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

Abstract

ObjectiveTo investigate the effect of various wheelchair tilt-in-space and recline angles on sacral skin perfusion in wheelchair users with spinal cord injury. DesignRepeated-measures, intervention and outcomes measure design. SettingUniversity research laboratory. ParticipantsPower wheelchair users with spinal cord injury (N=11). InterventionsSix 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 MeasuresSkin 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. ResultsSacral 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). ConclusionsOur 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.