Comparison of muscle and skin perfusion over the ischial tuberosities in response to wheelchair tilt-in-space and recline angles in people with spinal cord injury

Arch Phys Med Rehabil, 2013 · DOI: 10.1016/j.apmr.2013.03.027 · Published: October 1, 2013

Spinal Cord Injury Rehabilitation Dermatology

Simple Explanation

This study compares how different wheelchair positions (tilt-in-space and recline) affect blood flow in the muscles and skin of people with spinal cord injury (SCI). The goal was to find the best position to prevent pressure ulcers. The researchers measured blood flow in the muscles and skin over the ischial tuberosities (the bony part of your bottom) while participants sat in different combinations of tilt and recline. The study found that a larger angle of tilt and recline is needed to improve blood flow in muscles compared to skin. A position of 25° tilt-in-space combined with 120° recline effectively enhances blood flow in both muscles and skin.

Study Duration

Not specified

Participants

20 power wheelchair users with SCI

Evidence Level

Not specified

Key Findings

1
Muscle perfusion significantly increased at 25° and 35° tilt-in-space combined with 120° recline.
2
Skin perfusion significantly increased at all three tilt-in-space angles (15°, 25°, 35°) when combined with 120° recline, and at 35° tilt-in-space with 100° recline.
3
Even in positions with increased muscle and skin perfusion, the muscle perfusion change was significantly lower than the skin perfusion change.

Research Summary

The study investigated the effects of different wheelchair tilt-in-space and recline angles on muscle and skin perfusion over the ischial tuberosities in individuals with spinal cord injury (SCI). The results indicated that a larger angle of tilt-in-space and recline is needed to improve muscle perfusion compared to skin perfusion, with a position of 25° tilt-in-space combined with 120° recline being effective in enhancing both. The findings suggest that muscle tissues may be at a higher risk of tissue injury than the skin in people with SCI, highlighting the importance of appropriate pressure relief maneuvers.

Practical Implications

Clinical Practice

Clinicians should recommend specific angles of tilt-in-space and recline (25° tilt-in-space combined with 120° recline or larger) to wheelchair users with SCI to effectively reduce muscle and skin ischemia and prevent pressure ulcers.

Wheelchair Adjustment

Wheelchair users should be educated about the importance of performing pressure relief maneuvers with proper angles and durations of tilt-in-space and recline to reduce the risk of pressure ulcers, including deep tissue injury (DTI).

Future Research

Future studies should investigate the optimal recovery time for muscle perfusion of weight-bearing tissues and use larger sample sizes to verify the results, as well as consider participants with varying anthropometric characteristics.

Study Limitations

1
The depth of NIRS probe detection (up to 14 mm) may not have included the entire muscle thickness.
2
The 5-minute recovery period may not have been sufficient for a full vasodilatory response in muscle tissues.
3
The sample had a specific body size, which may limit the generalizability of the results.

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