Effect of Wheelchair Tilt-in-Space and Recline Angles on Skin Perfusion Over the Ischial Tuberosity in People With Spinal Cord Injury

Abstract

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-11 wheelchair users with SCI (9 men, 2 women; mean age ± standard deviation, 37.7±14.2 years; body mass index 24.7±2.6 kg/m 2 ; and duration of injury 8.1±7.5 years).Interventions-6 protocols of various wheelchair tilt-in-space and recline angles were randomly assigned to the participants. Each protocol consisted of a 5-min sitting-induced ischemic period and a 5-min wheelchair tilt-in-space and recline pressure relieving period. A participant sat in a position without tilt or recline for 5 minutes and then sat in one of 6 wheelchair tiled 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-min washout period (at 35° tilt-inspace 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 the changes of 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-When combined with 100° recline, wheelchair tilt-in-space at 35° resulted in a significant increase in skin perfusion as compared with upright seated position (no tilt/recline) © 2010 The American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.Correspondence to Yih-Kuen Jan, PT, PhD, Dept of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, 1200 N Stonewall Ave, Room 3135, Oklahoma City, OK 73117, yjan@ouhsc.edu. Reprints are not available from the author. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.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. (p<0.05), while there was no significant increase in skin perfusion at 15° and 25° tilt-in-space( non significance). When combined with 120° recline, wheelchair tilt-in-space at 15°, 25°, and 35° tiltin-space all showed a significant inc...

Everyday sitting behavior of full-time wheelchair users

“…Similar small movements of short duration were seen in a 2002 pilot study [36]. Although the effects of these movements on blood flow may be less significant [17,[43][44], they have the potential to change the internal deformation of tissue [11,45] and may provide important physiological benefits in terms of pressure ulcer prevention. Furthermore, small movements have the potential to help dissipate heat and reduce humidity [46].…”

Influence of different types of seat cushions on the static sitting posture in individuals with spinal cord injury

“…5,18 However, this posture increases the pressure on the ischium and sacrum, and can cause ulcers. 6,14 In the present study, it was observed that individuals with SCI have a pelvic tilt in the sitting position, greater than individuals without such injury. An interesting fact observed is that the different cushions evaluated did not interfere with pelvic inclination, which suggests that the choice among these types of cushions does not have influence on the alignment between the ASIS, nor an effective action in the correct positioning of the sacrum.…”

“…An interesting fact observed is that the different cushions evaluated did not interfere with pelvic inclination, which suggests that the choice among these types of cushions does not have influence on the alignment between the ASIS, nor an effective action in the correct positioning of the sacrum. It is important, as a previous study 14 already demonstrated that the 1101 backrest inclination increases the pressure on the ischium and none of the types of cushions evaluated in the present study improved the pelvis tilt.…”

“…It has a backrest with a 1101 inclination and was chosen because many individuals with SCI, mainly those with poor trunk control, use this wheelchair inclination. 6 However, this backrest inclination increases the pressure on the ischium, 14 sacrum and can cause ulcers. 6 Therefore, to evaluate the influence of types of cushion on posture alignment in this backrest position seems relevant to evaluate the more appropriate cushion to indicate in this case.…”

Physical activity and transcutaneous oxygen pressure in men with spinal cord injury

“…Therefore, recent studies have focused on evaluating the different effects of wheelchair tilt-in-space and recline angle on skin perfusion over the IT in wheelchair users with SCI by using laser doppler flowmetry [55]. Jan et al explained that to further understand the efficacy of wheelchair tilt-in-space and recline for decreasing PU risk, systemic research of the efficacy of various angles of wheelchair tilt-in-space and recline on decreasing skin and muscle perfusion ischemia is needed [55]. A transient increase in skin blood flow after ischemia is regulated by a protective mechanism called reactive hyperemia [48][49][50][56][57].…”