Article

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/m(2); 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 degrees tilt-in-space and 100 degrees
recline, (2) 25 degrees tilt-in-space and 100 degrees recline, (3) 35 degrees
tilt-in-space and 100 degrees recline, (4) 15 degrees tilt-in-space and 120
degrees recline, (5) 25 degrees tilt-in-space and 120 degrees recline, and (6) 35
degrees tilt-in-space and 120 degrees recline. A 5-minute washout period (at 35
degrees tilt-in-space and 120 degrees 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 degrees
recline, wheelchair tilt-in-space at 35 degrees 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 degrees and 25 degrees tilt-in-space (not significant). Combined with 120
degrees recline, wheelchair tilt-in-space at 15 degrees , 25 degrees , and 35
degrees 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 degrees for enhancing skin perfusion over the
ischial tuberosity when combined with recline at 100 degrees and should be at
least 25 degrees when combined with recline at 120 degrees . 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 degrees and
recline less than 100 degrees may not be sufficient for effective pressure
reduction for enhancing skin perfusion over the ischial tuberosity in people with
SCI.
CI - Copyright (c) 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS