Design-Able plans to design, manufacture, and test a prototype to assure 35 degree upper torso elevation for adults with severe brain injury or dementia. These adults are unable to maintain this medically-essential bed position during enteral feedings. Assurance of this upright position reduces risk of formula aspiration and subsequent pneumonia secondary to gastroesophageal reflux. Unfortunately, no existing product or nursing measure currently employed meets the unique positional needs of this growing population of end-users. In a recent four month experiment, significantly less aspiration and pneumonia occurred when a wedge-type product designed by researchers was used to maintain upper torso elevation. A Phase I award will support technological resources to perfect and test a more serviceable, comfortable, safe, and user friendly product. Design will incorporate a pneumatic component and lateral supports to stabilize position and facilitate caregiver use. Feasibility will be determined by using serial photography, bedside observations, and rating scales completed by the principal investigator, nursing staff, and families. Design modifications, large scale testing and marketing for institutional and home settings will occur in Phase 2. The company plans to patent and mass produce several standard and customized products by the end of Phase 3.