
         [0047]    For example, bladder  24  can be formed of a flexible plastic, such as urethane. Upon removal of gas from fluidized material  25 , bladder  24  flows concurrent with the flow of fluidized material  25  such that bladder  24  moves with movement of fluidized material  25 . For example, the gas can be air, helium, hydrogen or nitrogen. Optionally, gas can communicate throughout the whole bladder for allowing maximum contouring and functional displacement of both the gas and the fluidized chamber thereby providing maximum contouring to a desired body part. 
         [0048]      FIG. 3  is a schematic diagram of second ultra low pressure plenum  32 . Second ultra low pressure plenum  32  is formed of bladder  34 . Second ultra low pressure plenum  32  can have a width W 4  and a height H 4  that is identical or substantially similar to height H 2  and width W 2  of upper bladder  14  of the first ultra low pressure plenum  12 . 
         [0049]    Second ultra low pressure plenum  32  can be placed under first ultra low pressure plenum  12  as shown in  FIG. 4 . Alternatively, the second ultra low pressure plenum can be placed on top of the first ultra low pressure plenum. Positioner  23  is placed beneath both the first ultra low pressure plenum  12  and second ultra low pressure plenum  32 . Positioner  23  displaces air in both the first ultra low pressure plenum  12  and second ultra low pressure plenum  32 . Lower surface  26  of positioner  23  can be formed of a high friction material for preventing movement of positioner  23 . 
         [0050]    Bladder  24  is preferably filled with fluidized particulate material  25  with sufficient size and shape to displace an amount of gas in ultra low pressure plenum  12  and second ultra low pressure plenum  32  to offload pressure from the received body part, such as the bony prominences of the collar bone, rib cage and iliac crest when the body is in the prone position adjacent system  10 . Bladder  24  provides micro-contouring because fluidized material  25  can respond three-dimensionally. Alternatively, bladder  24  is formed of any contouring medium, such as foam or gel which is sufficient to displace air within first ultra low pressure plenum  12  and second ultra low pressure plenum  32 . 
         [0051]    For example, the pressure in ultra low pressure plenum  12  and second ultra low pressure plenum  32  can be below 20 mm of water. It will be appreciated that all equivalents such as mm Hg and PSI can be used for measuring the pressure within ultra low pressure plenum  12  and second ultra low pressure plenum  32 . 
         [0052]    The pressure within ultra low pressure plenum  12  and second ultra low pressure plenum  32  can be below about 20 mm of water if no positioner  23  is used or if an area of less than about 30% of ultra low pressure plenum  12  and second ultra low pressure plenum  32  are covered by positioner  23 . The pressure within ultra low pressure plenum  12  and second ultra low pressure plenum  32  can be below about 10 mm of water if an area of between about 30% to about 60% of ultra low pressure plenum  12  and second ultra low pressure plenum  32  is covered by positioner  23 . The pressure within ultra low pressure plenum  12  and second ultra low pressure plenum  32  can be below about 5 mm of water if an area of greater than about 60% of ultra low pressure plenum  12  and second ultra low pressure plenum  32  are covered by positioner  23 . 
         [0053]    Bottom surface  17  of first ultra low pressure plenum  12  or second ultra low pressure plenum  32  can be formed of a material having a low coefficient of friction to be used to move a patient on surface  19  underneath first ultra low pressure plenum  12  or second ultra low pressure plenum  32 . A suitable material having a low coefficient of friction is nylon or rip stop nylon material. Upper surface  18  of first ultra low pressure plenum  12  or second ultra low pressure plenum  32  can be formed of a material having a high coefficient of friction. A suitable material having a high coefficient of friction is a rubberized or non-skid material. 
         [0054]    An additional positioner  23  can be placed over lower bladder  16  of ultra low pressure plenum  12  to displace gas from lower bladder  16  to upper bladder  14  in the direction of arrows A 1 , as shown in  FIG. 4  or at various locations on first ultra low pressure plenum  12  or second ultra low pressure plenum  32 . When a patient is recumbent on first ultra low pressure plenum  12  and second ultra low pressure plenum  32  gas will be displaced in upper bladder  14  and second ultra low pressure plenum  32 . towards outer edges  13   a  for providing support adjacent to edges  13   b  and  13   d  thereby providing support of edges  13   b  and  13   d  of upper bladder  14  of the patient within edges  13   b  and  13   d  and to the edges of bladder  34  for lifting a patient from surface  11 . 
