Do tilt-in-space wheelchairs increase occupational engagement: a critical literature review

Measure It: Proper Wheelchair Fit Is Key to Ensuring Function while Protecting Skin Integrity

GENERAL PURPOSE

To review the biomechanics of posture, appropriate means to configure a wheelchair to permit proper postural support, and common problems arising from improper wheelchair fit.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:1. Synthesize the concepts influencing proper wheelchair fit.2. Identify the biomechanics of posture as they apply to wheelchair fit.3. Summarize the appropriate assessment guidelines for determining and preparing to adjust wheelchair fit.

Shifting loads as a result of chair articulations and associated perfusion responses in the context of pressure injuries: An investigation with able-bodied individuals

Wheelchair users with spinal cord injuries experience pressure injuries at high rates, causing a decrease in quality of life and an increased financial burden. The soft tissue in the buttocks (beneath the ischial tuberosities) and lower back (behind the sacrum) experience large interface pressures over long periods while seated, putting them at high risk of pressure injury development. The goals of this research were to evaluate the ability of an articulating chair design to redistribute pressures on the body and to affect blood perfusion in the buttocks tissue over the ischial tuberosities. Using a unique, custom-designed chair developed for this research, pressure and blood perfusion were obtained for numerous seated positions that included recline, seat pan tilt, and back articulations. Reclining the chair back increased maximum pressures in the buttocks and lower back regions, while it decreased maximum pressures in the upper back and thigh regions. Increasing seat pan tilt, or rotating the anterior edge of the seat pan above the posterior edge, decreased maximum pressures in the buttocks and lower back regions and increased perfusion in the buttocks. Results suggested that using back recline and seat pan tilt together to create a whole-body tilt increased pressures in the back and decreased pressures in the buttocks. Changes in back articulation redistributed pressure in all back regions. Thus, the articulating chair design redistributed pressures in all areas of the body and promoted blood perfusion in the buttocks while seated. Pressure redistribution and perfusion promotion are fundamental to reducing pressure injury risk.

Key Components Related to Pressure Injury Formation: An Initial Investigation Into Pressure Distribution and Blood Perfusion Responses in Wheelchair Users

Soft tissue around bony prominences in the buttocks and back are high-risk areas prone to the development of pressure injuries. From a clinical perspective, prevention of pressure injuries all together is the ideal situation. Unfortunately, prevalence rates still reach 47% with recurrence rates even higher. The goals of this study were to evaluate the effects of a series of wheelchair movements, some that currently exist in commercial wheelchairs and some new, on interface pressures and perfusion under the buttocks. Twenty-seven chair positions were obtained by varying back recline, seat pan tilt, and articulation of two supports along the back. Although back recline is commonly taught by therapists to be used as a pressure relieving posture, results indicated an increase in pressures under the ischial tuberosities and sacral areas in reclined positions. Articulation of the back supports produced changes in posture moving from an "erect" to "slouched" position. These movements successfully shifted pressures across back regions. Seat pan tilt was effective in shifting pressures off the ischial tuberosity regions. Additionally, in a portion of the participants, seat pan tilt consistently increased perfusion under the ischial tuberosity region. The findings of this research suggest that movements other than back recline should be considered to more effectively alter interface pressures, particularly in high-risk regions like the sacrum and ischial tuberosities.

Development of a Web-Based Monitoring System for Power Tilt-in-Space Wheelchairs: Formative Evaluation

Background

In order to prevent pressure ulcers, wheelchair users are advised to regularly change position to redistribute or eliminate pressure between the buttocks region and the seat of the wheelchair. A power tilt-in-space wheelchair (allowing simultaneous pivoting of the seat and the backrest of the wheelchair toward the back or front) meets many clinical purposes, including pressure management, increased postural control, and pain management. However, there is a significant gap between the use of tilt as recommended by clinicians and its actual usage. A Web-based electronic health (eHealth) intervention, including a goal setting, monitoring, reminder, and feedback system of the use of power tilt-in-space wheelchairs was developed. The intervention incorporates behavior change principles to promote optimal use of tilt and to improve clinical postprocurement follow-up.

Objective

This study aimed to conduct a formative evaluation of the intervention prototype to pinpoint the functionalities needed by end users, namely, power wheelchair users and clinicians.

Methods

On the basis of an evaluation framework for Web-based eHealth interventions, semistructured interviews were conducted with power wheelchair users and clinicians. A content analysis was performed with a mix of emerging and a priori concepts.

Results

A total of 5 users of power tilt-in-space wheelchairs and 5 clinicians who had experience in the field of mobility aids aged 23 to 55 years were recruited. Participants found the Web interface and the physical components easy to use. They also appreciated the reminder feature that encourages the use of the tilt-in-space and the customization of performance goals. Participants requested improvements to the visual design and learnability of the Web interface, the customization of reminders, feedback about specific tilt parameters, and the bidirectionality of the interaction between the user and the clinician. They thought the current version of the intervention prototype could promote optimal use of the tilt and improve clinical postprocurement follow-up.

Conclusions

On the basis of the needs identified by power wheelchair users and clinicians regarding the prototype of a power tilt-in-space wheelchair monitoring system, 3 main directions were defined for future development of the intervention. Further research with new wheelchair users, manual tilt-in-space wheelchairs, various age groups, and family caregivers is recommended to continue the formative evaluation of the prototype.