Comparison of Muscle and Skin Perfusion Over the Ischial Tuberosities in Response to Wheelchair Tilt-in-Space and Recline Angles in People With Spinal Cord Injury

Abstract

Objective To compare the efficacy of wheelchair tilt-in-space and recline on enhancing muscle and skin perfusion over the ischial tuberosities in people with spinal cord injury (SCI). Design Repeated measures and before-after trial design. Setting University research laboratory. Participants Power wheelchair users with SCI (N=20). Interventions Six combinations of wheelchair tilt-in-space and recline angles were presented to participants in a random order. The testing protocol consisted of a baseline 5 min sitting with no tilt/recline and 5 min positioned in tilted and reclined position at each of 6 conditions, 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. Main Outcome Measures Muscle and skin perfusion was assessed by near-infrared spectroscopy and laser Doppler flowmetry, respectively. Results Muscle perfusion was significantly increased at 25° and 35° tilt-in-space when combined with 120° recline and skin perfusion was significantly increased at 3 tilt-in-space angles (15°, 25°, 35°) when combined with 120° recline and at 35° tilt-in-space when combined with 100° recline (P<.05). Even in the positions of increased muscle perfusion and skin perfusion (25° and 35° of tilt-in-space combined with 120° of recline), the amount of muscle perfusion change was significantly lower than the amount of skin perfusion change (P<.05). Conclusions Our results indicate that a larger angle of tilt-in-space and recline is needed to improve muscle perfusion compared to skin perfusion. A position of 25° tilt-in-space combined with 120° recline is effective in enhancing muscle and skin perfusion of weight-bearing soft tissues at the ischial tuberosities.

Investigation of Peak Pressure Index Parameters for People with Spinal Cord Injury Using Wheelchair Tilt-in-Space and Recline: Methodology and Preliminary Report

“…Wheelchair recline was defined as “a change in seat to back angle while maintaining a constant seat angle with respect to the ground” [4, 5]. Configurations of tilt and recline are shown in Figure 2 and also described in our previous studies with the exception of recline measurements [14, 28, 29]. Previously, we reported recline measurements as the angle between the seat and the back support.…”

Backrest Shape Affects Head–Neck Alignment and Seated Pressure

“…Previous studies suggested that the shape of the wheelchair backrest affects the seated posture and the sitting-related problems of the user [17][18][19][20][21][22]. For instance, increasing the backward inclination of the backrest above 120° reduced buttock pressure.…”

Ischemia/Reperfusion: A Potential Cause for Tissue Necrosis

“…Ischemia and reperfusion injury is considered important in venous ulcer pathology, sickle cell and vasculitic ulcers, and pressure ulcers. Variations in muscle and skin fl ow, for example, are critical when deciding on sitting protocols for paraplegic patients to prevent pressure ulcer formation [ 10 ]. Improved diagnostic and therapeutic options for this condition will allow us to strategize our treatment plan.…”