         [0055]    In one embodiment, positioner  23  can be positioned at one of edges  13   b  and  13   d  to push air away from respective edges  13   b  and  13   d  thereby aiding in turning of a patient towards the opposite edge, as shown in  FIG. 5 . For example, if the patient is to be turned towards edge  13   d , positioner  23  can be placed at edge  13   b  for displacing gas behind the patient to towards edge  13   b  of upper bladder  14 , thereby pneumatically assisting in turning of the patient to face edge  13   d.    
         [0056]    System  10  including ultra low pressure plenum  12  and second ultra low pressure plenum  32  is functional whether positioner  23  is placed on top of ultra low pressure plenum  12  and second ultra low pressure plenum  32  or beneath ultra low pressure plenum  12  and second ultra low pressure plenum  32 . 
         [0057]      FIGS. 6-17  illustrate system for support of a body part of a patient turning and repositioning of the patient with simultaneous offloading of the bony prominences  300  in accordance with the teachings of the present invention. System  300  includes first ultra low pressure plenum  312  and second low pressure plenum  332 , as shown in  FIG. 6 . First ultra low pressure plenum  312  is configured to a shape to fit underneath a patient and support the lower back and/or hips of a patient. First ultra low pressure plenum  312  can include upper bladder  314  and extension bladder  315 . Extension bladder  315  extends from upper bladder  314 . Extension bladder  315  and upper bladder  314  can be integral to one another. Air pressure within upper bladder  314  and extension bladder  315  is reduced sufficiently for distributing pressure within first ultra low pressure plenum  312 , but is not providing support of the received body part by itself. Second ultra low pressure plenum  332  is formed of bladder  334 . Second ultra low pressure plenum  32  can be placed under first ultra low pressure plenum  12 . Dimples  311  can be formed in first ultra low pressure plenum  312  and dimples  331  can be formed in second ultra low pressure plenum  332 . Dimples  311  and dimples  331  can be aligned with one another. 
         [0058]    Cover  318  can be placed around first ultra low pressure plenum  312  and second ultra low pressure plenum, as shown in  FIGS. 7-9 . Cover  318  can be formed of a material having a low coefficient of friction. A suitable material having a low coefficient of friction is nylon or rip stop nylon material. Extension  325  of cover  318  receives extension bladder  315 . 
         [0059]    Portion  317  on upper surface  327  of extension  325  can be formed of a material having a high coefficient of friction. A suitable material having a high coefficient of friction is a rubberized or non-skid material. Portion  317  can be folded underneath rear surface  319  of upper bladder  314  to prevent movement of ultra low pressure plenum  312 , as shown in  FIG. 9 . Handles  320  can be provided adjacent either edge  322   a ,  322   b  of cover  318  to aid in movement. Handles  321  can be provided adjacent either edge  324   a ,  324   b  of extension  325  of cover  318  to aid in folding of extension  325  underneath rear surface  319 . 
         [0060]      FIGS. 10-17  illustrate use of system for support of a body part of a user turning and repositioning of the user with simultaneous offloading of the bony prominences  300 . In  FIG. 10 , system for support of a body part of a user turning and repositioning of the user with simultaneous offloading of the bony prominences  300  can be placed on bed  330 . System  300  can be moved to different positions on bed  330  using handles  320 , as shown in  FIG. 11 . 
         [0061]    Positioner  23  can be placed within pocket  331  of cover  318  to retain positioner  23 . Positioner  23  can be placed over upper bladder  314  of first ultra low pressure plenum  312  to displace gas in the direction of arrow A 2 , as shown in  FIG. 12 . When a user is recumbent on first ultra low pressure plenum  312  with their sacrum received on positioner  23 , gas will be displaced in upper bladder  314  in the direction of arrow A 3  towards outer edges  322   a ,  322   b  for providing support adjacent to edges  322   a  and  322   b  thereby providing support of the user within edges  322   a  and  322   b  and lifting user  340  from surface  311  of bed  330  and offloading the sacrum and trochanter of user  340 , as shown in  FIG. 13  and allow the body to be rotated over the support or bed. Additional positioners  23  can be placed in pocket  331  of cover  118  by lifting edge  322   a  to provide additional displacement of gas within upper bladder  314  as shown in  FIG. 14 . Extension  325  can be folded underneath rear surface  319  of upper bladder  314  to prevent movement of ultra low pressure plenum  312 , as shown in  FIG. 15 . 
         [0062]    In one embodiment, user  340  can be moved or turned by using handles  320 , as shown in  FIG. 16 . In one embodiment, positioner  23  can be positioned behind a side of cover  318  to push gas away from edges  322   a , thereby aiding in turning of a user towards the opposite edge, as shown in  FIG. 17 . For example, if the patient is to be turned towards edge  322   b , positioner  23  can be placed at edge  322   a  for displacing gas behind the patient to towards edge  322   b  of upper bladder  314 , thereby pneumatically assisting in turning of the patient to face edge  322   b.    
