WHEELCHAIR SEAT ANGLE AND LUMBAR SUPPORT ARE CRITICAL FACTORS FOR RESOLUTION OF FLEXIBLE SPINAL DEFORMITY AND DECUBITUS ULCER IN PERSONS WITH SPINAL CORD INJURY

Abstract

Background & Purpose: Persons with paralysis due to spinal cord injury are dependent on a wheelchair for functional mobility. These individuals remain in a seated position for several hours per day. Wheelchair seat inclination angle and position of lumbar support are critical to facilitate a stable seated position. Ineffective seating is commonplace and results in uneven weight-bearing and decubitus ulceration. The purpose of this case study is to highlight the key components of effective wheelchair seating for persons with complete spinal cord injury and flexible spinal deformity. Case Description: Four out-patient clients with complete motor and sensory paraplegia were selected for this case study. Subjects were diagnosed with T4, T8, T9 and L2 paraplegia, respectively. The primary reason for referral was onset of decubitus ulcer. Patients reported no specific incident to account for the wound, no change in activity and no improvement in the wound despite enhanced pressure relief routine. All subjects presented in ultra-light weight wheelchairs with pressure-relieving cushions. The majority of subjects were utilizing a solid seat back. All subjects reported dissatisfaction with perception of increased abdominal girth. Half of the subjects presented with seat incline of less than ten degrees. All subjects presented with some degree of pelvic obliquity. Interventions were adjustment of seat incline angle to 10–15 degrees and placement of lumbar support to achieve slight anterior pelvic tilt, thus restoring lumbar lordosis. Outcomes: All subjects noted resolution of the Stage I/II decubitus ulcer within six to eight weeks following interventions. In addition, subjects reported improved stability in seated position without need to utilize one or both upper extremity for erect seated posture. Pelvic obliquity was immediately resolved in all cases. Subjects also reported decreased abdominal girth. Discussion: For persons with paraplegia it is necessary to offer a seat incline angle of at least ten degrees. While improved stability can be achieved at twenty degrees of seat inclination, one must be cognizant of the patient's ability to transfer. Utilization of a solid seat back does not ensure any degree of lumbar support unless care is taken to achieve correct position. It may also be necessary to provide additional lumbar support padding within an existing solid seat back if wheelchair component lengths do not allow for adequate positioning. Physical therapists have the potential to significantly impact the functional outcome and quality of life of individuals who require full-time use of a wheeled mobility device due to spinal cord injury. Increased awareness of basic seating principles for all physical therapists will ensure that more patients with evidence of early spinal deformity can be identified and appropriate interventions provided. If detected early enough, flexible deformities can be corrected and subsequent complications averted.