  , Ischial pressure ulcer is an important risk for every paraplegic person and
a major public health issue. Pressure ulcers appear following excessive
compression of buttock's soft tissues by bony structures, and particularly in
ischial and sacral bones. Current prevention techniques are mainly based on
daily skin inspection to spot red patches or injuries. Nevertheless, most
pressure ulcers occur internally and are difficult to detect early. Estimating
internal strains within soft tissues could help to evaluate the risk of
pressure ulcer. A subject-specific biomechanical model could be used to assess
internal strains from measured skin surface pressures. However, a realistic 3D
non-linear Finite Element buttock model, with different layers of tissue
materials for skin, fat and muscles, requires somewhere between minutes and
hours to compute, therefore forbidding its use in a real-time daily prevention
context. In this article, we propose to optimize these computations by using a
reduced order modeling technique (ROM) based on proper orthogonal
decompositions of the pressure and strain fields coupled with a machine
learning method. ROM allows strains to be evaluated inside the model
interactively (i.e. in less than a second) for any pressure field measured
below the buttocks. In our case, with only 19 modes of variation of pressure
patterns, an error divergence of one percent is observed compared to the full
scale simulation for evaluating the strain field. This reduced model could
therefore be the first step towards interactive pressure ulcer prevention in a
daily setup. Highlights-Buttocks biomechanical modelling,-Reduced order
model,-Daily pressure ulcer prevention.
