Pressure ulcers (PrU) are a high-risk, high-volume, and costly problem for people with spinal cord injuries (SCI). Approximately 273,000 people live with SCI in the United States today, and approximately 12,000 new injuries occur each year [1]. People with SCI are at extreme risk of developing PrUs due to lack of sensation, immobility, dampness, and several other risk factors.2 The prevalence of PrUs in people with SCI ranges from 14 to 32%, and recurrence rates range from 31 to 79%.3 PrUs account for approximately one-third of all VA spinal cord injury admissions and more than half of all hospital days for veterans with of a spinal cord injury.3 The cost of managing a full-thickness ulcer can be as high as $70,0008 [JRRD article] and more than $17 billion is spent each year on the treatment of pressure ulcers in the United States. United [3]. The VA alone spends $100 million per year just on primary PrU diagnostics in Veterans with SCI [REF]. The National Pressure Ulcer Advisory Panel defines a PrU as a localized injury to the skin and/or underlying tissues, usually over a bony prominence, accordingly. pressure, or pressure combined with shear and/or friction.4 There is no doubt that high pressure applied to an area of ​​skin for a prolonged period of time will inevitably result in tissue damage.5,6 PrUs occur found most often on and around bony prominences; locations where interface pressures are highest. The majority of PrUs are found in the gluteal and sacral regions7, mainly in the ischial tuberosities, sacrum and coccyx. It is widely accepted that mechanical loading is the main cause of pressure ulcer formation; however, the pathophysiological responses to this burden are less agreed [REF]. Safe Patient Handling Equipment Mechanical lifting technologies have been...... middle of paper ...... manufacturer to measure pressures from 0 to 200 mmHg, with a reported accuracy of ±10%. A modern hospital bed with low air loss technology was used for all measurements (VersaCare AIR, Hill-Rom, Batesville, IN). Head of bed (HOB) elevation was measured using the bed's ball bearing indicator located in the side rail of the bed. A wheelchair (Quickie GPV, Sunrise Medical, Fresno, CA) and cushion (Invacare Absolute, Elyria, OH) were used for all seated sling transfers. A ceiling lift system (Maxi Sky 600, ArjoHuntleigh, Addison, IL) was used in a clinical laboratory for all participants and slings. The lifting system has a safe working load of 272 kg and a strap length of 2.3 m. A standard 2-point spreader bar was used for all seated harnesses. The manufacturer's recommended spreader bar (8 or 10 point) was used for each of the respective supine harnesses..