Abstract:
A patient support surface including a cover defining an interior region, a layer of three dimensional material, located at the interior region, and an air circulation device disposed adjacent the layer of three dimensional material. The patient support surface includes at least one of a percussion device and a vibration device, located at the interior region.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application claims the benefit of U.S. Provisional Patent Application Ser. No. 60/941,092, filed May 31, 2007, which is incorporated herein by this reference. 
     The present application is also related to U.S. patent application Ser. No. 11/119,980, entitled PRESSURE RELIEF SURFACE, and U.S. patent application Ser. No. 11/119,991, entitled PATIENT SUPPORT HAVING REAL TIME PRESSURE CONTROL, and U.S. patent application Ser. No. 11/119,635, entitled LACK OF PATIENT MOVEMENT MONITOR AND METHOD, and U.S. patent application Ser. No. 11/120,080, entitled PATIENT SUPPORT, all of which were filed on May 2, 2005, all of which are incorporated herein by this reference. 
     The present application is also related to U.S. Provisional Patent Application Ser. No. 60/636,252, entitled QUICK CONNECTOR FOR MULTIMEDIA, filed Dec. 15, 2004, which is incorporated herein by this reference. 
     The present application is also related to U.S. Provisional Patent Application Ser. No. 60/697,748, entitled PRESSURE CONTROL FOR A HOSPITAL BED and corresponding PCT application No. PCT/US06/26787 filed Jul. 7, 2006, and U.S. Provisional Patent Application Ser. No. 60/697,708, entitled CONTROL UNIT FOR A PATIENT SUPPORT, and corresponding PCT application No. PCT/US06/26788 filed Jul. 7, 2006, and U.S. Provisional Patent Application Ser. No. 60/697,748 entitled PATIENT SUPPORT and corresponding PCT Application No. PCT/US06/26620 filed Jul. 7, 2006 and PCT application No. PCT/US05/14897 entitled PATIENT SUPPORT filed May 2, 2005, all of which are incorporated herein by this reference. 
     The present application is also related to U.S. Provisional Patent Application Ser. No. 60/821,494, entitled PATIENT SUPPORT, which was filed on Aug. 4, 2006, the disclosure of which is incorporated herein by this reference. 
    
