Sprigle Stephen, Wootten Mary, Sawacha Zimi, Thielman Gregory
Research Center for Rehabilitation Technology, Helen Hayes Hospital, West Haverstraw, New York, USA.
J Spinal Cord Med. 2003 Fall;26(3):236-43. doi: 10.1080/10790268.2003.11753690.
Seated posture and trunk control are important factors affecting upper extremity (UE) function of wheelchair users. A stable pelvis and trunk are required to provide a base from which UE movement occurs, but, conversely, the ability to move one's trunk and pelvis can increase functional ranges of motion. For wheelchair users, balancing sufficient trunk support with adequate trunk mobility has important functional and medical consequences.
To determine the effect of cushion and backrest height on posture and reach and to determine the relationship between posture and UE reach using a randomized 2 x 3 repeated-measures factorial design.
Twenty-two subjects with spinal cord injury were tested in 6 configurations, including 3 types of cushions (segmented air, contoured viscous fluid/foam, and air/foam) and 2 of 3 backrest heights (referenced to T12, inferior scapular angle, and scapular spine) while performing unilateral and bilateral reaching tasks. Seated posture (pelvic tilt and torso angle) and American Spinal Injury Association (ASIA) score were also measured.
Pelvic tilt and ASIA score were significant predictors of reach. No evidence was found indicating cushion type or backrest height affected reach or posture. No consistent patterns of posture were found across cushion types or backrest heights.
The posture adopted by wheelchair users is a more important influence on UE reach than are the cushion or backrest height used. Sitting with increased posterior pelvic tilt enhanced stability and permitted greater reach. Because individuals adopt different postures when using different cushions and backrest heights, clinicians should monitor posture while assessing seating and function of wheelchair users.
坐姿和躯干控制是影响轮椅使用者上肢（UE）功能的重要因素。需要稳定的骨盆和躯干来提供上肢运动的基础，但是，相反地，移动躯干和骨盆的能力可以增加运动功能范围。对于轮椅使用者来说，在足够的躯干支撑和适当的躯干活动度之间取得平衡具有重要的功能和医学意义。
采用随机2×3重复测量析因设计，确定坐垫和靠背高度对姿势和伸展范围的影响，并确定姿势与上肢伸展范围之间的关系。
22名脊髓损伤受试者在6种配置下进行测试，包括3种类型的坐垫（分段充气式、仿形粘性流体/泡沫式和充气/泡沫式）以及3种靠背高度中的2种（以T12、肩胛下角和肩胛冈为参照），同时进行单侧和双侧伸展任务。还测量了坐姿（骨盆倾斜度和躯干角度）和美国脊髓损伤协会（ASIA）评分。
骨盆倾斜度和ASIA评分是伸展范围的重要预测因素。未发现有证据表明坐垫类型或靠背高度会影响伸展范围或姿势。在不同的坐垫类型或靠背高度之间未发现一致的姿势模式。
轮椅使用者所采用的姿势对上肢伸展范围的影响比所使用的坐垫或靠背高度更为重要。后倾骨盆倾斜度增加的坐姿可增强稳定性并允许更大的伸展范围。由于个体在使用不同的坐垫和靠背高度时会采用不同的姿势，临床医生在评估轮椅使用者的座位和功能时应监测其姿势。