         [0063]    In one embodiment, positioner  400  can include ultra low pressure bladder  402 , as shown in  FIG. 18 . The pressure within ultra low pressure bladder  402  is a range of less than about 20 mm of water to about 5 mm of water or a range of less than about 10 mm of water to about 5 mm of water. It will be appreciated that all equivalents such as mm Hg and PSI can be used for measuring the pressure within ultra low pressure bladder  402 . In this embodiment, positioner  400  is formed with sufficient size and shape to displace an amount of gas in ultra low pressure bladder  402  to offload pressure from the received body part. Lower surface  406  of positioner  400  can be formed of a high friction material for preventing movement of positioner  400 . Positioner  400  can be placed on top of first ultra low pressure plenum  12  and/or or second ultra low pressure plenum  32  or beneath ultra low pressure plenum  12  and/or second ultra low pressure plenum  32 . 
         [0064]    Positioner  400  can be placed over lower bladder  16  of ultra low pressure plenum  12  to displace gas from lower bladder  16  to upper bladder  14  in the direction of arrows A 1 , as shown in  FIG. 4 . 
         [0065]    In one embodiment, positioner  23  can be used together with positioner  400 . Positioner  400  can be placed over lower bladder  16  of ultra low pressure plenum  12  positioner  23  can be positioned at one of edges  13   b  and  13   d  to push air away from respective edges  13   b  and  13   d  thereby aiding in turning of a patient towards the opposite edge, similar to positioner  23  as shown in  FIG. 5 . For example, if the patient is to be turned towards edge  13   d , positioner  23  can be placed at edge  13   b  for displacing gas behind the patient to towards edge  13   b  of upper bladder  14 , thereby pneumatically assisting in turning of the patient to face edge  13   d.    
         [0066]      FIG. 19  is an alternate embodiment of system for support of a body part of a patient turning and repositioning of the patient with simultaneous offloading of the bony prominences  500 . Positioner  523  can include inner bladder  524 . Inner bladder  524  is filled with fluidized material  525  which can retain its shape after sculpting. The flowability or lubricity of fluidized material  525  can be increased by adding a lubricant or by the removal of air from the interstitial spaces or both. The preferred medium of fluidized material  525  is a particulate material that has been modified in such a way that it acts like a fluid. Fluidized material  525  refers to a compound or composition which can be sculpted and retain its shape and has no memory or substantially no memory. The no memory or substantially no memory feature enables bladder  524  to increase in height and maintain support of a body part. Fluidized material  525  is made of a viscosity that will allow it to contour but not collapse under the weight of the body part. 
         [0067]    At sea level, the normal interstitial air pressure would exceed about 760 millibars of mercury. This increases or decreases marginally as altitude varies. Depending on the nature of the particulate fluidized material  525 , the pressure can be lowered below about 500 millibars to about 5 millibars, preferably, 350 millibars to about 5 millibars, while still maintaining the necessary flow characteristics of the product. 
         [0068]    Fluidized material  525  can include compressible and non-compressible beads, such as polyethylene or polystyrene (PS) beads, expanded polyethylene (PE), crosslinked expanded polyethylene (PE), polypropylene (PP) pellets, closed cell foams, microspheres, encapsulated phase changing materials (PCM). The beads can be hard shelled or flexible. In one embodiment, the beads are flexible and air can be evacuated from the beads. In one embodiment, hard beads can be mixed with flexible beads in which air can be evacuated from the flexible beads. In an alternative embodiment, fluidized material  525  can a porous foam substance including pockets of interstitial air. In one embodiment, fluidized material  525  can be a polyurethane foam. The polyurethane foam can be open or closed cell and cut into small shapes such as spheres or blocks. For example, a sphere of polyurethane foam can have a size of 2 inches in diameter. For example, a block of polyurethane foam can be a 1×1×1 inch block. 
         [0069]    Suitable examples of fluidized material  525  can be formed of a mixture of microspheres and lubricant. The microspheres can include hollow or gas-filled structural bubbles (typically of glass or plastic) with an average diameter of less than 200 microns. The composition flows and stresses in response to a deforming pressure exerted on it and the composition ceases to flow and stress when the deforming pressure is terminated. For example, fluidized material  525  can be formed of a product referred to as Floam™. A flowable compound comprising lubricated microspheres, including the compound itself, formulations for making the compound, methods for making the compound, products made from the compound and methods for making products from the compound as defined by U.S. Pat. Nos. 5,421,874, 5,549,743, 5,626,657, 6,020,055, 6,197,099 and 8,175,585, each of which is hereby incorporated by reference into this application. 