    
     BACKGROUND 
     The present disclosure relates to support surfaces, such as mattresses. More particularly, the present invention relates to support surfaces used to support a patient on a bed frame, such as in a hospital or other patient care environment. Even more particularly, the present invention relates to support surfaces for patients that require pulmonary therapy. 
     Known hospital beds and mattresses are disclosed, for example, in U.S. Pat. No. 4,949,413 to Goodwin, U.S. Pat. No. 5,647,079 to Hakamiun et al., U.S. Pat. No. 5,731,062 to Kim et al., U.S. Pat. No. 6,269,504 to Romano et al., U.S. Pat. No. 6,701,556 to Romano et al., U.S. Pat. No. 6,708,352 to Salvatini et al., and U.S. Pat. No. 6,820,630 to Hand et al., all of which are assigned to the assignee of the present invention and all of which are incorporated herein reference herein in their entirety. 
     SUMMARY OF THE INVENTION 
     The present invention may comprise one or more of the features recited in the appended claims and/or one or more of the following features or combinations thereof. 
     According to one aspect of the present invention there is provided a patient support surface including a cover defining an interior region, a layer of three dimensional material, located at the interior region, the three-dimensional material including a network of thermoplastic fibers, an air circulation device disposed adjacent the layer of three dimensional material, and at least one of a percussion and a vibration device, located at the interior region. 
     According to another aspect of the present invention there is provided a patient support surface including a cover defining an interior region, a layer of three dimensional material, located at the interior region, the three-dimensional material including a network of thermoplastic fibers, an air circulation device disposed adjacent the layer of three dimensional material, and a hose, located at the interior region, including at least one connector adapted to couple to an external device. 
     Pursuant to another aspect of the present invention there is provided a hospital bed including a frame, to support a patient, and a support surface; located on the frame. The support surface includes a cover defining an interior region and a layer of three dimensional material, located at the interior region. The three-dimensional material includes a network of thermoplastic fibers, an air circulation device disposed adjacent the layer of three dimensional material, and at least one of a percussion and a vibration device, located at the interior region. 
     According to still another aspect of the present invention there is provided a patient support surface having a head end and a foot end. The patient support surface includes a cover defining an interior region, a layer of three dimensional material, located at the interior region, the three-dimensional material including a network of thermoplastic fibers, an air circulation device disposed adjacent the layer of three dimensional material, and a head elevation device, located at the head end of the patient support surface, the head elevation device including a support surface to elevate the head end of the patient support surface. 
     Features and other aspects of the present disclosure will become apparent to those skilled in the art upon consideration of the following detailed description of illustrative embodiments, which exemplify the best mode as presently perceived. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The detailed description particularly refers to the accompany figures in which: 
         FIG. 1  illustrates a perspective view of a pressure relief support surface including a slot for an x-ray cassette; 
         FIG. 2  illustrates an exploded perspective view of a multi-layered pressure relief support surface; 
         FIGS. 3 ,  4 , and  5  illustrate a perspective view a pressure relief support surface and an x-ray cassette at is passes through a slot; 
         FIG. 6  illustrates a perspective view of a multi-layered pressure relief support surface including percussion and vibration bladders; 
         FIG. 7  illustrates an exploded perspective view of sensors with respect to cushion sections; 
         FIG. 8  illustrates a perspective view of a multi-layered pressure relief support surface with turn assist bladders; 
         FIG. 9  illustrates a sectional view of the support surface of  FIG. 1  along a line  9 - 9 ; 
         FIGS. 10-12  illustrate perspective view of a controller including user interface; 
         FIG. 13  illustrates a perspective view of an airway clearance system integrated with a pressure relief support surface through a control unit; 
         FIG. 14  illustrates a perspective view of an airway clearance system integrated directly with a pressure relief support surface; 
         FIG. 15  illustrates a perspective view of a control unit with a holder for a deep vein thrombosis device; 
         FIGS. 16-18  illustrate user interface screens of the present invention; 
         FIG. 19  illustrates an end view of one embodiment of an elevation device; 
         FIG. 20  illustrates a side view of one embodiment of an elevation device; 
         FIG. 21  illustrates a schematic illustration of  FIG. 19 ; 
         FIG. 22  illustrates a pressure relief support surface and a frame including integrated device; 
         FIG. 23  illustrates a block diagram of a control and communication system; and 
         FIGS. 24-30  illustrate additional user interface screens of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF THE DRAWINGS 
       FIG. 1  illustrates a perspective view of a pressure relief support surface  10 , or mattress, including a slot  26  for inserting an x-ray cassette  27 . The pressure relief support surface  10  includes a cover  12  which surrounds a plurality of components to be described later herein. The cover  12  includes a top surface  14  and a bottom surface  16 , each of which is coupled together by longitudinal sides  18  and  20 . A first end portion  22  located at a head end  23  of the surface  10  and a second end portion  24  located at a foot end  25  of the surface  10  complete the cover  12 . Slot  26  includes an aperture located along at least one of the longitudinal sides  18 ,  20 . Slot  26  provides for placement of an x-ray cassette  27  beneath the top surface  14  of the cover  12 . 
     Such pressure relief support surfaces are typically used in health care facilities such as hospitals, nursing homes, and extended care facilities. The use of such surfaces is not limited to such facilities, however, and can be used where there is a need, including the home. 
     In the illustrated embodiment, the slot  26  extends from one side  18  of surface  10  to the other side  20 . The slot  26  includes a second aperture located along the longitudinal side  20  and provides for passage of the x-ray cassette  27  from a first side  18  of the mattress  10  to a second side  20  of the mattress  10 . The interior region of the slot  26 , located between sides  18 ,  20  of the mattress  10 , includes a low friction material to facilitate insertion and removal of the x-ray cassette  27  without disturbing a patient positioned on the mattress  10 . The slot  26  includes a length, L, which is greater than a width, W, of the x-ray cassette  27 . In addition, the longitudinal slot  26  is disposed along a central portion of the support surface  10 . Accordingly, that the x-ray cassette  27  can be positioned at a number of locations along the support surface and beneath a patient. While the longitudinal slot  26  is shown disposed towards a central portion of the support surface  10 , the longitudinal slot can be disposed closer to the head end or the foot end portions of the support surface  10 . Additional slots can be included as well. Also, the length L of the slot is not fixed but can be selected to accommodate a variety of sizes of x-ray cassettes  27  as well as to accommodate a variety of positions of the x-ray cassette  27  beneath a patient. For instance, the slot  26  as illustrated enables the caregiver to position the x-ray cassette  27  along or underneath the torso portion of a patient. 
