Abstract
Jan Y-K, Jones MA, Rabadi MH, Foreman RD, Thiessen A. Effect of wheelchair tilt-in-space
and recline angles on skin perfusion over the ischial tuberosity in people with spinal
cord injury.
Objective
To investigate the efficacy of wheelchair tilt-in-space and recline on enhancing skin
perfusion over the ischial tuberosity in wheelchair users with spinal cord injury
(SCI).
Design
Repeated-measures, intervention, and outcomes-measure design.
Setting
A university research laboratory.
Participants
Wheelchair users with SCI (N=11; 9 men, 2 women; mean ± SD age, 37.7±14.2y; body mass
index, 24.7±2.6kg/m2; duration of injury, 8.1±7.5y).
Interventions
Protocols (N=6) of various wheelchair tilt-in-space and recline angles were randomly
assigned to participants. Each protocol consisted of a 5-minute sitting-induced ischemic
period and a 5-minute wheelchair tilt-in-space and recline pressure-relieving period.
Participants sat in a position without tilt or recline for 5 minutes and then sat
in 1 of 6 wheelchair tilted and reclined positions, including (1) 15° tilt-in-space
and 100° recline, (2) 25° tilt-in-space and 100° recline, (3) 35° tilt-in-space and
100° recline, (4) 15° tilt-in-space and 120° recline, (5) 25° tilt-in-space and 120°
recline, and (6) 35° tilt-in-space and 120° recline. A 5-minute washout period (at
35° tilt-in-space and 120° recline) was allowed between protocols.
Main Outcome Measures
Laser Doppler flowmetry was used to measure skin perfusion over the ischial tuberosity
in response to changes in body positions caused by performing wheelchair tilt-in-space
and recline. Skin perfusion response to wheelchair tilt-in-space and recline was normalized
to skin perfusion of the upright seated position (no tilt/recline).
Results
Combined with 100° recline, wheelchair tilt-in-space at 35° resulted in a significant
increase in skin perfusion compared with the upright seated position (no tilt/recline;
P<.05), whereas there was no significant increase in skin perfusion at 15° and 25°
tilt-in-space (not significant). Combined with 120° recline, wheelchair tilt-in-space
at 15°, 25°, and 35° showed a significant increase in skin perfusion compared with
the upright seated position (P<.05).
Conclusions
Our results indicate that wheelchair tilt-in-space should be at least 35° for enhancing
skin perfusion over the ischial tuberosity when combined with recline at 100° and
should be at least 25° when combined with recline at 120°. Although smaller angles
of wheelchair tilt-in-space and recline are preferred by wheelchair users for functional
purposes, wheelchair tilt-in-space less than 25° and recline less than 100° may not
be sufficient for effective pressure reduction for enhancing skin perfusion over the
ischial tuberosity in people with SCI.
Key Words
List of Abbreviations:
ASIA (American Spinal Injury Association), LDF (laser Doppler flowmetry), SCI (spinal cord injury)To read this article in full you will need to make a payment
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Article info
Footnotes
Supported by the National Institutes of Health (grant no. R03HD060751) and the Oklahoma Presbyterian Health Foundation Seed Grant Program (grant no. PHF1545).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the author.
Identification
Copyright
© 2010 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
