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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

Authors
Journal
Archives of Physical Medicine and Rehabilitation
0003-9993
Publisher
Elsevier
Volume
94
Issue
10
Identifiers
DOI: 10.1016/j.apmr.2013.03.027
Keywords
  • Laser-Doppler Flowmetry
  • Rehabilitation
  • Spectroscopy
  • Near-Infrared
  • Wheelchairs
Disciplines
  • Design
  • Physics

Abstract

Abstract Objective To compare the efficacy of wheelchair tilt-in-space and recline on enhancing muscle and skin perfusion over the ischial tuberosities in people with spinal cord injury (SCI). Design Repeated-measures and before-after trial design. Setting University research laboratory. Participants Power wheelchair users with SCI (N=20). Interventions Six combinations of wheelchair tilt-in-space and recline angles were presented to participants in a random order. The testing protocol consisted of a baseline 5 minutes sitting with no tilt/recline and 5 minutes positioned in a tilted and reclined position at each of 6 conditions, 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. Main Outcome Measures Muscle and skin perfusion were assessed by near-infrared spectroscopy and laser Doppler flowmetry, respectively. Results Muscle perfusion was significantly increased at 25° and 35° tilt-in-space when combined with 120° recline, and skin perfusion was significantly increased at 3 tilt-in-space angles (15°, 25°, 35°) when combined with 120° recline and at 35° tilt-in-space when combined with 100° recline (P<.05). Even in the positions of increased muscle perfusion and skin perfusion (25° and 35° of tilt-in-space combined with 120° of recline), the amount of muscle perfusion change was significantly lower than the amount of skin perfusion change (P<.05). Conclusions Our results indicate that a larger angle of tilt-in-space and recline is needed to improve muscle perfusion compared with skin perfusion. A position of 25° tilt-in-space combined with 120° recline is effective in enhancing muscle and skin perfusion of weight-bearing soft tissues at the ischial tuberosities.

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