     The pressure relief support surface  10  includes a head of bed indicator  30 . The head of bed indicator  30  includes a light  32  or other illumination device which indicates when the head of the bed (HOB) elevation passes a certain predetermined elevation. In one instance, when the head of bed elevation passes thirty degrees, the indicator  32  will light thereby indicating that the desired elevation has been reached. Because the pressure relief support surface  10  can be used on any number of bed frames, including those which are fixed in a horizontal plane and those which are continuously or partially adjustable, the head of bed indicator  30  can be either permanently or detachably coupled to the support surface  10 . 
       FIG. 2  illustrates an exploded perspective view of the multilayered pressure relief support surface  10 . As illustrated in  FIG. 2 , the cover  12  including the slot  26  is shown at the bottom of the figure and is separated from the remaining layers or components of the pressure relief support surface  10 . A perimeter cushion system is disposed within the cover  12  and includes a first section or portion  40 , a second section or portion  42 , and a third section or portion  44 . The perimeter cushion system provides a side and end support of the support surface  10  such that a patient subjected to either turn assist or rotational therapy, to be described later herein, can be cradled to help maintain the patient&#39;s location within a central portion of the surface  10 . 
     The first section  40  includes a plurality of pieces as illustrated each of which can be either completely separated from an adjacent piece or coupled thereto but still including therebetween a separation line. The use of distinct individual pieces either completely separated or coupled to adjacent pieces provides for articulation of the support surface  10  when used on an articulateable frame. As can be seen, the first section  40  includes first and second end portions  46 , first and second head end portions  48 , first and section foot end portions  50 , first and second thigh portions  52 , and first, second, third, and fourth middle portions  54 . While a predetermined number of individual portions are illustrated, it is possible to incorporate more or less portions than shown depending on the application of the mattress and its use with a bed frame. 
     Each of the portions  48 ,  50 ,  52 , and  54  include an angled side wall which creates an interfacing surface with angled side walls of the individual portions of the second section  42 . The second section  42  includes first and second head end portions  56 , first and second foot end portions  58 , first and second thigh portions  60 , and first, second, third, and fourth middle portions  62 . 
     Each of the portions of the second section  42  include angled side walls which cooperate with and which contact the angled side walls of the portions of the first section  40  corresponding thereto. The height of the portions of the second section  42  are less than the height of the individual portions of the first section  40 . When the second section  42  is placed within the first section  40 , each of the portions  42  cooperate to define a substantially horizontal surface  64  upon which the third section  44  can be placed. 
     The third section  44  includes a plurality of perimeter bolsters including first and second head end portions  66 , first and second foot end portions  68 , first and second head end side portions  70 , first and second foot end side portions  72 , first and second thigh portions  74 , and first, second, third and fourth middle portions  76 . Each of the portions of the third section  44  are separable from adjacent portions or are coupled for flexibility when used with an articulated deck. In addition, the first and second parts of the portion  66  are spaced apart to define a gap  67  and a similar space or gap  69  exists between the first and second portions  68 . When the first section  40 , the second section  42 , and the third section  44  are assembled together, the space  67  between the portions  66  and the space  69  between the portions  68  correspond to spaces, respectively  80  and  82  of the first section. The spaces  67 ,  69 ,  80  and  82  define an aperture to locate a first air circulation device or fan  84  and a second fan or circulation device  86 , to be described later herein. 
     A plurality of pressure sensors  88  are located and disposed above turning/rotation air bladders  90  and  92 . Force sensing transducers can also be used. The turning/rotation bladders  90  and  92  provide for turning a patient and/or rotating a patient under continuous lateral rotation as would be understood by one of ordinary skill in the art. The plurality of pressure sensors  88  include a first section  94 , a second section  96 , a third section  98 , a fourth section  100 , and a fifth section  102 . Each of the plurality of pressure sensor sections provide a single signal which indicates a pressure amount being supported by respective sections  110  of air cushions. In particular, each section  110  can include a plurality of upstanding air cushions having a cylindrical shape. Other types of cushions or bladders are possible. 
     Each of the sections of upstanding cells or air cushions includes a plurality which is disposed directly upon a corresponding pressure sensor section. Consequently, when a patient lies upon the pressure relief support surface  10 , patient pressures upon different portions of the surface  10  can be individually determined by the pressure or force sensor located therebelow. Consequently, pressures for head portions, upper body portions, middle portions, side portions, and leg portions, and other portions of a patient can be individualized for each patient&#39;s body. 
     Each of the sections  110  of cells includes upstanding cylinders or inflatable cushions which have spaces disposed therebetween. Within the spaces of the upper body section, a thermo-regulation device  112  can be disposed. The device  112  provides for thermal regulation of a patient and can cool and warm a patient. The device  112  can include any number of thermal regulation mechanisms, however, the present device  112  includes a plurality of fluid filled or water filled chambers which are disposed between the spaces of the head end section  110  for the upper body portion. As fluid or water is moved through the thermal regulation device  112 , it is circulated beneath a patient to provide cooling or heating to the patient&#39;s upper body. Fluid flow or water flow can move in one direction throughout the device, as would be understood by one skilled in the art, and passes through a controlling device (not shown) which includes a pump and a mechanism for thermal regulation of the fluid. 
     A topper  114  is located above the sections  110 . The topper includes a three dimensional material or a three dimensional fiber network made of a breathable fabric or other known three dimensional materials. One such material is known as SPACENET® material. For a further discussion of three dimensional materials, see U.S. Pat. Nos. 7,191,482; 6,701,556; and 6,269,504; all of which are incorporated by reference herein in their entirety. 
     The three dimensional material  114  enables the air circulators  84  and  86  to circulate air through the topper  114 . The air circulators  84  and  86  can be configured such that one of the circulators  86  is used to push air through the topper and the other air circulator is used to pull air through the topper. Consequently, air flow can be directed in a single direction. 
