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

Objective: To investigate the effect of various wheelchair tilt-in-space and recline angles on sacral skin perfusion in wheelchair users with spinal cord injury. Design: Repeated-measures, intervention and outcomes measure design. Setting: University research laboratory. Participants: Power wheelchair users with spinal cord injury (N=11). Interventions: Six protocols of various wheelchair tilt-in-space and recline angles were randomly assigned to the participants: (1) 15 degrees tilt-in-space and 100 degrees recline, (2) 25 degrees tilt-in-space and 100 degrees recline, (3) 35 degrees tilt-in-space and 100 degrees recline, (4) 15 degrees tilt-in-space and 120 degrees recline, (5) 25 degrees tilt-in-space and 120 degrees recline, and (6) 35 degrees tilt-in-space and 120 degrees recline. Each protocol consisted of a 5-minute upright sitting and a 5-minute tilted and reclined period. Main Outcome Measures: Skin 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. Results: Sacral 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 degrees, 25 degrees, and 35 degrees tilt-in-space when combined with 120 degrees recline and at 35 degrees tilt-in-space when combined with 100 degrees recline (P<.008). Conclusions: Our 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. (C) 2013 by the American Congress of Rehabilitation Medicine