         [0070]    Fluidized material  525  can be kinetic sand. Kinetic sand can mold three-dimensionally. Kinetic sand can be formed of 98% sand and 2% polydimethylsiloxane to mimic the physical properties of wet sand. 
         [0071]    Fluidized material  525  can be a thixotropic fluid. 
         [0072]    For example, bladder  524  can be formed of a flexible plastic, such as urethane. Upon removal of gas from fluidized material  525 , bladder  524  flows concurrent with the flow of fluidized material  525  such that bladder  524  moves with movement of fluidized material  525 . For example, the gas can be air, helium, hydrogen or nitrogen. Optionally, gas can communicate throughout the whole bladder for allowing maximum contouring and functional displacement of both the gas and the fluidized chamber thereby providing maximum contouring to a desired body part. 
         [0073]    Outer bladder  530  is filled with fluidized material  532 . Fluidized material  524  is a composition which has greater flow characteristics than fluidized material  532 . Fluidized material  524  can be formed of a mixture of a lubricant and a material selected from the group comprising beads, polyethylene beads, polystyrene (PS) beads, expanded polyethylene (PE), crosslinked expanded polyethylene (PE), pellets, closed cell foams, microspheres, and encapsulated phase changing materials (PCM). Inner bladder  524  is adapted to be positioned adjacent a received body part to micro-contour to the received body part and outer bladder  530  macro-contours to inner bladder  524  after inner bladder  524  is micro-contoured to the received body part. 
         [0074]    Valve  540  can be coupled to outer bladder  530 . Valve  540  extending from outer bladder  530  permits the evacuation of all or some of the air from outer bladder  530  which causes outer bladder  530  to be reduced in size due to loss of air within fluidized material  524  and adjusts the rigidity of outer bladder  530 . Pump  550  can be attached to valve  540  for pumping air or releasing air manually or automatically. 
         [0075]    During operation, inner bladder  524  contacts a received body part to micro-contour to the body part. Outer bladder  14  is placed adjacent or underneath the inner bladder to macro-contour to inner bladder  524 . In one embodiment, air is removed from outer bladder  530  with valve  540  to support inner bladder  524 . After completion of use of system  500 , valve  540  can be released thereby drawing air back into outer bladder  530 . 
         [0076]    Outer bladder  530  can replace first ultra low pressure plenum  12  as shown in  FIG. 20 . Outer bladder  530  is configured to a shape to fit underneath a patient and support the lower back and/or hips of a patient. For example, outer bladder  530  can have a width W 1  of approximately 52 inches, and a height H 1  of about 35 inches. Alternatively, width W 1  can be a width of a bed, such as a hospital bed. Outer bladder  530  is formed of upper bladder  14  and lower bladder  16 . First upper bladder  14  can have a width W 2  and height H 2 . Lower bladder  16  has a smaller width dimension W 3  and height dimension H 3  than upper bladder  14 . Air pressure within upper bladder  14  and lower bladder  16  is reduced sufficiently for distributing pressure within first ultra low pressure plenum  12 , but is not providing support of the received body part by itself. Upper bladder section  14  extends between edges  13   a - 13   d . Lower bladder section  16  extends between edges  15   a - 15   d.    
         [0077]    Gripping handles  20  can be provided on either edge  22   a ,  22   b  to aid in movement of outer bladder  530  over surface  19 . Gripping handles  20  can be placed over a sheet of a bed and unweighted to allow the patient to be moved. In an alternative embodiment, gripping handles  20  are placed under the sheet and have a high coefficient of friction to prevent movement of outer bladder  530 . 
         [0078]    Outer bladder  530  can replace first ultra low pressure plenum  312  as shown in  FIG. 21  and  FIG. 22 . Portion  317  on upper surface  327  of extension  325  can be formed of a material having a high coefficient of friction. A suitable material having a high coefficient of friction is a rubberized or non-skid material. Portion  317  can be folded underneath rear surface  319  of outer bladder  530  to prevent movement of outer bladder  530 , as shown in  FIG. 21 . Handles  320  can be provided adjacent either edge  322   a ,  322   b  of cover  318  to aid in movement. Handles  321  can be provided adjacent either edge  324   a ,  324   b  of extension  325  of cover  318  to aid in folding of extension  325  underneath rear surface  319  as shown in  FIG. 22 . 
         [0079]    It is to be understood that the above-described embodiments are illustrative of only a few of the many possible specific embodiments, which can represent applications of the principles of the invention. Numerous and varied other arrangements can be readily devised in accordance with these principles by those skilled in the art without departing from the spirit and scope of the invention.