     A percussion and vibration system  116  is included and disposed at an upper body portion of the support surface  10 . The percussion and vibration system provides for the percussion and vibration of a chest portion of a patient as is understood by one of ordinary skill in the art. Percussion and vibration systems are known and can include a plurality of air bladders, three of which are illustrated. 
       FIGS. 3 ,  4 , and  5  illustrate a partial perspective view of the x-ray cassette  27  as it passes through the slot  26 . While  FIGS. 3 and 4  do not illustrate one of the portions of the topper  114 , the x-ray cassette  26  when in use can be located above the upper body portion of the topper  114 . 
       FIG. 6  illustrates a perspective view of the multi-layered pressure relief support surface  10  without the cover  12 . In this illustration, the percussion and vibration bladder  116  is located in the upper body portion of the mattress  10  to provide percussion and/or vibration to the chest area of a patient. 
       FIG. 7  illustrates the arrangement of the pressure sensors  88  with respect to the cushion sections  110 . The individual sections  110  have been moved closer together to illustrate that the upstanding cushions when assembled provide a substantially continuous support surface without gaps between sections as is illustrated in  FIG. 2 . The individual sections of the pressure sensors  88  have also been moved closer together and the entire combination fits within the cavity defined by the first section  40 , second section  42 , and third section  44  of the perimeter cushion system of  FIG. 2 . In other embodiments, horizontal, laterally-oriented or log-shaped bladders may be used in place of one or more of the upstanding cushion sections. 
       FIG. 8  illustrates the various portions and layers of  FIG. 2  excluding the cover  12  and the x-ray cassette  27 . The turning/rotation bladders  90  and  92  are substantially located within a central portion of the mattress for providing turning as well as continuous lateral rotation. 
       FIG. 9  illustrates a sectional view of the support surface  10  of  FIG. 1  along a line  9 - 9 . As previously described, and as seen here in additional detail, the portions  58  are in contact with the portions  50  of the first section  40  and define an interface therebetween along the angled side walls of each. The section  72  of the third section  44  sits upon a substantially flat and horizontally disposed top surface of the portion  50 . Also, as can be seen, the upstanding cushions  110  are located above the pressure sensors  102 . 
       FIGS. 10-12  illustrate a controller  120  including a user interface  122 . The user interface  122  is coupled to the controller  120  through a swiveling mechanism  124  which enables the  122  to lay substantially flat against a top portion  126  of the controller  120 . The swiveling mechanism  124  enables the pivoting screen to move about an axis substantially parallel to the long dimension of the controller  120 . The swiveling mechanism also includes a rotating portion  128  which enables the interface  122  to rotate about an axis substantially vertical with respect to the plane of the top portion  126 . The swiveling mechanism  124  and rotating portion  128  in combination provide an adjustment capability which allows the pivoting interface to be moved in a variety of positions for improving access of the interface  122  to a user or caregiver. The user interface can include a variety of selectors which can include touch screen selectors, pressure sensitive buttons, and/or mechanical switches. Other later described screens can include the same selectors. The user interface can also include an electronic display, such as an liquid crystal diode (LCD) display which can display user interface screens to be described later herein. 
       FIG. 13  illustrates a perspective view of an airway clearance system  130  integrated with a support surface through a control unit  131 . The mattress or support surface  10  is illustrated with the cover  12  but not including the slot  26 , which can be optional. The airway clearance system  130  includes a high frequency chest wall oscillation device  132  which is coupled to the control unit  131 . One example of such a device is available from Hill-Rom, Inc. as The Vest® airway clearance system. 
     The control unit  131  provides for chest wall oscillation through the use of forced air which is moved through first and second tubes  136 ,  138  which are coupled to the controller  131  through first and second couplers  140 ,  142 . The tubes  136  and  138  are coupled to an upper body portion  144  which surrounds the chest wall and provides high frequency chest wall oscillations for the purpose of airway lung clearance and ventilation as described in U.S. Pat. No. 6,736,785, which is incorporated in its entirety by reference herein. 
     As illustrated in  FIG. 13 , the controller  131  is coupled to the upper body portion  144  and enables a patient or other user who may or may not be located on the support surface  10  to use the airway clearance system  130 . For instance, when a patient is sufficiently mobile to move within a facility and to sit in a chair within a hospital room, the patient can wear the upper body portion  144  when seated in a chair. As further illustrated in  FIG. 14 , the controller  134  can also be coupled directly to the support surface  10  through a hose  150 . The hose  150  is coupled to a connector  152  which is in turn coupled to an internal hose device  154  which passes through and is incorporated in the support surface  10 . A first and a second connector  156  and  158  respectively terminate the hose  150 . Using this connection  156 ,  158  to couple to an external device, a patient lying with his or her head located at the head of the bed (HOB) can wear the upper body portion  144  when lying in bed to provide the chest wall oscillation. When controller  131  detects connection of an airway clearance system  132 , controller  131  automatically disables or bypasses the mattress pulmonary therapy functions and the controller user interface  123  is automatically updated to visually indicate the status of a connection or disconnection of the airway clearance system. In this way, controller  131  can be used to control inflation and deflation of bladder portions of mattress  10  and/or to control operation of the airway clearance system  132 . As such, the need to provide multiple separate control units (i.e., a mattress controller and an airway clearance system controller) may be eliminated. 
     Alternatively or in addition, controller  131  is sized and shaped so that a separate airway clearance system controller is stackable on top of or underneath controller  131 , to thereby conserve space in the patient&#39;s healthcare environment. Controller  131  may include all or a portion of the features of control unit  120  or control unit  160 . 
       FIG. 15  illustrates a perspective view of a control unit  160  having a holder  162  which can be used to support a deep vein thrombosis device (DVT)  164  by insertion into holder  162  as indicated by arrow  163 . A cuff is generally provided with DVT device  164  but is not illustrated. The controller  160  includes a first attachment device  166  and second attachment device  168 . Devices  166 ,  168  can include a first and second hook, which can be used to hang the controller  160  on a footboard, headboard, and/or side rail of a patient support frame. The controller  160  includes a user interface  170  which is fixed and coupled to the controller  160 . The DVT device  164  can be used to provide pneumatic pressure to a body limb to reduce or to prevent deep vein thrombosis. For additional details, please see U.S. Pat. Nos. 6,447,467 and 6,494,852 which are incorporated herein by reference in their entirety. 
