Department of Rehabilitation Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, 73117, USA.
Arch Phys Med Rehabil. 2010 Nov;91(11):1758-64. doi: 10.1016/j.apmr.2010.07.227.
To investigate the efficacy of wheelchair tilt-in-space and recline on enhancing skin perfusion over the ischial tuberosity in wheelchair users with spinal cord injury (SCI).
Repeated-measures, intervention, and outcomes-measure design.
A university research laboratory.
Wheelchair users with SCI (N=11; 9 men, 2 women; mean ± SD age, 37.7±14.2y; body mass index, 24.7±2.6kg/m(2); duration of injury, 8.1±7.5y).
Protocols (N=6) of various wheelchair tilt-in-space and recline angles were randomly assigned to participants. Each protocol consisted of a 5-minute sitting-induced ischemic period and a 5-minute wheelchair tilt-in-space and recline pressure-relieving period. Participants sat in a position without tilt or recline for 5 minutes and then sat in 1 of 6 wheelchair tilted and reclined positions, including (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. A 5-minute washout period (at 35° tilt-in-space and 120° recline) was allowed between protocols.
Laser Doppler flowmetry was used to measure skin perfusion over the ischial tuberosity in response to changes in body positions caused by performing wheelchair tilt-in-space and recline. Skin perfusion response to wheelchair tilt-in-space and recline was normalized to skin perfusion of the upright seated position (no tilt/recline).
Combined with 100° recline, wheelchair tilt-in-space at 35° resulted in a significant increase in skin perfusion compared with the upright seated position (no tilt/recline; P<.05), whereas there was no significant increase in skin perfusion at 15° and 25° tilt-in-space (not significant). Combined with 120° recline, wheelchair tilt-in-space at 15°, 25°, and 35° showed a significant increase in skin perfusion compared with the upright seated position (P<.05).
Our results indicate that wheelchair tilt-in-space should be at least 35° for enhancing skin perfusion over the ischial tuberosity when combined with recline at 100° and should be at least 25° when combined with recline at 120°. Although smaller angles of wheelchair tilt-in-space and recline are preferred by wheelchair users for functional purposes, wheelchair tilt-in-space less than 25° and recline less than 100° may not be sufficient for effective pressure reduction for enhancing skin perfusion over the ischial tuberosity in people with SCI.
研究轮椅倾斜空间和倾斜 recline 对脊髓损伤（SCI）患者坐骨结节皮肤灌注的影响。
重复测量、干预和结果测量设计。
大学研究实验室。
SCI 轮椅使用者（N=11；9 男，2 女；平均年龄±SD，37.7±14.2 岁；体重指数，24.7±2.6kg/m(2)；损伤持续时间，8.1±7.5 年）。
参与者随机接受各种轮椅倾斜空间和倾斜 recline 角度的方案（N=6）。每个方案由 5 分钟的坐姿诱导缺血期和 5 分钟的轮椅倾斜空间和倾斜 recline 减压期组成。参与者先在没有倾斜或 recline 的位置坐 5 分钟，然后坐在 6 个倾斜 recline 位置中的 1 个位置，包括（1）15°倾斜空间和 100° recline，（2）25°倾斜空间和 100° recline，（3）35°倾斜空间和 100° recline，（4）15°倾斜空间和 120° recline，（5）25°倾斜空间和 120° recline，（6）35°倾斜空间和 120° recline。方案之间允许 5 分钟的冲洗期（35°倾斜空间和 120° recline）。
激光多普勒血流仪用于测量坐骨结节皮肤灌注在执行轮椅倾斜空间和倾斜 recline 引起的体位变化时的反应。轮椅倾斜空间和倾斜 recline 的皮肤灌注反应归一化为直立坐姿（无倾斜 recline）的皮肤灌注。
与直立坐姿（无倾斜 recline）相比，35°倾斜空间与 100° recline 结合使用可显著增加皮肤灌注（P<.05），而 15°和 25°倾斜空间的皮肤灌注无显著增加（无显著差异）。与 120° recline 结合使用时，15°、25°和 35°的轮椅倾斜空间可显著增加皮肤灌注（P<.05）。
我们的结果表明，当与 100° recline 结合使用时，为了增强坐骨结节的皮肤灌注，轮椅倾斜空间应至少为 35°，当与 120° recline 结合使用时，轮椅倾斜空间应至少为 25°。尽管轮椅使用者出于功能目的更喜欢较小的轮椅倾斜空间和 recline 角度，但小于 25°的轮椅倾斜空间和小于 100°的 recline 可能不足以有效减轻压力，从而增强 SCI 患者坐骨结节的皮肤灌注。
