Wheelchair tilt-in-space and recline does not reduce sacral skin perfusion as changing from the upright to the tilted and reclined position in people with spinal cord injury

摘要

Objective: To investigate the effect of various wheelchair tilt-in-space and recline angles on sacral skin perfusion in wheelchair users with spinal cord injury. Design: Repeated-measures, intervention and outcomes measure design. Setting: University research laboratory. Participants: Power wheelchair users with spinal cord injury (N=11). Interventions: Six protocols of various wheelchair tilt-in-space and recline angles were randomly assigned to the participants: (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. Each protocol consisted of a 5-minute upright sitting and a 5-minute tilted and reclined period. Main Outcome Measures: Skin perfusion over the sacrum (midpoint between the right posterior superior iliac spine and the adjacent spinous process) and right ischial tuberosity was measured using laser Doppler flowmetry. Results: Sacral skin perfusion did not show a significant difference in all 6 protocols of various tilt-in-space and recline angles when changing from an upright to a tilted and reclined position (not significant). However, as previously reported, skin perfusion over the ischial tuberosity showed a significant increase at 15°, 25°, and 35° tilt-in-space when combined with 120° recline and at 35° tilt-in-space when combined with 100° recline (P<.008). Conclusions: Our results indicate that wheelchair tilt-in-space and recline enhances skin perfusion over the ischial tuberosities without reducing sacral skin perfusion when changing from an upright to a tilted and reclined position.