       FIGS. 16-18  illustrate various user interface screens displayed on a user interface  170  such as previously described. In the illustrated embodiments, a touch screen, including a liquid crystal display (LCD) and touch sensors are used, however, it will be understood by those skilled in the art that other suitable displays and/or input-output devices may also be used. Also, in the embodiment of  FIGS. 16-18 , status information is generally displayed on the left-hand side of the screen while activatable buttons are generally located on the right-hand side of the screen. Each of the tabs listed down the right-hand side of the screen, i.e., “home”, “rotation”, “percussion”, “vibration”, “chest device”, “max inflate”, “turn assist”, and “opti-rest” relates to another user interface screen comprising information and user-activatable controls relating to the identified functional capabilities. In this way, all of the available functions are displayed at all times for easy access by the user. However, in the illustrated embodiment the screen that is currently in use or active is emphasized or offset from the inactive screens by highlighting or contrasting color. 
     For example, as illustrated in  FIG. 16 , the user interface screen includes a portion  171  which is entitled “HOME”. The “HOME” section enables a user to select certain tabs which initiate therapies. Those tabs can include rotation, percussion, vibration, and chest device corresponding to the chest wall oscillation device. Additional tabs are provided for adjusting mattress functions such as maximum inflate, turn assist, and Opti-rest. Opti-rest is a wave-like comfort modality with cushion pressures alternating to enhance patient comfort. A status section  172  indicates the status of rotation, percussion and/or vibration depending on which tabs have been selected on the right hand portion of the user interface  170 . 
     As further illustrated in  FIG. 17 , should the rotation tab be selected, a rotation screen  170  indicates and provides the amount or percentage of rotation for a right, a center, and a left position at a status area  172 .  FIG. 17  illustrates an “empty” status area  172  in which no pulmonary therapy options have been initated.  FIG. 18  illustrates a status area  172  in which rotation percentages have been set and a rotation therapy is in progress. In such event, status area  172  indicates the amount of time remaining until the therapy is complete. 
     Slider bars, or arrows  173  and  174 , can be used to select the desired settings. For instance, as illustrated in the right tab in which the right side of the body is lower than the left side, the rotation is set at 50% with the up down arrow  173 . The pause time can be set to 15 minutes with the up down arrow  174 . An enter button  175  is provided to finalize or to accept the settings made for pause and rotation. In addition to the right screen, a center screen and a left screen are also provided which can be selected by touching the desired center or left tab. As described with respect to the right screen, the rotation percentage and pause time can be set for both center and left. Once the right, center and left settings have been selected, the enter button  175  is selected to enter the data into the controller. The rotation screen, located below the status screen  172 , indicates the values of rotation, pause, as well as time remaining. If either percussion and/or vibration is selected, the settings are made similarly as described with respect to the rotation screen and entered as necessary with the enter button. Once entered, the status screen  172  which includes a section for percussion and vibration shall illustrate the selected settings. A pause button  176  can be used to pause the selected treatments and then return to those treatments by touching the pause button a second time. Also, if it is desired to completely stop the selected treatment, the stop button  177  can be selected to stop the selected treatment as well as to clear the previously established settings. 
     The max inflate tab can be selected to inflate the cushions of the support system  10  to a maximum inflation, for instance, to enable a patient to enter and exit the bed more easily or to provide for cardio-pulmonary resuscitation. A turn assist tab is included and can be selected to elevate a left side or a right side of a patient to move a patient on one side or the other such that clothing and/or bed linens can be changed or removed. An Opti-Rest tab can be pressed to provide the wavelike comfort modality. 
       FIG. 19  illustrates a head-end view of one embodiment of an elevation device  180 , which may be used in place of turning/rotation bladders  90 ,  92 . The elevation device  180  has two hinge points  191  and  193  and thereby provides a function of alternatingly elevating each lateral side of the head end of the support surface. The elevation device  180  includes a bellows type of construction as illustrated in a side view of  FIG. 20  and a schematic view of  FIG. 21 . The elevation device  180  of  FIGS. 19-21 , illustrated in  FIG. 19  as an end view from the head end of the mattress and in  FIG. 20  as a side view from one of the sides of the mattress, includes first, second, third, and fourth compartments  182 ,  184 ,  186 , and  188 . Each compartment  182 ,  184 ,  186 , and  188  has a first width  185 , and a second width  187 . 
     As shown in  FIG. 21 , an outer layer of the bellows  180  includes a first length L 1  and an inner layer includes a length L 2 . Each compartment  182 ,  184 ,  186 , and  188  has length L 2 . The bellows  180  includes at least one fill port  190  which is used to fill the bellows or a portion thereof with a fluid such as air. A reinforcer  192  is used around the outer compartments of the bellows  180  to help prevent distortion due to pressure variations. 
     In the illustrated embodiment, device  180  is configured to elevate one lateral side of mattress  10 , relative to the other side, and another device  180  may be positioned laterally adjacent the first device  180  to elevate the other lateral side of the mattress  10 . For instance, one instance of device  180  is positioned to provide turning assistance or rotational therapy to a patient&#39;s left side while another instance of device  180  is positioned opposite the first instance of device  180 , across the width of the mattress  10 , to provide turning assistance or rotational therapy to a patient&#39;s right side. In this embodiment, the first width  185  of compartments  182 ,  184 ,  186 ,  188  is larger than the second width  187  so that when fluid is provided through port  190  the bellows shape is created such that the height of the device  180  on the side of the compartments  182 ,  184 ,  186 ,  188  containing the first width  185  is higher than the height of the device on the side containing the second width  187 , in order to provide the specified turning or rotation angle “A”. 
     In one alternative embodiment, referred to herein as the “dual hinge” embodiment, reinforcer  192  also comprises an internal air flow barrier along the dashed line between points  189  and  192  of  FIG. 21 , which extends into the interior region of compartments  182 ,  184 ,  186 , and  188  to control air flow between first and second portions  195 ,  197  of the compartments  182 ,  184 ,  186 , and  188 . As a result, air can be held in either portion  195  or portion  197  to provide turning assistance, or air can be alternatingly exchanged between portion  195  and  197  to provide rotational therapy. In the dual hinged embodiment, when portion  195  of compartments  182 ,  184 ,  186 , and  188  is inflated, device  180  is hinged at point  193 . When portion  197  of compartments  182 ,  184 ,  186 , and  188  is inflated, device  180  is hinged at point  191 . In the dual hinged embodiment, first and second widths  185 ,  187  are substantially the same. 
     As can be seen in  FIGS. 19 and 20 , device  180  comprises a pair of longitudinally spaced bellows  181 ,  183  that may be operable either in concert or independently to provide turning assistance or rotational therapy. Each device  181 ,  183  includes a substantially rigid support  194 ,  195 , which rests upon the top portion of the bellows  180  and is held thereto by straps  196 ,  197 . The substantially rigid support  194  provides for a supporting surface during elevation and rotation of the head or torso portion of the patient support  10 . 
     The device  180  is not limited to elevation of the head or torso, but may also be used to elevate the lower extremities if placed at the foot end of the support surface. For example, either or both of sections  181 ,  183  of device  180  may be positioned underneath leg, calf or foot portions of a patient, and portions  195 ,  197  may be alternatively inflated and deflated, independently or at the same time, to exercise either or both of the knee joints of a patient positioned on mattress  10 . 
     In one embodiment, the elevation device  180  is constructed to provide an elevation of about thirty degrees from horizontal. Other elevations are also possible, for example by inflating less than all of the compartments  182 ,  184 ,  186 , and  188 . To achieve a greater degree of rotation, i.e., in the range of about 45°, a portion of the surface bladders  110  may be deflated under one side  195  while the opposite bellows  197  are inflated, or vice versa. In such event, one or more perimeter bladders/supports  40 ,  42 ,  44  provide additional support to the non-elevated side of the patient. A string potentiometer, one or more ball switches, or other suitable device may be operably connected to the mattress and control unit to measure and monitor the degree of rotation provided by the portions  181 ,  183  of device  180 . 
       FIG. 22  illustrates another embodiment of the present invention in which the support surface  10  is placed upon a frame  200  which includes and integrated device or a number of integrated components and features which interact with and provide support for the features of the support surface  10 . For instance, all or a portion of the surface controls and user interfaces previously described with respect to the controllers  120 ,  131 ,  160  and also described later herein of  FIGS. 16 ,  17 , and  18  can be integrated into the one or more of the frame siderails  209 ,  211 . In addition, the frame  200  includes an integrated control system  199  including first and second connection ports  202  and  204  into which a high frequency chest wall oscillation device  215  can be connected via hoses  217 ,  219 . Vest device  132  may similarly be connected to ports  202 ,  204 . In the embodiment of  FIG. 22 , aspects of the controller  131  of  FIG. 13  are incorporated into the frame control system  199 . Because the support surface  10  includes an integrated percussion and vibration, rotational therapy, and low air loss wound care/prevention surface, the surface/frame combination can provide a plurality of healthcare features in an integrated surface/frame combination. 
       FIG. 23  illustrates a block diagram of a bed frame or pressure relief surface control and communication system, such as controllers  120 ,  131 ,  160 ,  199 , including controlling and communication devices to communicate with an integrated chest wall oscillation device such as device  132  or device  215 . The communication system includes a liquid control display (LCD) device or other user interface device  210  which receives from a user a selection of mode, mode parameters and alarm resets. This information is displayed to the user. The parameters can include, for example, comfort adjust, percussion, vibration, and settings for the chest wall oscillation device. The user interface screen is coupled to an algorithm control unit  212  which processes pressure relief algorithms for the pressure relief surface. In addition, pressure setpoints are determined by the algorithm control unit  212  and also algorithm control unit  212  also processes patient position monitoring, motion monitoring, and controls a compressor. The unit  212  also communicates with the chest wall oscillation device, power printed circuit board (PCB) and provides the control settings for the chest wall oscillation device. 
     The algorithm control unit  212  communicates and is coupled to the chest wall oscillation device power board  214  by a connection  224 , described further below. The power board  214  receives amplitude and frequency signals and directly stimulates the air generator for the chest wall oscillation device. The power board  214  also provides feedback to the algorithm control unit  212 . 
     An air control board  216 , which can be located within the pressure relief surface  10  or which can be located in one or more of the previously described controllers, is also coupled to the algorithm control unit  212 . The air control board  216  receives pressure setpoints which have been set in the algorithm control unit  212  as well as controls the valves in response to instructions either provided by the algorithm control unit  212  or which have been set by a user at the user interface or LCD  210 . The air control board  216  also generates requests to the algorithm control unit  212  to turn the pump ON and OFF which controls the pressure in the individual air cushions or bladders. 
     The support surface  10 , as previously described, includes pressure sensing or force sensing transducers  218 . These pressure sensing or force sensing transducers  218  are coupled to a multiplexor hub  220  which is, in turn, coupled to the algorithm control unit  212 . The multiplexor hub  220  receives data from the transducers or sensors and retransmits the data on a bus which is located in the communication system described in  FIG. 23 . The bus is a network bus and the network can be of one or more types, including an ECHELON network and/or controller area network (CAN). To provide communication between the bed frame and various other described features, a gateway device  222  receives data from the bed frame first network and provides information on a second network. The second network transmits signal information such as head angle, side rail status, side rail button, switch presses, and patient weight. The first network in the described embodiment can include an ECHELON network and the second network can include a CAN. 
     Interfacing an airway clearance system as a component in the mattress system may reduce the number of components required to be provided in the airway clearance system controller or eliminate the need for a separate controller. For instance, a local display may not be required at the airway clearance controller since the mattress controller display can be used to show airway clearance information and controls. Also, power and motor control may be shared by the two systems. This combined architecture requires isolation and grounding issues to be addressed. 
     Accordingly, connection  224  may include an AC isolation transformer and be configured to use the local ground as the system reference. For example, a 5 Amp AC isolation transformer may be used to isolate the airway clearance system board  214  from the AC supply, and allow the connection of the airway clearance system board  214  to the mattress system ground. If an isolation transformer is used, and an additional power relay is used to control the power to the airway clearance system board  214 , Table 1 illustrates signals that may be used to communicate from the algorithm board  212  to the airway clearance system board  214 . 
     
