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Effect of Tilt and Recline on Ischial and Coccygeal Interface Pressures in People with Spinal Cord Injury

Chen, Yanni MD; Wang, Jue PhD; Lung, Chi-Wen PhD; Yang, Tim D. BS; Crane, Barbara A. PT, PhD; Jan, Yih-Kuen PT, PhD

American Journal of Physical Medicine & Rehabilitation: December 2014 - Volume 93 - Issue 12 - p 1019–1030
doi: 10.1097/PHM.0000000000000225
Original Research Articles: CME Article . 2014 Series . Number 7

Objective Clinicians commonly recommend that power wheelchair users with spinal cord injury perform wheelchair tilt and recline maneuvers to redistribute seating loads away from the ischial tuberosities. However, ischial pressure reduction may be accompanied by coccygeal pressure increases. Although the coccyx is among the most common sites of pressure ulcers, few studies have reported coccygeal interface pressure. The purpose of this study was to investigate both ischial and coccygeal interface pressures in response to changes in wheelchair tilt and recline angles.

Design Thirteen power wheelchair users were recruited into this study. Six combinations of wheelchair tilt (15, 25, and 35 degrees) and recline (10 and 30 degrees, corresponding to traditional recline conventions of 100 and 120 degrees, respectively) angles were tested in random order. Each combination was tested with 5 mins of upright sitting, 5 mins of tilt and recline, as well as 5 mins of maximal pressure relief recovery. Peak pressure indices were calculated at the ischial and coccygeal sites.

Results Ischial pressures monotonically decreased in response to increasing combinations of tilt and recline. Increments of 15 degrees of tilt did not produce significant differences under either recline angle, whereas increments of 25 degrees of tilt produced significant differences under both recline angles. Coccygeal pressures increased in response to the four smallest (of six) combinations of tilt and recline, whereas they decreased in response to the largest two combinations.

Conclusions Ischial pressures seemed to be redistributed to the coccyx in response to the four smallest angle combinations and redistributed to the back support in response to the two largest angle combinations. Future work should confirm this pressure redistribution to the back support and determine the back support locations of redistribution.

From the Xi’an Children’s Hospital, Xi’an, China (YC); Key Laboratory of Biomedical Information Engineering of Ministry of Education and Institute of Biomedical Engineering, School of Life Science and Technology, Xi’an Jiaotong University, Xi’an, China (YC, JW); Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana–Champaign (YC, C-WL, TDY, Y-KJ); Department of Creative Product Design, Asia University, Taichung, Taiwan (C-WL); and Department of Rehabilitation Science, University of Hartford, West Hartford, Connecticut (BAC).

All correspondence and requests for reprints should be addressed to: Yih-Kuen Jan, PT, PhD, Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana–Champaign, 1206 South Fourth St, MC-588, Champaign, IL 61820.

Supported by the University of Illinois at Urbana–Champaign, Campus Research Board (#13288), and the Center for International Rehabilitation Research Information and Exchange (CIRRIE), International Exchange Program, funded by the National Institute on Disability and Rehabilitation Research. Yanni Chen was a visiting scholar in Yih-Kuen Jan’s laboratory while the study was conducted.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

© 2014 by Lippincott Williams & Wilkins