       
         
               
               
               
             
           
               
                 TABLE 1 
               
               
                   
               
               
                 SIGNAL 
                 TYPE 
                 DESCRIPTION 
               
               
                   
               
             
             
               
                 BLOWER_REQ 
                 OUT 
                 PWM to DC signal - control 
               
               
                   
                   
                 blower speed 
               
               
                 BLOWER_HALL 
                 IN 
                 Hall sensor - blower motor speed 
               
               
                 DIAPHRAGM_REQ 
                 OUT 
                 PWM to DC signal - control 
               
               
                   
                   
                 diaphragm speed 
               
               
                 DIAPHRAGM_HALL 
                 IN 
                 Hall sensor - diaphragm motor 
               
               
                   
                   
                 speed 
               
               
                 POWER_RELAY 
                 OUT 
                 Relay control for VEST power 
               
               
                   
                   
                 relay 
               
               
                 VEST_PRESENT 
                 IN 
                 VEST system is present/powered 
               
               
                   
                   
                 signal 
               
               
                 GND 
                 GROUND 
                 Signal ground - mattress side 
               
               
                   
               
             
          
         
       
     
     The POWER_RELAY signal may be used to power the airway clearance system, when requested, and the VEST_PRESENT may be used to verify that the airway clearance system is present and powered. The BLOWER_REQ signals control the blower motor voltage, and the BLOWER_HALL returns the motor speed. The DIAPHRAGM_REQ signals control the blower motor voltage, and the DIAPHRAGM_HALL returns the motor speed. Software algorithms correlate the speed and pressure. 
     An additional input to the algorithm processor  212  may also be needed, to detect when the airway clearance system air supply is connected to the mattress air system, rather than the actual airway clearance. 
     Connection  224  may alternatively include opto isolators and mechanical isolation. Optically isolated signals may be used to provide the needed airway clearance system isolation from the AC system. This configuration allows the airway clearance system board  214  to remain directly connected to the AC supply, and provides an interface with opto isolators in each direction to provide an isolated communication path between the algorithm board  212  and the airway clearance system board  214 . This approach may require a level of mechanical isolation to ensure isolation. A relay controlled by the algorithm board  212  may be provided between the AC source and the airway clearance system board  214 , for additional safety and to remove power to the airway clearance system when not in use. A signal indicates the connection and/or powering of the airway clearance system board  214 . 
     If the opto isolator approach is used, and an additional power relay is used to control the power to the airway clearance system board, Table 2 illustrates signals that may be used to communicate from the algorithm board  212  to the airway clearance system  214 . 
     
       
         
               
               
               
             
           
               
                 TABLE 2 
               
               
                   
               
               
                 SIGNAL 
                 TYPE 
                 DESCRIPTION 
               
               
                   
               
             
             
               
                 +5 V 
                 POWER 
                 Interface power - mattress side 
               
               
                 BLOWER_REQ 
                 OUT 
                 PWM to DC signal - control 
               
               
                   
                   
                 blower speed 
               
               
                 BLOWER_HALL 
                 IN 
                 Hall sensor - blower motor speed 
               
               
                 DIAPHRAGM_REG 
                 OUT 
                 PWM to DC signal - control 
               
               
                   
                   
                 diaphragm speed 
               
               
                 DIAPHRAGM_HALL 
                 IN 
                 Hall sensor - diaphragm motor 
               
               
                   
                   
                 speed 
               
               
                 POWER_RELAY 
                 OUT 
                 Relay control for VEST power 
               
               
                   
                   
                 relay 
               
               
                 VEST_PRESENT 
                 IN 
                 VEST system is present/powered 
               
               
                   
                   
                 signal 
               
               
                 GND 
                 GROUND 
                 Signal ground - mattress side 
               
               
                   
               
             
          
         
       
     
     The POWER_RELAY signal is used to power the airway clearance system, when requested, and the VEST_PRESENT is used to verify that the airway clearance system is present and powered. The BLOWER_REQ signals controls the blower motor voltage, and the BLOWER_HALL returns the motor speed. the DIAPHRAGM_REQ signals controls the blower motor voltage, and the DIAPHRAGM_HALL returns the motor speed. Software algorithms correlate the speed and pressure. Each side of the interface provides local +5V power and ground. 
     As additional input to the algorithm processor  212  may also be needed, to detect when the airway clearance air supply is connected to the mattress air system, rather than the actual airway clearance unit. 
     The opto isolators and relay may be located on the same circuit board, and may be associated with the airway clearance board  214  to minimize the exposure of the circuitry at a high voltage. 
     Two possible configurations for the mattress—airway clearance system interface are described above. Each approach has associated pro and cons. The opto isolated approach may have a lower electrical cost, but may have an increased mechanical cost to ensure sufficient airway clearance system isolation. The isolation transformer approach may provide a simpler mechanical design and better isolation, but may have an additional cost associated with the isolation transformer. The cost and risk associated with each approach will need to be evaluated to determine the best system approach for a particular implementation of the present invention. 
     The airway clearance system board interface is designed to communicate with the user interface board  210  in close proximity. If the cable distance between the algorithm board  212  and the airway clearance system board  214  is a significant distance, signal conditioning may be required, using digital signals, and an interface board may need to be located physically closer to the airway clearance system board  214 . Low voltage drivers, or RS232 drivers may be used to boost the signal level. The PWM to DC filtering should be done close to the airway clearance system board  214  to minimize noise on this signal. If the opto isolated approach is used, then the signals between the daughter board and airway clearance system board may need additional optical elements. 
       FIG. 24  illustrates one embodiment of a user interface screen which can be used on any of the previously described controllers and interfaces as well as with the bed frame described herein with reference to  FIG. 22 , where the interface can be embodied or incorporated into a siderail, head board, and/or footboard. As illustrated in  FIG. 24 , the user interface screen  300  can include a variety of selectors which can be touch screen selectors, pressure sensitive buttons, and/or mechanical switches. The features which can be accessed from the user interface screen of  FIG. 24  via selectors include a standard operating mode  302 , an Opti-Rest mode  304 , a rotation mode  306 , an airway clearance system mode  308 , a percussion mode  310 , a vibration mode  312 , a maximum inflate mode  314 , a turn assist mode  316 , and a cardio pulmonary resuscitation (CRR) assist mode  318 . In addition, start and stop buttons  320 ,  322  as well as back  332  and edit buttons  324  are available. Likewise, the user interface screen can be used to access other therapy and controls  326 , setting alarms  328 , and settings for a variety of features including pressure settings  330 . 
       FIG. 25  illustrates one example of a user interface screen  400  where percussion and vibration parameters can be set for the mattress support  10 . While FIG.  24  illustrates a single selector  310  for percussion and a single selector  312  for vibration, the user interface screen of  FIG. 24  may alternatively or in addition include a single button for both percussion and vibration (P&amp;V), which upon selection accesses the user interface screen of  FIG. 25 . 
     The user interface screen  400  of  FIG. 25  enables an individual to select percussion therapy only  402 , vibration therapy only  404 , or both percussion and vibration therapy  406  with a P &amp; V selector. In addition, the frequency  408 ,  416  intensity  410 ,  418  and duration  412 ,  420  can be set for percussion and/or vibration by selecting or activating a change selector  414 ,  422 , respectively. The change selectors  414 ,  422  access a second user interface screen (not shown) where frequency, intensity, and duration can be selected or changed for the percussion and/or vibration therapy. Once the settings for frequency and/or vibration have been changed, the selected values are displayed on the user interface screen of  FIG. 25 . For instance, in the illustrated embodiment, percussion frequency  408  and vibration frequency  416  are selected as a function of beats per second (bps), percussion intensity  410  and vibration intensity  418  are selected as being a low, medium, or high intensity, and percussion duration  412  and vibration duration  420  are selected as a value based on the number of minutes desired for the duration to occur. The percussion and vibration screen  400  of  FIG. 25  also enables the user to select and to change the values for continuous lateral rotation therapy (CLRT) via button  424 . Once button  424  is selected, the preselected values for percussion, vibration and continuous lateral rotation therapy can be started by pressing the start selector  428 . A help button  430  can be activated to provide user information for additional details and a close button  432  can be activated to close the displayed screen  400  and return to the screen  300  of  FIG. 24 . 
       FIG. 26  illustrates one example of a rotation user interface screen  500  which has been accessed through the selection of the CLRT selector  424  of  FIG. 25 . The turn (rotation) percentages  502 ,  504  can be selected for a patient at a left turn and a right turn and the pause  506 ,  508 ,  510  in minutes can be selected to place the patient at a particular position for the selected period of time. Additionally, a use rotation training button  512  can be used to acclimate the patient to continuous lateral rotation therapy. By selection of this particular selector  512 , the angle of rotation therapy is gradually increased to the maximum turn which has been selected. A rotation monitor  514  is also included and indicates the amount of time the patient has been under the rotation therapy in the most previous 24 hours. 
     If the airway clearance selector  308  of  FIG. 24  is selected, the user interface screen  600  of  FIG. 27  is displayed. At this screen, a user can select the pulse frequency  602  in beats per second, the intensity  604  of pressure applied by the airway clearance system to the chest of a patient, and time duration  608  of the airway clearance therapy in minutes. Screen  600  also includes a help/training graphic and/or visual feature  612  to aid the caregiver in administering the airway clearance therapy. 
       FIG. 28  illustrates a therapy reminder user interface screen  700  in accordance with the present invention. By selecting the therapy and controls selector  326  of  FIG. 24 , the therapy reminder screen  700  of  FIG. 28  is displayed. At this screen, a user can select reminders  702 ,  706 ,  710  for the therapies of rotation, percussion and vibration, and airway clearance. The length of time between the last therapy session and the reminders is specified at areas  704 ,  708 ,  710  for each of the rotation, percussion and vibration, and airway clearance therapies, respectively. This length of time is adjusted using button  714  to increase the delay and by using button  716  to decrease the delay. Other reminders are also possible. For instance, it is possible to provide an alert if rotation has been stopped for a selected period of time, which in this case is shown to be 90 minutes. Likewise, percussion and vibration as well as airway clearance reminders can be selected for every eight hours, for instance. Once the selected time period has elapsed, an alarm, such as a visual or aural alert is made to indicate that it is time to provide the therapy. While the figures show reminders and other parameters configured for each of the available therapies, it will be understood by those skilled in the art that any combination of the available therapies may be activated or deactivated at a given time. 
     By selecting the alarm selector  328  of  FIG. 24 , an alarm settings user interface screen  800  as illustrated in  FIG. 29  is displayed. Upon selection of this particular interface screen  800 , a user can select a bed exit alarm for a sitting up position  802 , a sitting on edge of bed position  804 , or an out of bed condition  806 . For instance, if a patient sits up and the sitting up selector  802  has been selected, whenever a patient sits up an audio or visual alarm will be activated. The volume level of the audio alarm which is activated can be selected by an alarm volume selector  812  which includes a negative or down volume selector  810  and a positive or up volume selector  812 . If the bed exit alarm of sitting on edge  804  has been selected, even though a patient sits up in bed, an alarm will not sound. However, when a patient moves to sitting on the edge of the bed, an alarm will sound or otherwise be activated. Should the user select the out of bed condition alarm  806 , a patient in a sitting up position or a sitting on edge position will not trigger the alarm. Only when a patient exits the bed will an alarm be activated. An edge lying alarm  808  is also included which indicates to a user that a patient is lying on the bed and is close to an edge which can be a condition that is not desirable. 
       FIG. 30  illustrates a therapy log user interface screen  900  which can be selected by the therapy and controls button  326  of  FIG. 24 . The therapy log user interface screen  900  can be used to review data which has been stored regarding the various selected therapies over a period of time, for instance, 24 hours as illustrated in  FIG. 30 . The details of rotation  902 , head elevation  904 , percussion and vibration  906 , alarms activated  908 , and airway clearance  910  can be displayed. A visual bar graph of rotation is shown in area  902  as well as the actual hours and minutes of time a patient has experienced rotation. Head elevation is also shown in area  904  as a series of icons which show a horizontal state, a partially elevated state and a more highly elevated state or sitting up state for the patient. Percussion and vibration is illustrated in area  906  by a bar located along a time line of zero to 24 hours to indicate when the percussion and vibration has been applied to a patient. In this instance, three treatments have been applied over a period of 24 hours. In the alarms portion  908  of the user interface screen  900 , one alarm occurred over the 24 hour period as shown by the 24 hour time line and as indicated by the statement of one alarm. In the airway clearance portion  910  of the therapy log  900 , there have been no treatments over the last 24 hours. However, the portion of the airway clearance area  910  indicates that the last treatment was five days ago. Consequently, if there has been no airway clearance procedures performed over the last 24 hours, the system can display when the last treatment occurred. It is also possible to display similar information for the other four displayed functions. For instance, if there have been no percussion and vibration treatments over the last 24 hours, it is possible to display the number of days which has elapsed since the last treatment. 
     Although the invention has been described in detail with reference to certain preferred embodiments, variations and modifications exist within the scope and spirit of the present invention. For instance, while the figures illustrate a surface including a plurality of upstanding air cushions having a cylindrical shape, other air cushions are within the scope of the present invention. Air bladder assemblies having horizontally disposed or transversely disclosed bladders are within the scope of the invention. Other pressure or force sensing transducers than those disclosed herein are also within the scope of the present invention. For additional details of such bladders or sensing transducers, please see U.S. Provisional Patent Application Ser. No. 60/821,494, the disclosure of which is incorporated herein by this reference.